Children < 1 year fed with regular cow’s milk formula and suspected severe CMPA

1. Children < 1 year fed with regular cow’s milk formula and suspected severe CMPA • Immediate reactions: • Laryngeal edema • Acute asthma with severe respiratory distress • Anaphylaxis • Late reactions: • Chronic diarrhoea,chronic vomiting, food refusal,with poor growth • Bloody stools with iron deficiency anaemia • Protido-losing enteropathy with hypoalbuminemia • Eosinophilic esophagogastroenteropathy confirmed by biopsy Infants should be referred to a specialized clinic. SPT and/or specific IgE should be performed Elimination diet: soy (if >6 months) or extensively hydrolyzed formula or amino acid formula (for 2 wks then continue with soy or extensively hydrolyzed formula) *. Cow’s milk challenge test in a clinical setting after 12 months of age and not before 6-12 months from the reaction. *Introduce extensively hydrolyzed formula or soy under medical supervision. Amino acid formula should be given if this is not feasible. • Extensively hydrolised formula or amino acid formula. • In case of poor growth, anaemia, hypoabuminemia: elimination diet for 10 days-6 weeks with amino acid formula (to switch to extensively hydrolyzed formula). Improves ? No Yes Regular cow’s milk formula Cow’s milk challenge test after 6-12 months of avoidance and 1year of age in a clinical setting.