Cow's milk protein allergy (CMPA)

• How many types of CMPA are there?


  2
• What are the 2 types of CMPA?


  IgE mediated

  Non IgE mediated
• When do the symptoms of CMPA tend to appear?


  First few weeks or months of life - typically following the intro of cow's milk into their diet
• What are some signs and symptoms of CMPA?


  Diarrhoea

  Vomiting

  Abdo pain

  Failure to thrive

  Constipation

  Eczema

  Rash

  Asthma-like symptoms
• What are some immediate IgE-mediated reactions of CMPA?


  Urticaria

  Angioedema

  Vomiting

  Wheezing
• When do immediate IgE-mediated reactions for CMPA occur?


  Within 2 hours of ingestion
• When do non-IgE mediated reactions tend to occur?


  Up to 48 hours afetr ingestion
• CMPA can sometimes present alongside other food allergies or intolerances
• WHat are the first line investigations for CMPA?


  Dietary elimination and reintroduction

  Skin prick test

  Specific IgE testing
• What are some further investigations for CMPA if first-line is still not clear?


  Faecal calprotectin

  Endoscopy with biopsies
• What are some ddx fro CMPA?


  Lactose intolerance

  GERD

  Eosinophilic oesophagitis
• How is CMPA managed?


  Formula fed: Replace with extensive hydrolysed formula

  Breast fed: Remove cow's milk from maternal diet -> use eHF when breastfeeding stops
• CMPA usually resolves in most children