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Flag_icon When is early intervention with an AAF recommended?
Flag_icon When is early intervention with an AAF recommended?
Flag_icon When is early intervention with an AAF recommended?
Flag_icon When is early intervention with an AAF recommended?
  • This section contains a background to CMA. It provides information on managing CMA by appropriate assessment and diagnosis using the NICE guidelines and advice on when to use a specialist amino acid formula to meet nutritional requirements, improve tolerance and outcomes for infants and children with CMA.


    CMA is a distressing condition for infants and their parents/carers:


    • CMA is an immune mediated reaction to the proteins within cow’s milk and is one of the most common food allergies affecting 2-5% of infants.1 Up to 40 000 babies a year in the UK may develop CMA.2
    • Most cases of CMA present in infancy and the majority of children will grow out of the allergy by the age of 5 years.
    • CMA can be complex to diagnose as many infants will often present with two or more symptoms frequently seen in infancy.
    • The most common symptoms are of dermatological, gastrointestinal and respiratory origin

    CMA-Overview-image
  • NICE have produced a guideline (CG 116) to aid in the diagnosis and assessment of food allergy in children and young adults. The first steps are initial recognition, an assessment of the symptoms and the allergy focused history. The guideline includes a series of algorithms, which have been reproduced with the permission of NICE for use on this website.

  • National Institute for Health and Care Excellence (2011) Adapted from CG 116 Food allergy in children and young people. Diagnosis and assessment of food allergy in children and young people in primary care and community setting. London: NICE. Available from www.nice.org.uk/CG116 Reproduced with permission.

  • CMA can be classified according to whether the allergic reaction is an IgE mediated (within 2 hours) or a non IgE mediated (delayed, chronic) response. The NICE guideline helps determine the type of allergy and outlines the tests that should be used to confirm the diagnosis.


    Once an allergy is suspected NICE recommends that an elimination diet should be tried for 2 to 6 weeks. The allergen should then be reintroduced to confirm diagnosis. NICE also recommends that the advice of a dietitian with appropriate competencies should be sought to assist with nutritional adequacies, timings of elimination and reintroduction, and follow-up.


    The algorithms found below have been reproduced with the permission of NICE.


    Once the diagnosis of the CMA has been confirmed, including the type of allergy (IgE or non IgE), a management plan can be established.


  • National Institute for Health and Care Excellence (2011) Adapted from CG 116 Food allergy in children and young people. Diagnosis and assessment of food allergy in children and young people in primary care and community setting. London: NICE. Available from www.nice.org.uk/CG116 Reproduced with permission.

  • CMA is managed by excluding cow’s milk protein from the diet.


    Breast feeding is always the preferred way to feed an infant. If an infant is being breast fed, the mother needs to follow an exclusion diet with the support of the dietitian to ensure that the maternal diet is adequate. Calcium and Vitamin D supplements are recommended.


    Should the mother need to provide top ups to breast milk, the use of an amino acid based formula is recommended in CMA. The ranges of B-lactoglobulin (BLG) levels and peptide sizes of cow’s milk protein in breast milk are similar to those in an eHF, therefore reaction to these in breast milk are likely to then also occur with an eHF.1


    Formula fed infants will need to be provided with a replacement hypoallergenic formula, either an extensively hydrolysed or amino acid formula.


    It is important to understand:


    Up to 10% of infants with uncomplicated CMA and up to 40% of infants with more complex allergy may be intolerant to an eHF.2


    • AAF formulas were found to be effective where symptoms persist (even if their intensity has decreased) with an eHF.

    There are specific times where the use of an amino acid formula is indicated.

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