Interactive Algorithm

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Suspected Cow's Milk Allergy (CMA) in the 1st Year of Life - having taken an Allergy-focused Clinical History

TB/AF/NS/CV/JW | Oct 2013

Mild to Moderate Non-IgE-mediated CMA 'Delayed' Onset Symptoms


Mostly 2-­72 hrs. after ingeston of cow's milk protein

Formula fed, exclusively breast fed or at onset of mixed feeding

One, or often, more than one of these symptoms:

‘Colic’

Vomiting - ‘Reflux’ -­ GORD

Food refusal or aversion

Loose or frequent stools

Perianal redness

Constipation

Abdominal discomfort,

Blood and/or mucus in stools in an otherwise well infant

Pruritus, erythema

Significant atopic eczema

‘Catarrhal’ airway symptoms (usually in combinaton with one or more of the above symptoms)

Severe Non-IgE-mediated CMA 'Delayed' Onset Symptoms


Mostly 2-72 hrs. after ingestion of cow's milk protein

Formula fed, exclusively breast fed or at onset of mixed feeding

Severe persisting symptoms of one or more of:

Diarrhoea, vomiting, abdominal pain, food refusal or food aversion, significant blood and/or mucus in stools, irregular or uncomfortable stools.

+/- Faltering growth

Severe Atopic Eczema

+/- Faltering Growth

Mild to Moderate IgE-mediated CMA 'Acute' Onset Symptoms


Mostly within minutes of ingestion of cow's milk protein

Mostly formula fed or at onset of mixed feeding

One or more of these symptoms:

Acute pruritus, erythema, urticaria, angioedema

Acute ‘flaring’ of atopic eczema

Vomiting, diarrhoea, abdominal pain/colic

Acute rhinitis and/or conjunctivitis

Severe IgE mediated CMA



ANAPHYLAXIS

Immediate reaction with significant respiratory and/or Cardiovascular system signs and symptoms.

(Rarely a severe gastrointestinal presentation)

Emergency Treatment and Admission