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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

  1. 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)
  2. Prescribing infant formula for cow’s milk protein allergy in primary care April 2020 Our ref: (gmmmg.nhs.uk)
  3. Pathway for the Management and Treatment of infants with Cows’ Milk Protein Allergy (CMA) and Lactose Intolerance (LI) cmpa-pathway.pdf (shropshiretelfordandwrekinccg.nhs.uk)
  4. Guidelines for the Appropriate Prescribing of Specialist Paediatric Formulas in Berkshire West Primary Care Specialised Infant Formula Prescribing Guidelines (Nov’17).pdf (berkshirewestccg.nhs.uk)

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