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Cow's Milk Protein Allergy (CMPA)

An immune-mediated reaction developing against cow's milk proteins in infancy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Cow's Milk Protein Allergy (CMPA)?

Cow's milk protein allergy (CMPA) is the most common food allergy of infancy, occurring when proteins in cow's milk (casein, alpha-lactalbumin, beta-lactoglobulin) become target of the immune system. It is divided into two main forms: IgE-mediated and non-IgE.

The non-IgE form of CMPA presents particularly in the early months with bloody stool and enteropathy; this picture includes allergic proctocolitis and food protein induced enterocolitis syndrome (FPIES). FPIES presents with recurrent severe vomiting and severe dehydration 1-4 hours after milk.

Most forms of CMPA are spontaneously tolerated at 1-3 years of age; in IgE-mediated forms, tolerance develops later. Tolerance development is monitored with regular allergy testing and managed re-exposure.

Symptoms

Vomiting and colic with formula or breastfeeding mother's cow's milk intake
Bloody-mucous stool (allergic proctocolitis)
Severe vomiting attacks 1-4 hours after (FPIES)
Eczema, urticaria or angioedema
Growth retardation and feeding refusal
Wheezing and chronic nasal discharge

Risk Factors

Family history of atopy
Personal atopic dermatitis
Not having received breast milk
Early cow's milk exposure (first days)
Reduced microbiome diversity (C-section, antibiotics)
Male gender (slight tendency)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • In bloody stool or growth retardation
  • Recurrent severe vomiting after formula (FPIES suspicion) to emergency
  • Serious anaphylaxis reaction to emergency
  • At 6-12 monthly allergology check to monitor tolerance development

Treatment Methods

01
Elimination: all cow's milk and derivatives discontinued
02
Maternal elimination diet for breastfed infant (and calcium supplementation)
03
For formula-fed infant: extensively hydrolyzed formula; FPIES/severe: amino acid formula
04
Soy formula: not recommended in some CMPA cases due to cross-reactivity
05
Oral immunotherapy (OIT): gradual tolerance induction in selected patients
06
Tolerance follow-up: controlled challenge with cooked cow's milk every 6-12 months

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.