Suspected CMA in the first year of life


NI Guideline for suspected CMA in first year of life April 2013

Mild-moderate CMA

Non-IgE mediated CMA


  1. Infantile “colic”

  2. “Reflux”

  3. Loose or frequent stools

  4. Blood or mucus in stools ( in an otherwise well infant)

  5. Abdominal pain

  6. Constipation

  7. Food refusal or aversion

  8. Perianal redness

  1. Pruritus / itching of skin

  2. Erythema / flushing of skin

  1. Catarrhal airway signs

Severe CMA

IgE and or Non -IgE


  1. Skin - severe atopic eczema

  2. Gut

  3. Faltering growth  and persistent patterns of

  4. diarrhoea

  5. vomiting

  6. abdominal discomfort

  7. severe food refusal

  8. significant blood/mucus

  9. irregular and uncomfortable stools

Mild-moderate CMA

IgE mediated


  1. Skin

  2. acute pruritus

  3. acute erythema

  4. acute urticaria

  5. acute angioedema

  6. acute “flaring” of eczema

  7. Gut

  8. Acute onset GIT hypersensitivity  signs and symptoms:

  9. +/- diarrhoea

  10. +/- vomiting

  11. +/- abdominal pain/ colic

  12. Airway ( less common)

  13. acute rhinitis

  14. acute conjunctivitis

Anaphylactic reaction

An immediate reaction with respiratory/ CVS signs and symptoms or severe GIT presentation (uncommon)

Emergency admission
Urgent referral to paediatrician with interest in allergy
Management in Primary careStep_1_-_Commence_CMP_free_diet.html
Early referral to paediatrician with interest in allergy
Management by a competent clinician:
 Start CMP free diet with an extensively hydrolysed formula (eHF) for  2-6 week trial
 May need Amino acid formula (AAF)
 Initial IgE testing and follow-up
 Dietetic referral

Key Points

  1. CMA  occurs in 2.5-5% of children, most commonly in the first year of life

  2. Most children grow out of their allergy by 18-24 mth: 45-50% at year 1, 60-75% at year 2 and 85-90% at year 3. IgE mediated CMA may persist for much longer