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 has been published.

The international version of the management of milk allergy in primary care (iMAP) guideline builds on the 2013 UK MAP guideline, and incorporates further published UK guidance, feedback from UK healthcare professionals and affected families, and international guidance and expertise. The iMAP guideline includes updated recommendations on:

  • presentation and recognition of cow’s milk allergy (CMA)
  • diagnosis
  • management of mild-to-moderate confirmed non-IgE-mediated CMA within primary care or by the ‘first contact’ clinician
  • suspected severe non-IgE-mediated CMA
  • referral.

A diagnosis of CMA is made based on an allergy-focused clinical history. Classification of mild-to-moderate non-IgE-mediated CMA requires strict avoidance of foods containing cow’s milk for a trial period (an elimination diet) followed by clinical improvement, and then subsequent relapse coincident with reintroduction.

The iMAP guideline includes updated algorithms on the presentation of suspected CMA in the child’s first year of life, and the management of mild-to-moderate non-IgE-mediated CMA. A number of additional resources have been developed alongside the iMAP guideline to support parents and carers, including:

  • the iMAP initial factsheet for parents
  • the iMAP home reintroduction protocol to confirm diagnosis
  • the iMAP milk ladder
  • the iMAP milk ladder recipes.

Speaking about the iMAP guideline, Dr Trevor Brown, Honorary Consultant in Paediatric Allergy and co-author of iMAP, said: ’Cow’s milk allergy in the early weeks and months of life continues to be challenging to recognise and then to optimally manage. In 2013 the MAP milk allergy guideline was published and has become widely used in the UK. Now, learning from the positive feedback from its use and the input of international milk allergy experts, this new version—the iMAP guideline—aims to further facilitate the better recognition, diagnosis, and management of milk allergy in primary care settings.