For Healthcare Professionals only

A Step-By-Step Diagnostic Solution for Cow’s Milk Allergy
By - Danone Nutricia Academy


CMA: Cow’s milk allergy; CMP: Cow milk protein; DRACMA: Diagnosis and Rationale for Action against Cow's Milk Allergy; GI: Gastrointestinal; ESPGHAN: European Society for Pediatric Gastroenterology Hepatology and Nutrition; IgE: immunoglobulin E; iMAP: Milk Allergy in Primary Care; NICE: National Institute for Health and Clinical Excellence.


  1. do Nascimento Rangel AH, Sales DC, Urbano SA, JÚNIOR JG, de Souza MACÊDO C. Lactose intolerance and cow’s milk protein allergy. Ciência e Tecnologia de Alimentos. 2016 Jun;36(2):179-87.
  2. Matthai J, Sathiasekharan M, Poddar U, Sibal A, Srivastava A, Waikar Y, Malik R, Ray G, Geetha S, Yachha SK. Guidelines on Diagnosis and Management of Cow’s Milk Protein Allergy. Indian Pediatrics. 2020 Aug;57(8):723-9.
  3. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. Journal of pediatric gastroenterology and nutrition. 2012 Aug;55(2):221-9.
  4. Venter C, Brown T, Meyer R, Walsh J, Shah N, Nowak-Węgrzyn A, Chen TX, Fleischer DM, Heine RG, Levin M, Vieira MC. Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clinical and translational allergy. 2017 Dec;7(1):1-9.
  5. Fiocchi A, Brozek J, Schünemann H, Bahna SL, Von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA. World Allergy Organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines. World Allergy Organization Journal. 2010 Jan;3(4):57-161.
  6. Diagnosis and assessment of food allergy in children and young people in primary care and community settings. 2011. CG116. [Accessed date 29/01/2021].


The World Health Organization (WHO)* has recommended that pregnant women and new mothers be informed of the benefi¬ts and superiority of breast-feeding, in particular, the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for and maintenance of lactation, with special emphasis on the importance of the well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle feeding or other foods and drinks should be discouraged since it will have a negative effect on breast-feeding. Similarly, mothers should be warned of the diffi¬culty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and ¬financial implications of her decision. For example, if a baby is exclusively bottle-fed, more than one can (500g) per week will be needed, so the family circumstances and cost should be kept in mind. Mother should be reminded that breast milk is not only the best but also the most economical food for babies. If a decision to use infant formula is taken, it is important to give instruction on correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect dilution can lead to illness.

*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.

Importance of Breastfeeding:

(i) Immediately after delivery, breast milk is yellowish and sticky. This milk is called colostrum, which is secreted during the fi¬rst week of delivery. Colostrum is more nutritious than mature milk because it contains more protein, more anti-infective properties which are of great importance for the infant's defense against dangerous neonatal infections. It also contains higher levels of, Vitamin 'A', (ii) breast miIk- A) is, a complete and balanced food and provides all the nutrients needed by the infant [for the -first six months of life] (B) has anti-infective properties that protect the infants from infection in the early months (C) is always available; (D) needs no utensils or water (which might, carry germs) or fuel for its preparation, (iii) breastfeeding is much cheaper than feeding infant milk substitutes as the cost of the extra food needed by the mother is negligible compared to the cost of feeding infant milk substitutes, (iv) mothers who breast-feed usually have longer periods of infertility after child birth than non-lactators; (b) details of management of breast feeding, as under:- (i) breast-feeding- (A) immediately after delivery enables the contraction of the womb and helps the mother to regain her -figure quickly; (B) is successful when the infant suckles frequently and the mother wanting to breast-feed is confi¬dent in her ability to do so (ii) in order to promote and support breast-feeding the mother’s natural desire to breast feed should always be encouraged by giving, where needed, practical advice and making sure that she has the support of her relatives. (iii) adequate care for the breast and nipples should be taken during pregnancy. (iv) it is also necessary to put the infant to the breast as soon as possible after delivery, (v) let the mother and the infant stay together after the delivery, the mother and her infant should be allowed to stay together (in hospital, this is called "rooming-in"); (vi) give the infant colostrum as it is rich in many nutrients and anti-infective factors protecting the infants from infections during the few days of its birth; (vii) the practice of discarding colostrum and giving sugar water, honey water, butter or other concoctions instead of colostrum should be very strongly discouraged; (viii) let the infants suckle on demand; (ix) every effort should be made to breast-feed the infants whenever they cry; (x) mother should keep her body and clothes and that of the infant always neat and clean. Breast-feeding is the best form of nutrition for babies and provides many benefi¬ts to babies and mothers. It is important that, in preparation for and during breast-feeding, you eat a healthy, balanced diet. Combined breast and bottle-feeding in the ¬first weeks of life may reduce the supply of your own breast-milk and reversing the decision not to breast-feed is dif¬ficult. Always consult your Healthcare Professional for advice about feeding your baby. The social and fi¬nancial implications of using infant formula should be considered. Improper use of an infant formula or inappropriate foods or feeding methods may present a health hazard. If you use infant formula, you should follow manufacturer's instructions for use carefully - failure to follow the instructions may make your baby ill. Published by: Nutricia International Pvt. Ltd. Building A, unit no. 304, 3rd Floor, Agastya Corporate Park, Kamani Junction, L.B.S. Marg, Opp. Fire Brigade, Kurla (West), Mumbai 400070 Date of Publishing : 27th April, 2021

For the use of Health Care Professionals only

CVM code: 1617451939421