<<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.