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New Guidelines Set to Improve Standard of Cows’ Milk Allergy Care

Only hypoallergenic formulas such as eHF and AAF suitable for children with CMA.

New guidelines on the diagnosis and management of cows’ milk allergy (CMA), published today in the Archives of Disease in Childhood, are set to improve the standard of care of infants with CMA, the most common food allergy in children.1

The Guidelines for the Diagnosis and Management of Cows’ Milk Protein Allergy recommend only extensively hydrolysed (eHF) and amino acid-based formulas (AAF), and the Taskforce’s recommendations warn against the risks of soy and other mammalian milks, such as sheep and goat, in CMA management.

Drawn up by the independent international Taskforce of allergy experts Act Against Allergy, and supported by an educational grant from SHS International, a leader in the field of specialised clinical nutrition, the guidelines offer clear recommendations on how to diagnose and manage CMA as well as two algorithms – one for breast-fed infants and one for formula-fed infants – addressing all levels of disease severity.

“These are the first practical guidelines on CMA diagnosis and management and are specifically aimed at primary care physicians and general paediatricians”, says Professor Yvan Vandenplas, Paediatric Gastroenterologist at Vrije Universiteit Brussel, Brussels, Belgium and Chair of the Act Against Allergy Taskforce. “Our recommendations will assist in establishing CMA diagnosis and level of severity, offering clear guidance on the recommended management at each stage, whilst debunking some of the misconceptions over the value of soy and other alternative milk sources in CMA.”

In their paper, the Taskforce recommends against the use of soy, especially in infants under six months old, due to the risk of secondary intolerance which can be present in up to 60% of CMA infants.2 Alternative mammalian milks, such as sheep, buffalo, horse, camel or goat, present an even higher risk of cross-reactivity and are not recommended at all in CMA. Furthermore, milk substitutes based on grains, legumes or nuts, such as rice, oat, pea or almond milk, are to be avoided in infants and young children due to their poor nutritional profile. According to the Act Against Allergy Guidelines, the only milk alternatives recommended for the effective management of CMA are specialised hypoallergenic CMA formulas, namely eHF’s and AAF’s.

AAF is the only formula type recommended for all degrees of CMA severity (i.e. mild, moderate and severe). These formulas are based on amino acids, the building blocks of protein, which are considered virtually incapable of provoking an allergic reaction,3 while providing optimal nutrition for of the infant. Immediate usage of AAF is also recommended in infants with suspected CMA showing failure to thrive – insufficient weight and/or length gain – in order to rapidly stabilise the infant’s physical development.

In cases of mild to moderate, but not severe, CMA, the Taskforce advises that an eHF may be sufficient. When milk proteins are broken down (hydrolysed) into smaller fragments – as happens in the production of eHF’s – their ability to provoke an allergic reaction is reduced. However, if symptoms do not improve sufficiently on an eHF, an AAF should be considered.

The SHS / Nutricia portfolio of hypoallergenic infant formulas is the only range of products that fully covers all degrees of CMA severity (i.e. mild to moderate and severe). The portfolio also includes the only AAF that is globally available and the most extensively clinically validated.

Jonathan Wogel, Global Allergy Director of SHS International says, “SHS International and Nutricia have a long-standing heritage in the development the medical nutrition field, with over two decades’ experience in the production of specialised CMA formulas. To date however, there has been confusion over the diagnosis and usage of cows’ milk alternatives. We are proud to have been able to support the Act Against Allergy Taskforce in this initiative in order to finally set a clear protocol on CMA management and improve the quality of lives of infants with cows’ milk allergy and their families across the world.”


1. Niggeman B, Binder C, Dupont C, et al. Prospective, controlled, multi-center study on the effect of an amino acid based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol. 2001;12:78–82

2. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic Infant Formulas. Pediatr. 2000;106:346-349

3. Host A, Koletzko B et al. Dietary products used in infants for treatment and prevention of food allergy. Arch Dis Child. 1999: 81:80–84.

Claire Greeff | alfa
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