Cows Milk Protein Allergy (CMPA) Diagnosis and Management Pathway Refer to Paediatrician Suspicion of Non IgE mediated CMPA Slower onset over 2 hours or longer One or more of the following: • Skin symptoms • Gastro symptoms • Respiratory symptoms
If exclusive breast feeding Check feeding technique
Allergy focused history
If formula feeding Extensively hydrolysed formula (EHF) for 2-4 weeks
Strict maternal milk free diet for 2-4 weeks
Milk free weaning from 6 months
Milk free weaning from 6months
Improvement
If exclusive breast feeding Reintroduce cow’s milk into maternal diet A
If formula feeding or mixed feeding Reintroduce cow’s milk formula
If symptoms return this confirms CMPA diagnosis Restart maternal milk free diet Milk free weaning from 6 months
If symptoms return this confirms CMPA diagnosis Continue with EHF and/or restart maternal milk free diet Milk free weaning from 6 months
Suspicion of IgE mediated CMPA Rapid onset within minutes to 2 hours One or more of the following: • Urticaria • Wheeze • Anaphylaxis
For Urgent advice or Rapid Access Clinic Telephone – Poole Hospital NHS Foundation Trust 01202 665511 Bleep 0155 Dorset County Hospital NHS Foundation Trust 01305 251150 Bleep 353
If mixed breast and formula Strict maternal milk free diet Plus Extensively hydrolysed formula (EHF) for 2-4 weeks Milk free weaning from 6 months
No improvement
Eliminate soya as well for 2-4 weeks
Partial improvement Telephone advice from Paediatrician (see above) or Children's Dietitian West Dorset 01305 255535 Poole 01202 442840
Still no improvement CMPA less likely Gradual return to normal diet Refer to Paediatrician if symptoms persist
March 2016. Taken from the full Medicines Code Chapter: Suspected Cow’s Milk Protein Allergy in Infants - Guidelines for Health Professionals in Primary Care
Cows Milk Protein Reintroduction Pathway NB Seek specialist advice first if initial presenting symptoms were severe/acute onset
Seek specialist advice from Paediatrician
At around 12 months of age or 6 months after diagnosis Attempt a planned reintroduction of Cows milk
If breastfeeding Reintroduce cows milk in to maternal diet
Poole Hospital NHS Foundation Trust 01202 665511 Bleep 0155
If mixed feeding Reintroduce milk in to the infants diet
Dorset County Hospital NHS Foundation Trust 01305 251150 Bleep 353 Children's Dietitian West Dorset 01305 255535
No change
Return to normal diet
Return of symptoms
Return to milk free diet and repeat reintroduction of Cows milk in a further 6 months time
If symptoms of eczema persist, seek advice from Dermatology service or Paediatrician
March 2016. Taken from the full Medicines Code Chapter: Suspected Cow’s Milk Protein Allergy in Infants - Guidelines for Health Professionals in Primary Care
