Free, independent CPD for Irish doctors by Irish doctors

Cow’s Milk Protein Allergy in Primary Care

By

• Professor Juan Trujillo
• Dr Alice O’Neill

Reviewed by: Priscilla lynch

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About this Module

Cow’s milk protein allergy (CMPA) represents one of the most frequent clinical challenges encountered in primary care, affecting approximately 2-to-3 per cent of infants and young children across Europe. CMPA usually presents before six months of age and may resolve spontaneously in childhood. However, research increasingly shows that the rates of resolution are slowing down, meaning that the allergy can persist into adulthood. Prolonged allergen avoidance and persistent dietary restriction of cow’s milk can have significant long-term health and psychological implications.

As front-line clinicians, GPs play a pivotal role in distinguishing true immunological hypersensitivities from ubiquitous, transient functional gastrointestinal symptoms. Early identification and accurate management are paramount not only to prevent acute, potentially life-threatening allergic reactions, but also to protect infant growth trajectories, preserve feeding behaviours, and alleviate severe family distress.

Primary Learning Objectives

1. Early Identification and Impact Recognition: Understand the physiological and psychosocial consequences of delayed or inaccurate diagnosis, including growth faltering, feeding aversion, and parental burnout.
2. Clinical Differentiation: Distinguish between IgE-mediated and non-IgE-mediated CMPA presentations, while differentiating CMPA from functional paediatric disorders such as gastro-oesophageal reflux disease (GORD), infantile colic, and lactose intolerance.
3. Guideline-Aligned Diagnostic Pathways: Implement structured trial elimination and reintroduction protocols aligned with the iMAP pathway in both breastfed and formula-fed infants.
4. Dietary Management of CMPA: Navigate management of CMPA in exclusively breastfed infants, formula-fed infants, and weaning children. Apply evidence-based indications for maternal elimination diets, safeguarding maternal nutrition, and supporting continued lactation. Understand the clinical indications for Extensively Hydrolysed Formulas (EHFs) and the precise criteria for prescribing of Amino Acid Formulas (AAFs).
5. Nutritional Monitoring and Weaning: Monitor anthropometric parameters effectively, mitigate micronutrient and macronutrient deficiency risks, and guide early allergen introduction and diet diversity to optimise long-term allergic tolerance.

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Module Steps

To earn CME credit, follow these steps:

• Study the educational content.
• Complete the 5 MCQs that follow the case study. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. These questions are part of the educational content and are designed to challenge you. You will not be penalised for answering the questions incorrectly.
• Complete the 10 True or False questions in the Post-Module Assessment. These questions are designed to demonstrate that the module has improved your knowledge base on this topic.
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• By providing information on how the module has enhanced your knowledge and/or practice, you may qualify for additional CPD credits during a CPD review.
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Each DoctorCPD module is designed to be completed within the time designated on the Module Introduction page. This is an estimate of the maximum time required to complete the specific module and is determined by the format and content of the module. Users should claim only those credits that reflect the time actually spent on the activity.

To successfully earn credit, participants must complete the activity online, and receive a minimum score of 70% on the post-module assessment.