{"id":21045,"date":"2024-10-02T13:43:30","date_gmt":"2024-10-02T12:43:30","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=21045"},"modified":"2024-11-28T10:33:29","modified_gmt":"2024-11-28T10:33:29","slug":"cows-milk-protein-allergy-cmpa","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/allergy\/cows-milk-protein-allergy-cmpa\/","title":{"rendered":"Cow\u2019s Milk Protein Allergy (CMPA)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Information<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These are guidelines for the diagnosis and management of suspected cow\u2019s milk protein allergy (CMPA) in primary care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis of non-IgE mediated CMPA. <strong>Do not<\/strong> re-challenge for suspected IgE mediated CMPA.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Introduction<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>These guidelines are for the diagnosis and management of suspected cow\u2019s milk protein allergy.<\/li>\n\n\n\n<li>The prevalence of cow\u2019s milk allergy is up to 3% of infants during the first year of life.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy is frequently over diagnosed with allergy formula milks being over-prescribed.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy commonly presents in infancy, with most affected infants presenting&nbsp;with symptoms by 6 months of age.<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy&nbsp;can be classified into IgE mediated&nbsp;reactions (immediate onset) and non- IgE mediated (delayed onset).<\/li>\n\n\n\n<li>Cow\u2019s milk protein allergy will resolve in the majority of children during early childhood.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><div class=\"wpcp-wp-lightbox-host wpcp-advanced-image-lightbox-icon-hover\"><a class=\"wpcp-wp-lightbox-image-link\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5.png\" data-wpcp-wp-lb-image=\"1\"><img loading=\"lazy\" decoding=\"async\" width=\"854\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-854x1024.png\" alt=\"CMPA FLOWCHART V5\" class=\"wp-image-21704\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-854x1024.png 854w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-250x300.png 250w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-768x921.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-1281x1536.png 1281w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-1708x2048.png 1708w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-951x1140.png 951w\" sizes=\"auto, (max-width: 854px) 100vw, 854px\" \/><\/a><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5.png\" data-fancybox=\"wpcp-wp-img-21704\" class=\"wpcp-lightbox-trigger wpcp-advanced-image-lightbox-icon wpcp-position-top-right wpcp-advanced-image-lightbox-icon-hover wpcp-global-lightbox-icon wpcp-lightbox-icon--global wpcp-lb-icon-style-default\" data-wpcp-lb-icon-source=\"global\" aria-label=\"Open image in lightbox\" data-thumb-src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/CMPA-FLOWCHART-V5-250x300.png\" data-wpcp-lb-single=\"1\"><span class=\"wpcp-icon-container\"><svg viewBox=\"0 0 20 20\"><path d=\"M17.6585 16.025L14.2437 12.6198C15.1716 11.3338 15.6121 9.7613 15.4871 8.1819C15.362 6.60251 14.6795 5.11847 13.5607 3.99351C12.936 3.36206 12.1916 2.86066 11.3709 2.51845C10.5502 2.17623 9.66952 2 8.77995 2C7.89039 2 7.00969 2.17623 6.18899 2.51845C5.36829 2.86066 4.62395 3.36206 3.99919 3.99351C3.36594 4.61649 2.86312 5.35871 2.51992 6.17708C2.17673 6.99545 2 7.87365 2 8.76068C2 9.64772 2.17673 10.5259 2.51992 11.3443C2.86312 12.1627 3.36594 12.9049 3.99919 13.5279C5.11957 14.6901 6.62279 15.4103 8.23285 15.5562C9.84291 15.7022 11.4517 15.2641 12.7639 14.3224L16.1788 17.7275C16.3849 17.9034 16.6473 18 16.9186 18C17.1899 18 17.4523 17.9034 17.6585 17.7275C18.1138 17.16 18.1138 16.5925 17.6585 16.025ZM5.59278 12.0523C5.16258 11.6298 4.82094 11.1263 4.58774 10.5709C4.35455 10.0156 4.23446 9.41951 4.23446 8.81744C4.23446 8.21536 4.35455 7.6193 4.58774 7.06394C4.82094 6.50859 5.16258 6.00503 5.59278 5.58257C6.01644 5.15359 6.52144 4.81292 7.07838 4.58039C7.63532 4.34786 8.23308 4.22811 8.83687 4.22811C9.44066 4.22811 10.0384 4.34786 10.5954 4.58039C11.1523 4.81292 11.6573 5.15359 12.081 5.58257C12.5112 6.00503 12.8528 6.50859 13.086 7.06394C13.3192 7.6193 13.4393 8.21536 13.4393 8.81744C13.4393 9.41951 13.3192 10.0156 13.086 10.5709C12.8528 11.1263 12.5112 11.6298 12.081 12.0523C11.6573 12.4813 11.1523 12.822 10.5954 13.0545C10.0384 13.287 9.44066 13.4068 8.83687 13.4068C8.23308 13.4068 7.63532 13.287 7.07838 13.0545C6.52144 12.822 6.01644 12.4813 5.59278 12.0523Z\" \/><\/svg><\/span><\/a><\/div><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dietetics \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"mailto:loth.cypdieteticsinfantfeeding@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.cypdieteticsinfantfeeding@nhs.scot<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-1-CMPA-signs-and-symptoms-v2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix-1-CMPA-signs-and-symptoms.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-for Doctors and Health Visitors v1.doc<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-3-Prescribing-allergy-formula.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 3 PRESCRIBING-ALLERGY-FORMULA-MILKS.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.R.M &amp; L.W 15-11-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">GPs, Health Visitors, Paediatric Physicians, Family Nurse<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected non-IgE CMPA who meet the criteria for specialist dietician management as per the above flow chart e.g:<\/li>\n<\/ul>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>&lt; 12 months old<\/li>\n\n\n\n<li>Faltering growth<\/li>\n\n\n\n<li>Multiple allergies suspected including CMPA<\/li>\n\n\n\n<li>Blood in stools<\/li>\n\n\n\n<li>Feeding aversion<\/li>\n\n\n\n<li>Multiple maternal dietary exclusions<\/li>\n\n\n\n<li>Under family nurse practitioner<\/li>\n<\/ol>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected non-IgE CMPA who meet criteria for initial primary care management but who develop further symptoms following a subsequent milk challenge.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infants with suspected IgE CMPA \u2013 Please refer these infants to RHCYP <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricdietetics\/\" target=\"_blank\" rel=\"noreferrer noopener\">General Paediatric Dietetics<\/a>. <strong>Do not<\/strong> re-challenge for suspected IgE mediated CMPA.<\/li>\n\n\n\n<li>Infants with suspected non-IgE CMPA who can be assessed safely in primary care and who do not develop symptoms following a subsequent milk challenge following a period off dairy.&nbsp; See Primary Care Management tab.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A Sci-Gateway referral pathway is currently under development for this service.&nbsp; In the meantime please email <a href=\"mailto:loth.cypdieteticsinfantfeeding@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.cypdieteticsinfantfeeding@nhs.scot<\/a> with allergy assessment form attached.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>After Referral:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Please see below detailing what families should expect from the Dietetic CMPA pathway <strong>following confirmation of CMPA diagnosis:<\/strong><\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Maternal dietary measures for breast fed infants, or allergy formula for formula fed infants, should continue whilst awaiting review (see Primary Care Management tab).<\/li>\n\n\n\n<li>Family will be called at 5 months of age and booked into cow\u2019s milk free weaning group (in person or online). To continue dietary measures for breast fed infants or allergy formula for formula fed infants.<\/li>\n\n\n\n<li>Family will be called at 12 months of age and booked into cow\u2019s milk reintroduction group (online)<\/li>\n\n\n\n<li>Discharged from dietetics after 12 months of age, unless ongoing dietetic review required. Prescription of allergy formula discontinued.<\/li>\n\n\n\n<li>One to one dietetic clinic appointments can be arranged as required where appropriate.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">We have close working relationships with RHCYP Medical Paediatrics and Allergy teams and can forward referrals as appropriate<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">The following patients can be safely assessed and have initial management carried out in primary care:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&lt;12 months old<\/li>\n\n\n\n<li>No growth concerns<\/li>\n\n\n\n<li>Suspected single non-IgE allergy to milk<\/li>\n\n\n\n<li>No blood in stools<\/li>\n\n\n\n<li>No feeding aversion<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Step 1: <\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>To confirm\/refute non-IgE CMPA diagnosis, complete 4 week dairy exclusion and subsequent milk challenge following guidance in the information sheets.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">See <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">parent information sheet for breast fed babies<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">See parent information sheet for <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">combination fed babies and formula fed babies<\/a>. &nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>If baby was previously tolerating dairy through maternal diet and became symptomatic on introduction of formula milk please advise Mum to continue to keep dairy in her own diet.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For formula fed infants, please prescribe appropriate <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-3-Prescribing-allergy-formula.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PRESCRIBING-ALLERGY-FORMULA-MILKS.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">allergy formula <\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>PLEASE NOTE:<\/em><\/strong> <strong><em>If no improvement after 2 weeks minimum on extensively hydrolysed formula, consider trial of amino acid formula for a further 2 weeks minimum, or alternative diagnosis eg. gastro-oesophageal reflux.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">See <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf\" data-type=\"link\" data-id=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">parent information sheet for babies on solids<\/a> <\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Step 2: <\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><strong>If CMPA confirmed on re-challenge<\/strong>, please refer to infant feeding dietetics  &#8211; <\/strong><em>see the Referral Guideline tab <\/em>&#8211; <em>IFD mailbox \u2013loth.cypdieteticsinfantfeeding@.nhs.scot<\/em> (<em>SCI-gateway protocol under development)<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please continue allergy formula milk<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please see \u201cafter referral\u201d in the Referral Guidelines tab to inform family of what to expect from dietetics<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If no return of symptoms on milk challenge, resume normal diet and consider alternate diagnosis.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Appendix-2-Infant-Allergy-Clinical-History-Assessment-Form-v1.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Infant Allergy Assessment Form for Doctors and Health Visitors<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Milk challenge information sheets<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Milk-free trial and re-challenge information for breastfed children with suspected non-IgE CMPA: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-with-suspected-non-IgE-CMPA.pdf<\/a><\/li>\n\n\n\n<li>Milk-free trial and re-challenge information for formula fed children with suspected non-IgE CMPA: <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FMilk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C89a20ae2f4b349b1660408dcded9530a%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638630272180697157%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=BjiMkn3CM3UzrYsjFw%2BFHr%2FQZRHaKmLUSFXCrsQy0ts%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-formula-fed-children-with-suspected-non-IgE-CMPA.pdf<\/a><\/li>\n\n\n\n<li>Milk-free trial and re-challenge information for breastfed children on solids: <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FMilk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C89a20ae2f4b349b1660408dcded9530a%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638630272180706821%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=bCqJACsnXih290vYaahhJnVHSFvL6ny%2FIW6uHeb30Ac%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/Milk-free-trial-and-re-challenge-information-for-breastfed-children-on-solids.pdf<\/a><\/li>\n\n\n\n<li>&nbsp;Cow\u2019s milk protein allergy \u2013 frequently asked questions.&nbsp;:&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fpolicyonline.nhslothian.scot%2Fwp-content%2Fuploads%2F2024%2F04%2FCMPA-and-feeding-difficulties-FAQ.pdf&amp;data=05%7C02%7CHeather.Levy%40nhs.scot%7C884fbfab92484858e62708dd03f5b0c1%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638671075941488840%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=L%2FGpcc6ZPJF5RZoMbY9nW%2FXRTLWKzcFw7QAM6l2dwzc%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/04\/CMPA-and-feeding-difficulties-FAQ.pdf<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Feeding difficulties in babies- what is normal: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/Feeding_difficulties_in_babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/Feeding_difficulties_in_babies.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Food allergy and eczema: <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/07\/Food-allergy-and-eczema-FAQs.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/07\/Food-allergy-and-eczema-FAQs.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dyschezia:  <a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/10\/Dyschezia-in-babies.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/medical-paediatrics\/feeding-difficulties-in-infants-under-6-months\/\" target=\"_blank\" rel=\"noreferrer noopener\">Feeding Difficulties in Infants Under 6 Months \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatriceczemaatopic\/\" target=\"_blank\" rel=\"noreferrer noopener\">Eczema, Atopic \u2013 RefHelp (nhslothian.scot)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information These are guidelines for the diagnosis and management of suspected cow&rsquo;s milk protein allergy (CMPA) in primary care. Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":13346,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1169],"class_list":["post-21045","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-cows-milk-protein-allergy-cmpa"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-allergy-services\/https-apps-nhslothian-scot-refhelp-cows-milk-protein-allergy-cmpa\/\" rel=\"tag\">Cows Milk Protein Allergy (CMPA)<\/a>","rttpg_excerpt":"Information These are guidelines for the diagnosis and management of suspected cow&rsquo;s milk protein allergy (CMPA) in primary care. Please note there are no allergy tests for non-IgE mediated CMPA. Diagnosis is based on resolution of symptoms on a cows milk protein free diet AND reoccurrence on re-introduction of milk. Re-challenge is essential for diagnosis","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21045","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=21045"}],"version-history":[{"count":0,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21045\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/13346"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=21045"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=21045"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}