Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy—a UK primary care practical guide

Venter, Brown, Shah, Walsh and Fox

History taking

  • Taking an allergy-focused history forms the cornerstone of the diagnosis of food allergies including cow’s milk allergy (CMA), and the UK NICE clinical guideline (CG) 116 Diagnosis and assessment of food allergy in children and young people in primary care and community settings recommends that questions should be asked regarding:
    • any family history of atopic disease in parents or siblings
    • any personal history of early atopic disease
    • the infant’s feeding history
    • presenting symptoms and signs that may be indicating possible CMA
    • details of previous management, including any medication and the perceived response to any management
    • was there any attempt to change the diet and what was the outcome?
  • Following on from these questions, the next important step is to attempt to differentiate between possible IgE and non-IgE-mediated allergies (see first algorithm) and decide which tests to do

IgE-mediated CMA

  • For the diagnosis of IgE-mediated CMA, the use of skin prick tests (SPT) or serum-specific IgE tests are recommended, but these should only be performed by those competent to interpret the tests

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