Primary Care Pathway for the Management of
Cow’s Milk Allergy (CMA) in Bolton
Reminder: CMA more prevalent if history of atopic disease in parent, sibling or patient
Discuss previous management, including any medication and perceived response to any management
Onset of symptoms after ingestion of Cow Milk Protein
Mostly 2-72hrs
Suggests
‘Acute’ onset within minutes
One or more of these symptoms
Severe
One or more of these symptoms
Gastrointestinal
Skin
 Severe colic
Pruritis,erythema
 Reflux-GORD
Significant atopic eczema
 Food refusal or aversion
 Loose or frequent stools Respiratory
Catarrhal airway symptoms
 Perianal redness
(with other symptoms)
 Constipation
 Abdominal discomfort,
 Blood/mucus in stools (in an otherwise well infant)
Gastrointestinal
Vomiting, diarrhoea, abdominal pain/colic
Respiratory
Acute rhinitis and/or conjunctivitis
Skin
Acute pruritus, erythema, urticaria,
angioedema. Acute ‘flaring’ of atopic eczema
Respiratory
CVS
or
GI symptoms
Anaphylaxis
Emergency
Treatment
and
Admission
Signs of faltering growth
(suggests severe Non-IgE mediated CMA)
No
Yes
Formula Fed
(+mixed Formula & Breast fed)
Prescribe: 4x400g tins (two
weeks) of
< 6 months: Nutramigen® Lipil 1
Or
> 6 months: Nutramigen® Lipil 2
Patients with improvement:
Prescribe: Nutramigen® 1 or 2
8x400g tins per month
Breast Fed
Exclusion of cow’s milk
containing foods from
maternal diet
Prescribe:
Mother Calcichew® D3
2od
Infant Abidec® 0.3ml
under 12 months old
Infant Abidec® 0.6ml
over 12 months old
(Dalivit® if peanut allergy)
Patients with no improvement:
Prescribe: Neocate® LCP4x400g per
month
Referal to dietitian
Formula fed
(+mixed Formula &
Breast fed)
Prescribe: Neocate®
LCP 4x400g for 2 weeks
Referal to dietitian &
paediatrician
Improvement
Prescribe: Neocate®
LCP 8x400g per month
Breast Fed
Exclusion of cow’s milk
containing foods from
maternal diet
Prescribe:
Mother: Calcichew® D3
2od
Infant Abidec® 0.3ml
under 12 months old
Infant Abidec® 0.6ml
over 12 months old
(Dalivit® if peanut allergy)
Referal to dietitian &
paediatrician
Referal to dietitian &
paediatrician
Referral to a Dietitian will ensure patients/parents get appropriate support including:
monitor nutritional intake (Calcium etc)
advice on weaning diet challenge and aim to move onto normal diet
review prescription formula at regular intervals (can be continued to 1-2 years based on assessment)
Dietitian contact Tel 01204 462694 for advice and information
Lactose intolerance is rare - lasting
for 4-6 weeks post gastroenteritis.
Do not prescribe Colief®, soya or lactose
free formula formula. Parents advised to
buy this over the counter.
Soya is not recommended as first
line treatment in CMA especially
under six months.