Diagnosing CMA

The first step to relieving your child's symptoms will be visiting your healthcare professional and finding out if your baby has cow's milk allergy. They will then be able to manage your child's condition.

How can you find out if your child is allergic to cows' milk?

Diagnosing CMA can take a lot of investigation. Your child's symptoms, medical history and overall assessment will be taken into account, along with any test results when determining if your child has a food allergy.

How will the Doctor confirm the diagnosis?

Your child's Doctor will use all of the information that you provide to help decide whether allergy tests are required. Allergy tests can be performed on the skin or the Doctor may suggest a blood test, in some children they do both skin and blood tests. Some allergies can't be picked up using blood or skin prick tests, these allergies require a specific diet to aid the diagnosis of the allergy. 

Allergy testing can involve:

Skin tests are often the starting point because they are quick to do. If your child has an immediate reaction after eating, skin or blood tests are much more likely to be positive. If the symptoms of the allergy typically appear hours or even a day or two later, then it may not show on skin or blood tests. Of course, this type of allergy test is just one part of the diagnosis process – sometimes the results (both positive or negative) can be wrong. That means that your child can show allergy symptoms in spite of the test saying he or she is not allergic.

Skin Prick Tests are especially accurate in testing for cows’ milk allergy. Small drops of cow’s milk (or other foods which are suspected) are placed on the child’s forearm. A small prick is made through each drop into the skin. If the child’s skin becomes red and itchy, it usually means that he or she is allergic to that particular food. This is called a positive reaction. If no reaction is shown in the test, there is still a chance your child has a food allergy. This can happen if your child shows a delayed reaction after food intake, a so-called non-IgE reaction.

Skin Prick Tests are quick. So they are often used as first tests to find which foods cause reactions. Once the allergens are identified, some doctors may perform more specific tests (these are known to doctors as Specific IgE tests or RAST test).

Specific IgE tests are blood tests that can measure the concentration of specific antibodies in your child’s blood. These antibodies are called IgE. IgE levels in the blood are often higher in children who have allergies or asthma. If the test is negative, it is still possible that your child has a food allergy, but in this case it is known as a non-IgE or delayed reaction.

If allergic reactions happen hours or days after the food is eaten. These diets may require elimination of certain foods or specific food challenges.

An elimination diet may be recommended by your child’s Doctor or Dietitian in order to prove that your child reacts to foods such as cows’ milk, eggs, wheat, or soya. With the results from this elimination diet, the medical history of your child, (blood tests - not always required) as well as the food and symptom diary, your Doctor will have more to work on when trying to reach a diagnosis.

How elimination diets work

Under the strict supervision of your child’s Doctor or Dietitian, the food suspected to cause the trouble will be eliminated from your baby’s diet e.g. cow's milk for about two to six weeks. It is important that you avoid all foods that contain the relevant trigger; your child’s Doctor or Dietitian will give you precise instructions on how to do this. To feed your child adequately during an elimination diet, a special cows’ milk protein-free infant formula is likely to be prescribed. This may be an extensively hydrolysed formula (eHF) or an amino acid-based formula (AAF).

Following an elimination diet your child’s Doctor or Dietitian will encourage you to undertake a ‘food challenge’ if they still need to confirm a diagnosis. This occurs in non-IgE or delayed reaction allergies.

If your child is suspected of having a Cow's Milk Allergy and symptoms improved or resolved when cow's milk was removed from your child'd diet, if you then reintroduce cow's milk and your child has a reaction this confirms the diagnosis. Ensure you always follow the advice of your Doctor or Dietitian.

Other food challenges may occur if your Doctor or Dietitian suspects that your child may have outgrown their allergy or they are no longer as sensitive e.g. they can tolerate a very small amount of the allergen or they can tolerate the allergen in a different form e.g. a baked cake that contains milk.

What can you expect?

If you are doing a food challenge to see if your child is still allergic, very small amounts of an allergen may be given onto the juices, pureed foods or cooked dishes depending on the age of the child. Depending on the severity of your child's allergy depends on where and how the food challenge is conducted. It may be in a hospital, in a Doctor's clinic or at home with advice provided by your Doctor or Dietitian.

Important note

Challenge tests should be supervised by your child’s doctor or dietitian and are best conducted in a clinic or hospital setting with qualified personnel and equipment. Always follow your Doctor or Dietitian's advice when completing a food challenge.

With the information from your child’s medical background, symptoms and allergy testing, you and your child’s doctor will be able to develop a plan to manage the symptoms.

Preparing for your Doctor’s appointment

When it comes to diagnosing allergies, your child’s medical history may be as important as any diagnostic test results. So do make a note of any information about your family’s medical history as well as the medical history of your child before visiting the Doctor.

Identifying the symptoms is the first step in providing relief for your baby. So the more you tell your doctor, the better. You may find it helpful to take photos of rashes or swelling to be able to show your Doctor. Remember some of the symptoms of allergies are common symptoms for babies and toddlers, but if you notice things that are out of the ordinary for your child make a note of this too.

Make a note of any questions you would like to ask the Doctor

There is a lot to cover at the Doctor’s appointment so it’s a good idea to make a note of any questions you might like to ask so you don’t forget.

  • Could my child’s symptoms be caused by a food allergy?
  • Is it possible to confirm if my child has a food allergy?
  • Which tests will have to be performed?
  • Do I need to see a specialist?
  • What will be the next steps?

  • How old was your child when you first noticed the symptoms?
  • How quickly do symptoms develop after eating?
  • How severe are the symptoms?
  • How long do the symptoms last? e.g. minutes, hours, days.
  • How often do they happen? e.g. daily, weekly.
  • Where do symptoms usually appear? e.g. at home, or at school?
  • Do the same symptoms happen each time your child eats a particular food?
  • Do you suspect a specific food is involved – if so, how much of the suspected food does your child need to eat for symptoms to appear?

Keep a Diary

Why not keep a diary to see how different foods affect your child?

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BREAST MILK IS BEST FOR BABIES. Any decision to introduce a formula feed should be made following discussions with your Healthcare Professional, after consideration of all feeding options, including breastfeeding.