Clinical Guidance: Managing Cow’s Milk Allergy in Infants While Breastfeeding

Information for Healthcare Professional Use OnlyThis short video explains how IgE-mediated and non-IgE-mediated cow’s milk allergies (CMA) present differently in infants, emphasising the importance of recognising symptom patterns across body systems for accurate diagnosis and management.HighlightsIgE-mediated CMA causes rapid onset symptoms, typically affecting the skin (hives, redness, swelling), gut (oral itching, nausea, vomiting, diarrhoea), and respiratory system (hay fever-like symptoms). Severe cases may result in anaphylaxis.Non-IgE-mediated CMA results in delayed symptoms, often across multiple systems:- Skin: Persistent eczema, redness, itching.- Gut: Vomiting, reflux, loose stools ("poonamis"), soft stool constipation, blood in stool, and anal redness.- Growth: Severe cases may show faltering growth (poor weight/height gain).Respiratory symptoms are not typically recognised by National Institute for Clinical Excellence (NICE) for non-IgE CMA, but Milk Allergy in Primary Care (MAP) guidelines acknowledge congestion in affected infants.Multiple symptoms across systems—rather than a single isolated sign—are a hallmark of non-IgE-mediated CMA. You may also be interested in this webinar about CMA diagnosis and management.IMPORTANT NOTICE:We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age.We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.

Information for Healthcare Professional Use OnlyIn this webinar Paediatric Dietitian, Sophie Rawlings, presents best practices for diagnosing and managing cow’s milk protein allergy (CMPA) in infants, with a focus on practical, evidence-based approaches in community settings.Highlights of the webinar include:Overview of IgE and non-IgE mediated food allergies and typical symptoms.Discussion of risk factors, including family history and environmental influences.Importance of allergy-focused history and elimination diets in diagnosis.Use of tools like BSACI and Milk Allergy in Primary Care i(MAP) guidelines to support accurate CMPA identification.Management strategies including breastfeeding advice and use of extensively hydrolysed or amino acid formulas where appropriate.Guidance on when to refer to secondary care or allergy centres.An explanation of Birmingham’s CMPA care pathway and dietetic triage process.Watch the full webinar to learn more about the appropriate management of cow’s milk allergy.IMPORTANT NOTICE:We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age.We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.Download Certificate

Information for Healthcare Professional Use OnlyThis short video introduces the Cows’ Milk Related Symptom Score (CoMiSS) tool developed by experts, supported by Nestlé Health Science.The CoMiSS tool enables primary healthcare professionals to more efficiently interpret symptoms and consider earlier intervention in relation to cow’s milk related symptoms. CoMiSS will significantly aid in raising awareness of Cows’ Milk Allergy (CMA) to help support the diagnosis of this common infant allergy.The CoMiSS® scoring form is not intended to be used as diagnostic tool and should not replace an oral food challenge (OFC). Diagnosis of CMA can only be confirmed by a 2 to 4 week elimination diet followed by an OFC.IMPORTANT NOTICE:We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age.We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.

Information for Healthcare Professional Use OnlyIn this short video with Kristian Braven, Specialist Paediatric allergy and gastroenterology dietitian, discusses the caution against using soya formula for infants under six months in cows’ milk allergy.Highlights include:Current guidelines advise against soya formula for children under six months.Concerns arise from soy’s phytoestrogens content, potentially affecting fertility in later life.Research on this topic remains inconclusive.Soya formula may be acceptable if other milks are intolerable.Soya formula can be considered for specific conditions like galactosemiaIMPORTANT NOTICE:We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age.We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.

Information for Healthcare Professional Use OnlyThis webinar presented by specialist allergy dietitian, Kate Grimshaw, discusses the GA²LEN (Global Allergy and Asthma European Network) 2022 guidelines on managing food allergies, aiming to help healthcare professionals effectively support patients with food allergies.Highlights of the webinar include:Purpose and Development: The GA²LEN guidelines were created by a multidisciplinary team of allergy experts to unify research on food allergies and improve clinical practice through a structured methodological approach.Key Clinical Questions: The guidelines address 5 key areas including dietary interventions, educational strategies, and identifying individuals at risk of severe allergic reactions.Dietary Recommendations: The guidelines suggest avoiding offending foods for allergic individuals. The guidelines also suggest that breastfeeding mothers of infants with food allergies do not typically need to avoid allergens themselves. This is based on the lack of clinical studies supporting the effectiveness of exclusion in breastfeeding mothers. The guidelines suggest that if there is a need for a breast milk alternative, they suggest a hypoallergenic extensively hydrolysed cow's milk formula or an amino acid formula.Individualised Advice: Emphasising tailored dietary management to accommodate individual patient needs, including various dietary preferences like vegetarianism.Education and Training: There is a call for improved education and support for families managing food allergies to bridge knowledge gaps and encourage informed decision-making.Watch the full webinar to learn more about the latest guidelines for managing food allergies.We also have a number of webinars on cow’s milk allergy including diagnosis and symptoms.IMPORTANT NOTICE:We believe that breastfeeding is the ideal nutritional start for babies and we fully support the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months of life followed by the introduction of adequate nutritious complementary foods along with continued breastfeeding up to two years of age.We also recognise that breastfeeding may not be an option due to certain medical conditions. Parents should only feed infant formula for special medical purposes under supervision of a healthcare professional after full consideration of all feeding options, including breastfeeding. Continued use has to be assessed by the healthcare professional in relation to the baby's progress bearing in mind any social and financial implications for the family. Infant formula should always be prepared, used and stored as instructed on the label in order to avoid risks to a baby’s health.Download Certificate

During the last decade, the prevalence of allergic diseases in infants and children has increased significantly either through better awareness of the symptoms or through generally more children being affected.1-3 Therefore, it is no surprise that the numbers of children presenting to clinics in district general hospitals has also increased.4-5 Diagnosis of true milk allergy is key...

Prof O’Mahony began by discussing how the human gut is colonised by a wide diversity of microbes. He went on to review the evidence for how they exhibit highly evolved synergistic relationships to provide essential biological functions to the host and how the gut microbiome is influenced by many factors in early life. Prof Renz proceeded to describe the importance of establishing a s..

With ever increasing pressures on healthcare systems and the need to move to online consultations this webinar looks at introducing clinicians to the Cow’s Milk-related Symptom Score Tool - CoMiSS®. Exploring the latest evidence for this simple, fast and easy-to-use awareness tool for non-IgE mediated cows’ milk-related symptoms, this webinar will include practical examples of how the CoMiSS® tool can be used in practice and how it can aid digital consultations as part of a cow’s milk protein allergy digital pathway.

Cows’ milk protein allergy (CMPA) is the leading cause of allergy in infants. Previous studies assessing milk formulas with extensively hydrolyzed proteins have reported issues such as reactivity to residual allergens, bitter taste, and the impracticability of adding lactose.

Kate discusses how important it is for the child to be on the right formula. She discusses how there is evidence that an EHF could be seen as the first step of the milk ladder, introducing a child back onto dairy products to see if they have outgrown their allergy. She also highlights cases where this shouldn't be tried - these cases a child should be under the care of a paediatric allergy dietitan.

Human milk contains bioactive components that confer protection on the newborn. These include complex carbohydrates called Human Milk Oligosaccharides (HMO). Research is revealing the full extent of the beneficial properties of HMOs.

Cow's milk allergy (CMA) is a prevalent food allergy in children globally, but diagnosing non-IgE mediated CMA is often difficult due to symptom overlap with functional gut disorderS. This webinar, led by Dr. Rosan Meyer, addresses newly published guidelines designed to assist healthcare professionals in diagnosing both IgE and non-IgE mediated CMA. The discussion will focus on the recently updated DRACMA and ESPGHAN guidelines, examining their potential impact on clinical practice.