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Table 1 Guidance on formula choice

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

Clinical presentation DRACMA 1stChoice (Fiocchi et al[2]) ESPGHAN 1stChoice (Koletzko et al[7]) USA 1st Choice (Boyce et al[10], Bahtia et al[22] American Academy of Pediatrics[25]) AUSTRALIAN Consensus Panel 1stChoice (Allen et al[11])
Anaphylaxis AAF AAF No recommendation AAF
Acute urticaria or angioedema eHF No specific mention but eHF in general as 1st line treatment for CMA apart from specific indications for AAF No recommendation eHF if < 6 months
Soya if > 6 months
Atopic eczema/dermatitis eHF No specific mention but eHF in general as 1st line treatment No recommendation eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Immediate gastrointestinal allergy eHF No specific mention but eHF in general as 1st line treatment No recommendation eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Allergic eosinophilic oesophagitis AAF AAF (as well as other eosinophilic disorders of the gut) AAF/hypoallergenic formula (NIAID) AAF
Gastroesophageal reflux disease (GORD) eHF No specific mention but eHF in general as 1st line treatment No recommendation eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Cow’s milk protein-induced enteropathy eHF (Severe enteropathy complicated by faltering growth and hypoprotenemia) AAF eHF/AAF eHF if < 6 months
Soya if > 6 months
eHF if >6 if also presenting with faltering growth
Food protein-induced enterocolitis syndrome (FPIES) eHF AAF Hypoallergenic formula (NIAID) eHF/AAF eHF
CM protein-induced gastroenteritis and proctocolitis eHF No specific mention but eHF in general as 1st line treatment   Gastro-enteritis:
eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Proctitis: eHF
Severe irritability (colic) eHF No specific mention but eHF in general as 1st line treatment Hypoallergenic formula eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Constipation/Diarrhoea eHF No specific mention but eHF in general as 1st line treatment No recommendation eHF if < 6 months
Soya if > 6 months
eHF if >6 months if also presenting with faltering growth
Milk-induced chronic pulmonary disease (Heiner’s syndrome) AAF No recommendation No recommendation No recommendation
Faltering growth No recommendation AAF (particularly presenting with enterocolitis complicated by hypoprotenemia and anaemia) No recommendation See with other conditions – but defaults to eHF
Breast fed infants – not responding on maternal milk avoidance No recommendation AAF “alternative formulas” eHF/AAF No recommendation
Multiple food allergies No recommendation eHF/AAF No recommendation No recommendation
Severe atopic eczema/dermatitis No recommendation AAF (particularly if presenting with faltering growth complicated by hypoprotenemia and anaemia) No recommendation No recommendation