The MAP Guideline

The situation in the UK

Early recognition, timely diagnosis and appropriate management and dietary advice are key to managing CMA effectively and reducing its impact on patients and families and burden on the healthcare system1.

Many infants with CMA undergo months of differing management approaches before the real cause of their symptoms is recognised and the appropriate management initiated1.

A survey of 201 GPs carried out in 2013 and focusing on cow’s milk allergy, found that 92% of GPs would like a clearer explanation of the options for diagnosis, and 91% would like to increase their understanding of management options for CMA2.

Interactive Algorithm

The MAP Guideline uses algorithms to help primary care staff to provide early recognition, timely diagnosis and appropriate management and dietary advice.


Interactive MAP Guideline

The NICE guideline on the diagnosis and assessment of food allergies in children and young people gives recommendations on the diagnosis and assessment of IgE- and non-IgE-mediated food allergies in children presenting in primary care settings3.

A quick reference guide and fast, easy-to-use pathway summarising the NICE guideline are available at http://guidance.nice.org.uk/CG116.

It was outside of the agreed scope of the NICE guideline to focus on:

  • The specific diagnosis of CMA
  • The management of any specific food allergy, including CMA

Some of the NICE guideline authors, with the help of a tertiary care-based paediatric gastroenterologist, identified a need for a more practical, algorithm-based guideline focusing specifically on CMA, to help primary care staff to recognise all forms of CMA and then to manage the infants with the more common mild to moderate non-IgE-mediated CMA seen in the community4.

They developed the MAP Guideline for the diagnosis and management of cow’s milk allergy presenting in infancy for use in UK primary care4.

  • How to recognise the differing presentations of CMA in infancy (IgE-mediated and non-IgE-mediated)
  • How to distinguish between severe and mild to moderate clinical expressions of CMA
  • When to refer patients onwards
  • Practical guidance on the initial management of mild to moderate non-IgE-mediated CMA in primary care
  • Practical guidance on the on-going primary care management of such infants

The MAP Guideline uses algorithms to help primary care staff to provide early recognition, timely diagnosis and appropriate management and dietary advice. The MAP Guideline algorithms include clear pathways showing the steps needed to make the diagnosis and ongoing management. To use the algorithms and familiarise yourself with the different pathways, click below.

Interactive Algorithm

You can also download a PDF of the algorithm here.

Downloadable PDF of algorithm

The MAP Guideline was developed independently by its authors, and was not commissioned or in any way financially supported by any commercial sponsor.

1. Sladkevicius E, Nagy E, Lack G et al. Resource implications and budget impact of managing cow milk allergy in the UK. J Med Econ 2010;13(1):119-28.

2. Act on CMA campaign survey of 201 GPs. 2013. Data on file.

3. NICE. Diagnosis and assessment of food allergy in children and young people in primary care and community settings [Online]. 2011. Available at: www.nice.org.uk/CG116 [Accessed Sept 2013].

4. Venter C, Brown T, Shah N, Walsh J, Fox AT. Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy – a UK primary care practical guide [Online]. Clin Transl Allergy 2013;3(1):23. Available at: http://www.ctajournal.com/content/3/1/23 [Accessed Oct 2013].