Cows milk protein allergy

what is cows milk protein allergy

immune response to cows milk protein

how many children outgrow CMPA by age 5

95%

what happens in IgE mediated CMPA

cascade of immune events

IgE immunoglobulin response

what are the IgE mediated symptoms

acute pruritis

erythema

urticaria

angioedema

flaring of persistent atopic dermatitis

vomiting

diarrhoea

abdominal pain/ discomfort

acute rhinitis and or conjunctivitis

anaphylaxis

when do IgE mediated response occur

0-2 hours post ingestion

how do non-IgE mediated CMPA occur

lymphocyte activation

t helper cells

cytotoxic CD8 T cells involvement

creating inflation

2-48 hours after onset

what are the moderate non-IgE symptoms

persistent irritability

reflux

food refusal/ aversion

looser stools

painful gas/ abdominal discomfort

blood/mucus in a well infant

itching

non-specific rashes

atopic dermatitis

what are the severe non-IgE symptoms

vomiting

food refusal/aversion

diarrhoea

abdominal pain

significant blood/ mucus in stools

severe atopic dermatitis

faltering growth

what are the key differences between IgE and non-IgE mediated CMPA

IgE is like a normal allergy, non-IgE is more GI symptoms

time of onset is much quicker in IgE with more life threatening symptoms.

what tests can be done for non-IgE mediated CMPA

none - only elimination and re introduction

what test can be done for IgE medicated CMPA

Skin prick

RAST

what is RAST?

• Can be done for allergens including milk

• Measuring specific IgE antibodies

• Can be done without needing to stop antihistamines

• Can be completed in primary care, interpreted in secondary care

• Results must be interpreted alongside the clinical picture/symtpoms

what does iMAP say about breastfeeding mother should do if baby has suspected non IgE mediated CMPA

CMP free diet

monitor change

if improved reintroduce

if no improvement remove other allergens

what does iMAP say breastfeeding mother should do if baby has suspected IgE mediated CMPA

eliminate CMP

no not reintroduce to confirm diagnosis

what does iMAP say mixed fed baby should do if suspected non IgE CMPA

extensively hydrolysed formula for 2-4 weeks. clinical judgement if maternal diet needs CMP exclusion.

if no clear improvement trial amino acid formula

if clear improvements, reintroduce to confirm diagnosis.

what does iMAP say mixed fed baby should do if suspected IgE CMPA

extensively hydrolysed trial, or soya based formula is IgE testing rules out soya allergy

why is soya first choice cows milk replacement

similar nutrient profile to cows milk

what are examples of amino acid based formulas

Neocate

alfamino

what are examples of extensively hydrolysed formulas

nutramigen

aptamil pepti 1