Cow's Milk Allergy (CMA) Symptoms

Symptoms and Signs of Cow's Milk Allergy (CMA)

• Symptoms span multiple systems: skin (urticaria, angioedema, eczema), gastrointestinal (vomiting, abdominal pain, constipation), and respiratory (rhinorrhea, sneezing, dyspnea).
• Severe reactions can lead to systemic issues like cardiovascular collapse.
• Reactions primarily occur after milk ingestion, but can also result from inhalation or skin contact with milk.

Diagnosis of CMA

• Diagnosis begins with an allergy-focused clinical history and a thorough physical examination.
• Important to collect information about the infant’s feeding practices and any personal or family history of allergic diseases.

Elimination Diet Techniques

• Non-IgE mediated CMA requires a diagnostic elimination diet lasting 2–4 weeks before reintroduction of milk.
• IgE-mediated allergies may have a shorter elimination period of 1–2 weeks.
• Recovery is typically faster in IgE-mediated allergies compared to non-IgE mediated cases.

Improvement Timelines

• Improvement in infants with severe atopic dermatitis may take 6 to 8 weeks, aligning with natural disease progression.

Evidence for Formulas in CMA Management

• Cow's milk-based extensively hydrolyzed formulas (eHFs) are recommended for diagnostic elimination diets.
• Hydrolyzed rice formulas (HRFs) and soy formulas may also be beneficial, but lack sufficient evidence for recommendation.

Over-Diagnosis Concerns

• Over-diagnosis of CMA can occur in children who exhibit symptoms due to other conditions, leading to unnecessary elimination diets and potential harm.