{ "schema_version": 1, "kind": "condition", "id": "cows-milk-protein-allergy", "name": "Cow's milk protein allergy (infant)", "category": "paediatric", "sources": "SW London Integrated Medicines Optimisation Committee: Cow's Milk Protein Allergy primary care guidance (NHS, 2024) · No labelled dose - a dietary exclusion, not a medicine · SW London Integrated Medicines Optimisation Committee: Cow's Milk Protein Allergy primary care guidance (NHS,)", "review_status": "reviewed", "verified_against": "No labelled dose - a dietary exclusion, not a medicine · SW London Integrated Medicines Optimisation Committee: Cow's Milk Protein Allergy primary care guidance (NHS,) · Cow's milk protein allergy (infant) - disease-level clinical article (cows-milk-protein-allergy-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 539, "generic": "Maternal cow's milk exclusion (breastfed infant)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "The mother excludes cow's milk protein strictly for 2-4 weeks while breastfeeding continues", "adult_duration": "2-4 weeks, then reintroduce to confirm", "dose_source": "No labelled dose - a dietary exclusion, not a medicine", "rationale": "Breast milk stays the best feed for these babies. The allergen is what leaves, not the breastfeeding.", "cautions": [ "Encourage her to keep breastfeeding. The commonest harm in this diagnosis is a mother being moved onto formula she did not need.", "A mother off dairy needs 10 micrograms (400 units) of vitamin D daily, and 1,000 mg of calcium if her diet will not cover it. Excluding dairy without replacing calcium takes it out of her bones." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The infant carries on breastfeeding throughout. It is the mother's diet that changes.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cows-milk-protein-allergy" }, { "id": 540, "generic": "Extensively hydrolysed formula", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Not applicable - an infant feed", "adult_duration": "2-4 week trial, then reintroduce to confirm", "dose_source": "SW London Integrated Medicines Optimisation Committee: Cow's Milk Protein Allergy primary care guidance (NHS,)", "rationale": "First line for a formula-fed infant. At least nine in ten respond to it, which is why an amino acid formula is not where you start.", "cautions": [ "Three things that get used for this and should not be: soya formula, which is not for infants under 6 months; lactose-free formula, which removes the sugar and leaves the protein that is causing the problem; and goat or sheep milk, which cross-reacts.", "Reintroduce cow's milk over a week after 2-4 weeks. If nothing comes back, it was not CMPA and the diagnosis should be dropped rather than carried for years. If symptoms return, it is confirmed.", "Refer any suspected IgE-mediated case - immediate hives, swelling, wheeze, vomiting within minutes - to paediatric allergy without delay. Non-IgE disease, the slow gut-and-skin picture, can be managed in primary care.", "Faltering growth alongside gut symptoms, or any acute systemic reaction, is a referral not a formula trial." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Replaces the usual formula for 2-4 weeks. If the response is partial, try a second different EHF before moving on.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cows-milk-protein-allergy" }, { "id": 542, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Cow's milk protein allergy (infant) - disease-level clinical article (cows-milk-protein-allergy-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Avoid soy-based formulas due to the high cross-intolerance risk.", "RED FLAG - An oral food challenge must be conducted in a medical setting." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cows-milk-protein-allergy" }, { "id": 541, "generic": "Amino acid formula", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Not applicable - an infant feed", "adult_duration": "Ongoing, under dietetic review", "dose_source": "SW London Integrated Medicines Optimisation Committee: Cow's Milk Protein Allergy primary care guidance (NHS,)", "rationale": "For the roughly one in twenty who do not settle on hydrolysed formula, and for severe disease.", "cautions": [ "Two different EHFs first. Amino acid formula is far dearer and is not a stronger version of the same idea.", "Get a dietitian involved before weaning starts - the solid diet is where the exclusion goes wrong." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Second line, after two different extensively hydrolysed formulas have been tried.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cows-milk-protein-allergy" } ] }