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Symptoms

Cow’s milk allergy is associated with a spectrum of distressing gastrointestinal, dermal and respiratory symptoms from mild through to severe.  Onset of symptoms can be immediate or delayed, and are classed as IgE and non-IgE reactions to cow’s milk.1

Infants with mild-to-moderate cow’s milk allergy will have ≥ 1 of the
mild-to-moderate symptoms listed below. Infants with severe cow’s milk allergy will have a severe or "alarm" symptom alone or in combination with mild-to-moderate symptoms.1


Table adapted from Vandenplas 2007


When do symptoms of cow’s milk allergy develop ?

Symptoms normally develope after:

- Exposure to cow’s milk in infant formula

- Breastfeeding - cow’s milk protein is transmitted from the maternal diet into breast milk

- Consuming cow’s milk-based weaning food i.e. when introducing solids
 

IgE vs non-IgE mediated cow’s milk allergy symptoms

Cow’s milk allergy can be classified as IgE-mediated, non-IgE mediated or mixed.2




Time of symptom onset often differs for IgE-mediated and non-IgE-mediated reactions3 



Cow’s milk allergy symptoms can be divided into IgE and Non-IgE mediated1-4

IgE mediated cow’s milk allergy

- IgE mediated CMA provokes an immediate reaction within minutes to hours of ingesting milk3

- Typically presents with: urticaria, angioedema, vomiting or acute flare of atopic dermatitis1


Non-IgE mediated cow’s milk allergy

- Non-IgE mediated CMA has a delayed onset, usually 2-72 hours after ingesting milk2
 
- More difficult to diagnose
 
- Typically presents with: eczema or GI symptoms1
 

Mixed IgE & Non-IgE mediated cow’s milk allergy

- In clinical practice some infants will express acute and delayed onset reactions3



References
  1. Vandenplas 2007
  2. Venter 2013 -MAP
  3. Koletzko 2012
  4. NICE CG116, 2011
  5. Babyexpert.co.uk 2013