CMPA – Hypoallergic milk formulas

first line , either whey or casein based extensively hydrolysed proteins are not recognised by the immune system and hence do not trigger an allergic reaction suitable for majority > 90 % of children with CMPA for mild and moderate IgE mediated CMPA

Lactose free , hydrolysed casein , LCPs , contains probiotic lactobacillus rhamnosus GG

Use EHF as first line and a trial for 2 weeks for tolerance Taste of hydrolysed formulas is unpleasant & has a bitter smell understandable younger infants take EHF's more readily than older infants It may take up to 4-6 weeks for the symptoms to resolve

for severe IgE mediated allergy ( severe symptoms, multiple allergies ) after at least 4 weeks trial of EHF ( for e.g two different EHF formula ) and no improvement contains 100 % free amino acids and is considered non-allergic only about 10 % of infants with CMPA would require management with AAF about 3 times more expensive than EHF guidance may vary -whether these can be started in primary care , across regions

REFERENCES

Guidelines for Prescribing Specialist Infant Formula in Primary Care June 2019 Guidelines for Prescribing Specialist Infant Formula in Primary Care July 2019.pdf (birminghamandsurroundsformulary.nhs.uk)...