<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> 3-6% presents <3/12 in formula fed infants, and rarely in exclusively breastfed infants. Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions are seen. CMPA - immediate reactions, CMPI for mild-moderate delayed reactions. ''Features'' regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur ''Diagnosis'' - mostly clinical (e.g. improvement with cow's milk protein elimination). ''Investigations'' skin prick/patch testing total IgE and specific IgE (RAST) for cow's milk protein ''Management'' If severe (e.g. failure to thrive) refer to a paediatrician. if formula-fed 1st line - extensive hydrolysed formula (eHF) milk 2nd line or if severe - amino acid-based formula (AAF) 10% of infants are also intolerant to soya milk if breast-fed continue breastfeeding eliminate cow's milk protein from maternal diet use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months CMPI usually resolves by 1-2 years of age. A challenge is often performed in the hospital setting as anaphylaxis can occur.