Resources for Managing Cow's Milk Allergy (CM) in Infants

Watch our webinar: “Assembly of the gut microbiome in early life”, where we will delve into the expertise of international expert Dr. Ruairi Robertson. He will share insights on the processes of infant gut microbiome assembly, the nutritional and environmental factors that affect this process and the outcomes for child health. The session aims to provide practical take-homes and advice regarding early life assembly of the gut microbiome.

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.

This webinar focuses on the challenges of weaning infants with cow's milk allergy and the introduction of other food allergens. It highlights recent research on allergy prevention, including factors like maternal diet and the timing of introducing cow's milk, as well as insights from the LEAP study. Key discussions include the challenges of early introduction, including what’s happening in day-to-day practice, high reliance and low dosage of commercial foods and practical application. The session aims to cover emerging evidence on early allergen introduction and new trends in clinical practice.

In this webinar Dr Helen Evans-Howells, a GP with an extended role in allergy, talks us through the use of amino acid-based formulas for the management of cow’s milk allergy (CMA). Dr Evans-Howells discusses the differences between IgE and non-IgE mediated allergy, the nutritional considerations in CMA and when to consider an amino acid formula, including relevant guidelines to support your clinical practice.

In this webinar expert Paediatric Allergy Dietitian, Lydia Collins-Hussey, takes us through the Milk Ladder for the reintroduction of cow’s milk in children with CMPA and the latest research in this area. The session explores how to use the Milk Ladder, the different published Milk Ladders available, as well as how and when to move your patients along the ladder. Take this opportunity to increase your awareness and confidence with cow’s milk reintroduction.

In this webinar, Professor Yvan Vandenplas and Dr. Rosan Meyer, on behalf of the CoMiSS expert group, discuss the global prevalence of cow’s milk protein allergy (CMPA), the accepted methods for diagnosis and the subsequent challenges faced with diagnosis, particularly in relation to non-IgE mediated CMPA. We invite you to watch and learn from international experts why the diagnosis is so challenging and what healthcare professionals can do to try and minimise over and under-diagnosis.

Cow’s milk allergy (CMA) is one of the most common food allergies worldwide. The diagnosis remains a challenge due to overlapping symptoms with other common childhood illness, and both under and over diagnosis have negative consequences. We welcome you to watch and learn from International Experts how CoMiSS® can help connect the dots in clinical practice to provide fast and effective evaluation of symptoms related to cow's milk and improve health outcomes.

The weaning guide contains recipes developed with leading dietitians from across the UK to help your patients' carers prepare milk-free recipes. The weaning guide can help give them confidence, that as their child grows, family meals can be adapted to make them suitable for CMA.

The GA²LEN 2022 guideline has been developed by a multidisciplinary task force and focuses on the ways healthcare professionals can best manage diagnosed food allergy in infants, children, adolescents, and adults.  Dietitian Dr Kate Grimshaw delves deeper into what these guidelines are and how they can support best practise management in food allergies.   Download Certificate

What are the key aspects of diagnosing cow’s milk allergy and when should you refer into secondary care?  Highly specialised Paediatric Dietitian Sophie Rawlings explores best practise in the management of cow’s milk allergy in this CPD accredited module, covering the different forms and presentations of cow’s milk allergy and the gold standard for diagnosis of cow’s’ milk allergy.   Download Certificate

Experts, supported by Nestlé Health Science, have introduced a simple to use scoring tool – the Cows’ Milk Related Symptom Score (CoMiSSTM) – enabling primary healthcare professionals to more efficiently interpret symptoms and consider earlier intervention. CoMiSSTM will significantly aid in raising awareness of CMA to help support in the diagnosis of this common infant allergy.

WHAT MAKES AN EFFECTIVE SPECIALIST CMA FORMULA? Very few eHFs and AAFs have been shown effective, both in terms of allergy and growth.6,7 At Nestlé Health Science, we set the highest standards for our CMA formulas, SMA® Althéra® and SMA® Alfamino®, ensuring both manufacturing excellence and robust clinical evidence to demonstrate: Proven hypoallergenicity  According to guidelines, the gold standard is for hypoallergenic formulas to be tolerated by at least 90% of infants with proven CMA (with 95% confidence interval) in a clinical trial.1,3,6  Growth and development  According to guidelines, the gold standard is for hypoallergenic formulas to demonstrate normal growth in a clinical trial, because whilst eHF and AAF nutritional profiles are governed by strict regulations,7,8 there are still significant compositional differences between brands.5 REFERENCES: 1. Luyt D et al. Clin Exp Allergy 2014; 44: 642–672. 2. Grimshaw K et al. Clin Transl Allergy 2016; 6: 1. 3. Koletzko S et al. JPGN 2012; 55(2): 221–229. 4. Muraro A et al. Allergy 2014; 69(5): 590–601. 5. Meyer R et al. EMJ Allergy and Immunol. 2017; 2(1): 46–51. 6. Chauveau, A. et al. Pediatr Allergy Immunol. 2016; 27(5): 541–543.   7. Commission Delegated regulation (EU) 2016/128. 8. Commission directive 1999/21/EC

The aim of this webinar is to aid primary care individuals in the diagnosis and management of cows' milk protein allergy. Evidence suggests that it can take an average of 10 weeks and 4 visits to a healthcare professional to get a diagnosis of cows' milk allergy (CMA).1

Download Score card The CoMiSSTM score ranges from 0 to 33. Each symptom has a maximal score of six, with the exception of respiratory symptoms (maximal score of three). An arbitrary cut-off value of ≥10 was selected as the criterion to pick up infants at risk of CMA. A score of 10 requires the presence of at least two severe symptoms and a score higher than 10 requires the presence of at least three symptoms and the involvement of two organ systems. Published data using the CoMiSS in clinical trials show that the predictive value of the tool is 80% if the score is >10 at the start and decreases to < 6 within 2 weeks under an elimination diet with an extensiviley hydrolysed formula. To access the full content and download the brochure, register now.

Kristian discusses that the introduction of solids shouldn’t change due to cows’ milk allergy. He gives recommended timelines for this introduction and other weaning advice.

Kate discusses  how the introduction differs between IgE and non-IgE mediated allergy. She discusses how, with suitable patients, the milk ladder and how it works. 

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.

Kristian discusses how taste buds of infants mean they don’t notice taste differences in milks. He mentions how some formula taste better than others, specifically lactose containing formulas. He also mentions a method of titrating from one milk to another.

Kate discusses how adding flavours isn’t recommended - she further discusses how formulas containing lactose can taste better and therefore may be tolerated better.

Helen discusses the amount of formula and how it varies by infant condition and weight. She also gives a rough guide based on age.

Helen discusses the vitamins and minerals needed with both breastfed infants and formula fed infants both with or with cows’ milk allergy.

Kristian discusses how it isn’t advised to concentrate up a feed as a norm but further discusses special areas under the advice of a dietitian where it might occur.

Kristian discusses that guidance says that soya formula shouldn’t be used for Infants under 6 months of age and the reasons behind this.

Helen discusses that all amino acid formulas are suitable for a halal diet. She tells us that only SMA Althera is currently suitable for a halal diet in the extensively hydrolysed formulas.

Kate discusses that approximately 90% of patients should tolerate an EHF. She further discusses how an EHF should be first line choice in dietary management of cows’ milk allergy. She also highlights the areas where an amino acid formula should be used.

Helen discusses how and why you would order samples of formula for patients.

Helen discusses the difference between an EHF and an AAF. The differences between certain EHFs and when to use an AAF. 

Kate discusses the much misunderstood differences between lactose intolerance and cows’ milk allergy. She also discusses the different types of lactose intolerance.

Helen discusses the importance of history taking to help diagnose IgE mediated allergy and also the tell tale signs that occur with this type of allergy. She also discusses the different tests that can be taken to diagnose the allergy.

Helen discusses the difficulties in identifying non-IgE mediated allergy. She discuses methods to help inform the likelihood of allergy and then how to perform an elimination diet and reintroduction to diagnose the allergy.

Helen discusses the differences between IgE and non IgE allergy and the different body reactions between the two types of allergy. She also mentions ways of identifying between the two.

Kate discusses the importance of breastfeeding and steps that can be taken to maintain this in a child with cows’  milk allergy. She discusses the need for close dietary management to make sure vital nutrients deficiencies don’t occur with a dairy exclusion diet.

Helen discusses the differences in the symptoms associated with both IgE and Non-IgE mediated cows’ milk allergy. She discusses where symptoms which appear in different parts of the body. Helping you to not only identify cow’s milk allergy but what type it may be.

A webinar explaining the dietary management of Cows’ Milk Allergy in primary care. 

The symptom diary is for a carer of an infant suffering from signs and symptoms that could be linked to Cow's Milk Allergy (CMA) or other food allergies. Help your patients carer prepare for their next health visit, learn about common symptoms, which will help inform you to make a correct diagnosis.

THE DIETARY MANAGEMENT OF A COMPLEX COWS’ MILK ALLERGY PATIENT USING ALFAMINO® A 2 month old baby was referred for Nasogastric feeding following an episode of bronchiolitis. The baby had a past medical history of atopic eczema and was previously managed by the GP and Allergy & Dermatology team. Patient’s background, medical history, physical diagnosis The patient was born full term in August 2014. Pre-October 2014, there was one admission to hospital fo...

A practical approach to managing a CMA infant with Althera™ Cows’ Milk Allergy (CMA) can occur in 1.8% - 7.5% of infants in the first year of life.1 The allergy is defined as an adverse reaction to the proteins in milk with most children growing out of their allergy by the time they reach one year. The treatment consists of the exclusion of cows’ milk from the infant’s diet. There...

Cows’ milk allergy (CMA) is one of the major food allergies during infancy and childhood. Hypoallergenic formulas can be necessary for managing infants and children with severe CMA. According to the American Academy of Pediatrics (AAP), a formula is “hypoallergenic” if it does not provoke allergenic activity in 90% of infants or children with confirmed CMA with 95% confid...

" MANAGING COWS’ MILK PROTEIN ALLERGY WITH ALFAMINO® Overview of cows’ milk protein allergy in infants Cows’ milk protein allergy (CMPA) is one of the most common food allergies in infants.1 Symptoms of CMPA include :  Gastrointestinal (32-60% cases) Skin (5-90%) Anaphylaxis (0.8-9%) Respiratory Many of these symptoms overlap. CMPA can be classified into two groups: IgE mediated or non-IgE mediated (delayed hypersensitiv..."

" THE USE OF AMINO ACID FORMULA IN THE DIETARY MANAGEMENT OF SEVERE INFANT COWS’ MILK ALLERGY Approximately 2-7.5% of infants have symptoms of CMA1 whilst symptoms suggestive of Cows’ Milk Allergy (CMA) may be encountered in up to 15% of infants,  emphasising the importance of controlled elimination/milk challenge procedures2. The diagnosis and treatment pathways for cases of CMA are well documented and several guidelines exist to support the healthcare professional in..."

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.

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...

Differentiating milk allergy (IgE and non-IgE from lactose intolerance: understanding the underlying mechanisms and presentations.

There is much confusion between the diagnostic terms ‘lactose intolerance’ and ‘cows’ milk allergy’, which are often used interchangeably, resulting in the potentially incorrect clinical management of these two distinct conditions.

Professor Antonella Muraro, Paediatric Allergist, discusses the tests available to help support diagnosing CMA in infants. Filmed 2017.

The diagnosis of CMA can be difficult and a diagnosis must be confirmed. Clinical symptoms, elimination and challenge must all be considered. Filmed 2017.

Dr Carina Venter discusses the diagnosis and management of food protein-induced enterocolitis (FPIES) and eosinophilic esophagitis (EOE) in infants and young children. Filmed in Oct 2016.

Professor Mike Thomson, Paediatric Gastroenterologist, discusses cows’ milk allergy and the impact of delayed diagnosis, the typical symptoms and how it can be dietary managed. Filmed in Sept 2016

Rachel DeBoer, specialist paediatric allergy dietitian, discusses the challenges faced when weaning (complementary feeding) infants with CMA. Filmed in May 2017.

Food allergies can have an impact on eating habits and food intake. This includes CMA where feeding difficulties has been described as a possible feature. Dr Polly James, paediatric clinical psychologist, discusses practical tips for managing feeding aversions in the allergic child. Filmed in May 2017

To characterize the peptide profile of a whey-based, extensively hydrolysed formula (eHF) prepared with a non porcine enzyme blend, and to assess whether it meets the hypoallergenicity criteria of the Ame...

The aim of the symposium was to share learnings from the recently established European Academy of Allergy and Clinical Immunology (EAACI) Task Force on special products for cow’s milk protein allergy (CMPA), with the intention of providing an overview on controversies regarding extensively hydrolysed formulas (eHFs), their utility, and the validity of the definition ‘special products ...

This symposium took place during the 2018 meeting of the European Academy of Allergy and Clinical Immunology (EAACI). Focussing on the fundamental issues of suboptimal management of patients with cow’s milk protein allergy (CMPA), the speakers discussed key themes for optimising management.

To assess if an amino acid-based formula supports normal growth in infants with cow's milk protein allergy (CMPA).

The CoMiSS score was developed as an easy-to-use awareness tool for primary health care providers to increase the awareness of the most common symptoms of cow's milk protein allergy (CMPA) and the evolution of symptoms during a therapeutic intervention. The purpose of the study was to evaluate the score in infants with symptoms indicative of CMPA and to evaluate...

To determine whether an extensively hydrolyzed formula (EHF) supplemented with two human milk oligosaccharides (HMO) was tolerated by infants with cow’s milk protein allergy (CMPA). Methods: A whey-based EHF (Test formula) containing 2′fucosyl-lactose (2′FL) and lacto-N-neotetraose (LNnT) was assessed for clinical hypoallergenicity and safety. The Control formula was...

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..

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.

Lactose intolerance is one of the more common forms of food intolerance and is often confused with cows' milk allergy. This video explains the differences in both symptoms, diagnosis and treatment. It also explains the different types of lactose intolerance.

16 weeks old, female twins were identified on EMIS search at a GP practise by an Oviva community dietitian for review. They were not already under the care of a dietitian and had both been started on Neocate LCP® for suspected cows’ milk allergy (CMA) at 6 weeks old by a paediatrician. The dietitian successfully switched both twins to SMA Alfamino and later stepped them down to SMA Althera.

HMOs, the third solid component of human milk, are complex structures with a high potential for specific functions. HMOs and prebiotic oligosaccharides have completely different structures, which impact on their functions. Additionally to prebiotic effects, HMOs reduces adhesion of pathogens and have immune modulator effect.

The process of diagnosing a child with a cows’ milk allergy (CMA) can be difficult as the symptoms of CMA are non-specific, making the allergy often difficult to detect. Our video goes through the first steps to diagnosing the condition (date: 01/06/2017)

The first 1,000 days of life are a window of opportunity to set solid foundations for infants’ future health. This period is a time of rapid physiological change and plasticity with significant potential for lasting effects.1 It is also a period of heightened vulnerability.2

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.