In an effort to improve the standard of care for infants with cow's milk allergy (CMA), Act Against Allergy, an "independent" international taskforce of allergy experts, has prepared guidelines for the diagnosis and management of CMA within the UK. The guidelines are said to be stricter than those set forth by by the American Academy of Pediatrics, and can be summarized as follows:
First and foremost, breastfeeding is still consider the best option for infants with CMA. But, if this is not an option, then the taskforce recommends hypoallergenic formulas only (see disclaimer below). Here is a brief breakdown of the formula options discussed:
Partially Hydrolized Formulas – This is often not tolerated with CMA, as it contains 1,000 to 100,000 times higher concentrations of intact cow's milk protein than extensively hydrolyzed formulas
Extensively Hydrolyzed Formulas – The next line of defense, better than partially hydrolyzed formulas, though still not always tolerated.
Amino Acid-Based Formulas – Recommended if symptoms continue for two to four weeks with an extensively hydrolyzed formula or if the child refuses to drink the hydrolyzed milk. Along with doctor supervision, this should be the first line of defense against severe CMA.
Alternative Mammal Milks – The taskforce recommended against formulas based on milk from other mammals, such as sheep, buffalo, horse, camel, or goat, because of the high risk of cross-reactivity.
Soy Formula – This is the least expensive formula alternative, though the taskforce recommended that pediatricians only consider soy for infants who refuse to drink an extensively hydrolyzed or amino acid-based formula. On the Act Against Allergy website they site that 40 to 60% of infants with CMA are also allergic to soymilk. However, other stats show that this number is much lower, at around 10% to 35%.
Many object to the use of hyrdolyzed and amino-acid formulas as a first line of defense, because they are extremely expensive. Soy formulas are far more cost-effective, so many parents choose to trial this route first.
Full details of the guidelines have been published in the journal Archives of Disease in Childhood.
Important Disclaimer: The Act Against Allergy website is run by SHS International, the manufacturer of Neocate, a top line amino-acid based infant formulas.