Cow's Milk Allergy

Cow's Milk Allergy (CMA) is one of the most common food allergies, affecting 2-5% of infants globally.1

CMA typically develops in an infant’s first year, and it occurs when the immune system reacts inappropriately to a protein in cow's milk.2 The allergic reaction usually causes symptoms like diarrhoea, wheezing and eczema - these symptoms are common in infants who aren't well, so it can take time to diagnose.

Welcome to the healthcare professional pages of Cow’s Milk Allergy. Here you’ll be able to access a range of valuable articles and resources related to this topic, including clinical guidelines and detailed product information.

The role of nutrition

Allergy can place a significant burden on both the patient and their families, as well as on healthcare resources3,4. Allergies, including cow’s milk allergy (CMA), are caused by the body’s immune system overreacting to stimuli that are otherwise harmless.

Breastfeeding is the very best nutrition for all infants. When breastfeeding is not possible, there are tailored nutritional solutions – hypoallergenic formulas – specially designed for infants with cow’s milk allergy.

The mainstay of dietary management of CMA infants is the avoidance of all cow’s milk and cow’s milk protein-based infant formulas. Breastfeeding is the gold standard for infant nutrition; however, it may not always be possible for all CMA infants. Therefore, healthcare professionals may prescribe specialized infant formulas based on hydrolyzed protein or amino acids for dietary management.

Due to the recognition that there is gut microbiota dysbiosis in allergy5-7, there is a compelling rationale for the addition of both pre- and probiotics ingredients to formula for infants with CMA. An extensive clinical trial program has investigated the role of synbiotics (a blend of pre- and probiotics) in the dietary management of CMA8-11.

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Resources & Tools

Recognising CMA Symptom Tool

Support tool for healthcare professionals in recognising symptoms and proper management of CMA

CMA Support Tool for HCPs

A support tool to help healthcare professionals identify symptoms of CMA and resources to support in diagnosis. 

Clinical Guidelines

World Allergy Organization DRACMA Guidelines

The World Allergy Organization (WAO) expert panel have developed the evidence-based Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines.

ESPGHAN GI Committee practical guidelines

Diagnosis and management of cow’s milk allergy can be a complex process. ESPGHAN’s evidence-based guidelines can support the care clinicians offer to their CMA patients.

Milk Allergy in Primary Care (MAP/iMAP)

The GP Infant Feeding Network have collaborated with the MAP/iMAP team to update cow’s milk allergy diagnosis algorithms and create a parent leaflet to support the need to protect breastfeeding.

Managing CMA


Learn more about breastfeeding with CMA infants, authored by Angharad Banner

 Recognising CMA

Signs and symptoms

Learn to identify common CMA symptoms, including the differences between IgE and non-IgE CMA

Diagnosis and management

From Lydia Collins-Hussey, learn about the appropriate diagnosis of CMA according to guidelines

Access Expert Education at Nutricia Academy

Danone Nutricia Campus: Pediatric Allergy

The rise in infant immune diseases, most notably allergies, highlights the specific vulnerability of the immune system to early environmental challenges. A strong, balanced immune system acts as the first line of defence.

Immune-gut Interplay

70% of our immune cells are located in the gut15, making it our largest immune organ. Find out how our gut microbiota in early life can affect our chances of developing an allergy.

From avoidance to active dietary management

Avoiding allergens has long been the established way of managing food allergy. Emerging evidence suggests that a more active, nutritional approach may be more effective.

  1. Fiocchi A, et al. World Allergy Organization Journal. 2010;3(4):57-161.
  2. DRAMCA. WAO Journal April 2010. 2. NICE. Food allergy in under 19s: assessment and diagnosis. CG116. 2011
  3. Michaelis L, et al. Upskilling healthcare professionals to manage clinical allergy. Clin Exp Allergy. 2019;49:1534-1540.
  4. Meyer R, et al. The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organization Journal. 2017:10; 8
  5. Berni Canani R, et al. ISME J, 2016;3:42-50.2
  6. Ling Z, et al. Appl Environ Microbiol, 2014;80:2546-54.3
  7. Thompson-Chagoyan OC, et al. Pediatr Allergy Immunol, 2010;21:e394-400
  8. Burks A et al. Pediatr Allergy Immunol. 2015;26(4):316-22
  9. Candy D et al. Pediatr Res. 2018;83(3):677-86
  10. Fox AT et al. Clin Transl Allergy. 2019;9:5
  11.  Chatchatee P et al. JACI. 2021
  12. Collado MC, et al. Pediatr Res, 2015;77,182-8.
  13.  Jandhyala SM, et al. World J Gastroenterol, 2015;21(29); 8787–803.
  14.  Collado MC, et al. Pediatr Res, 2015;77,182-8.
  15.  Lee YY, et al. J Paediatr Child Health, 2017;53,1152-8.
  16. Prescott, S.L, Origins: Early-life solutions to the modern health crisis, Published on 2015: University of Western Australia Press, Crawly, Western Australia.

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