IMPORTANT NOTICE: Breastfeeding is best for babies and is recommended for as long as possible.
COW’S MILK PROTEIN ALLERGY (CMPA) IS A COMMON FOOD ALLERGY IN BABIES AND INFANTS IN THE UK.
It affects between 1.6-3.5% of babies and young children.1
CMPA generally develops within the first few months of a baby’s life and is usually outgrown by the age of three.2 Most cases are outgrown by the time a child starts school.3
This page provides more information on CMPA, the signs and symptoms and what type of nutritional support your baby may receive if they have an allergy towards cow's milk protein.
WHAT IS COW’S MILK PROTEIN ALLERGY?
CMPA is a condition which occurs when a baby's immune system reacts abnormally to the proteins which are found in cow’s milk, causing an allergic reaction.4
Allergic reactions can sometimes happen immediately after consuming cow’s milk (this is sometimes called IgE-mediated CMPA) or the reaction may be delayed between 2-72 hours after having cow’s milk (sometimes called non-IgE-mediated CMPA).4
Common symptoms and signs of CMPA include:4,5
Skin irritation
Swelling, rashes/itching, eczema
Digestive issues
Stomach pain/discomfort, diarrhoea, being sick
Symptoms in the chest
Coughing/wheezing, chest tightness, shortness of breath
DIAGNOSING CMPA
Sometimes diagnosing CMPA can be difficult as the symptoms can also be common in babies suffering with other conditions, such as acid reflux or stomach upsets.6,7
If you think that your baby might be showing signs of CMPA, it is important to get it checked out by their healthcare professional (GP, Nurse or Health Visitor)8 as ongoing allergic reactions can impact the wellbeing of both you and your baby.4,9,10
If your baby’s healthcare professional suspects that they might have CMPA, their healthcare professional will usually diagnose this by asking you some questions about your baby's symptom history to help decide if the cause is because of an allergy or something else.8
They may also examine your baby to review their growth, look for physical signs of allergy such as skin rashes or eczema and see if your baby has other symptoms which might mean the reaction is caused by another condition. If your baby has immediate symptoms of CMPA, they may conduct further tests, such as skin prick testing or blood tests.11
Your baby's healthcare professional may refer your baby to an allergy specialist for these tests if their symptoms are severe, allergy testing requires a specialist, or the diagnosis is not certain.11,12
DIETARY MANAGEMENT FOR INFANTS OR BABIES WITH CMPA
Babies with CMPA often experience digestive issues, such as stomach pain/discomfort, diarrhoea and being sick,4 which may mean they can't get the energy and/or nutrients they need, which may affect their growth.13
Your baby’s healthcare professional will help you decide the best course of treatment for your baby, and it is important that you follow their recommendations.
Breast feeding is best for babies as it provides all of the nourishment that a young baby needs.5 However, if you are not breastfeeding, or are mixed feeding, their healthcare professional may recommend a hypoallergenic formula.5,14
Nutritional management in babies with CMPA may include:
Cow’s milk elimination – While breastfeeding, you may be advised to exclude anything from your diet which contains cow’s milk. Your baby’s healthcare professional may offer advice on how to exclude cow’s milk whilst ensuring you and your baby still get the nutrients you need15
Extensively hydrolysed formulas (eHFs) – This is a hypoallergenic formula where the proteins have been broken down into smaller segments so they are less likely to cause an allergic reaction5,15
Amino acid formulas (AAF) – These formulas are based on the building blocks (amino acids) that make up protein. They are usually recommended if the allergy is very severe or where other hypoallergenic formulas haven’t improved your baby’s symptoms after two weeks5,15
Hydrolysed rice formulas (HRFs) – These are plant-based formulas where the protein is broken down from rice. These formulas are usually suitable for plant-based, vegetarian, halal and kosher diets16,17
CMPA AND WEANING
It is recommended that a baby with CMPA is weaned onto a milk-free diet from the age of 6-months. Your child’s healthcare professional will advise on the best way to wean your child, depending on the severity of their allergy. It is important to always follow their advice.18
References:
1. Venkataraman D, et al. Clin Exp Allergy. 2018 Apr;48(4):394-402
2. Venter C et al. Clin Transl Allergy. 2013;3(1):23
3. Grabenhenrich et al. Allergy. 2020;00:1–15
4. NICE, 2024. Cow’s milk allergy in children. Available online: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/ (Last accessed January 2025)
5. BDA, 2021. Milk Allergy. Available online: https://www.bda.uk.com/resource/milk-allergy.html Last accessed January 2025
6. Vandenplas Y, et al. Arch Dis Child. 2007 Oct; 92(10): 902–908.
7. Lozinsky AC et al. Children 2015;2,:317-329
8. Allergy UK, 2024. Cow’s Milk Allergy. Available online: https://www.allergyuk.org/about-allergy/allergy-in-childhood/cows-milk-allergy/ Last Accessed January 2025
9. Meyer R, et al. World Allergy Organ J. 2017;10(1):1–8
10. Birdi G, et al. J Allergy (Cairo). 2016;2016:1497375
11. NICE, 2024. How should I assess a child with suspected cow's milk allergy? Available online: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/diagnosis/assessment/#:~:text=Offer%20skin%20prick%20testing%20and,select%2C%20perform%20and%20interpret%20them. Last accessed February 2025
12. NICE, 2024. Scenario: Suspected cow's milk allergy. Available online: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/management/suspected-cows-milk-allergy/ Last accessed February 2025
13. NHS, 2023. Malnutition Causes. Available online: https://www.nhs.uk/conditions/malnutrition/causes/ Last accessed February 2025
14. Vandenplas Y, et al. J Asthma Allergy. 2021 Oct 21;14:1243-1256.
15. Coppola S et al. Nutrients 2023;15(15):3328
16. Anania C et al. J Clin Med 2022;11(16):4823
17. Similac® Arize™ datasheet. May 2024.
18. Berkshire Healthcare NHS Foundation Trust, 2024. Available online: https://www.berkshirehealthcare.nhs.uk/our-services/physical-and-community-healthcare/nutrition-and-dietetics/managing-your-childs-cows-milk-protein-allergy/ Last accessed January 2025
Stay Connected