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Key questions on cow’s milk protein allergy

Key points

  • Cow’s milk protein allergy (CMPA) is often considered in babies presenting with crying and distress after feeding
  • Careful assessment is important to ensure appropriate diagnosis and avoid over-medicalisation
  • Avoid milk trials based only on parental request even if siblings are affected; a full, detailed history is required to assess each case
  • Most lactose intolerance is secondary and transient. Primary lactose intolerance is rare, and will require acute referral, so should not be confused with CMPA
  • Most CMPA will resolve within 3-5 years; agree ongoing prescribing with local dietetic team

Dr Samantha Ross is a GPSI in preschool growth and nutrition based in Glasgow

Q: The terms cow’s milk protein intolerance and cow’s milk protein allergy seem to be used interchangeably, but are they different? Where does lactose intolerance fit in?

A: The correct term is cow’s milk protein allergy (CMPA). CMPA is not an intolerance but an immune-mediated reaction due to sensitisation to proteins in the casein or whey fractions in cow’s milk. CMPA is relatively rare, with
a prevalence of 0.5-3%. It is far less common in breastfed than non-breastfed babies. The risk of sensitisation and development of CMPA in exclusively breastfed babies is very low.

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Most infants with confirmed CMPA will outgrow this over time (typically by age three in non-IgE CMPA and by age five in IgE CMPA).

Lactose intolerance is entirely different and is not immune mediated: symptoms are related to a relative imbalance or deficiency of lactase, the enzyme that metabolises lactose, in the brush border of the small intestine.  Secondary lactose intolerance can occur in babies and young children after gastroenteritis infection due to transient lactase deficiency, and usually improves after a few weeks. Other forms of lactose intolerance are relatively rare in infancy.

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Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 24 November, 2021 4:57 pm

The key question is why is it a middle class bail out diagnosis for lack of parenting? The formula feed industry is having a colic and laugh.
Poor neglected misdiagnosed children.