Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website http://www.theijcp.org

Case Report

Volume 9, Number 3, September 2020, pages 98-102

Challenges and Pitfalls in the Diagnosis and Management of Non-IgE Cow’s Milk Protein Allergy: Two Cases

Tables

**Table 1.** Common Gastrointestinal Symptoms/Signs of Non-IgE CMPA in the First Year of Life
Mild to moderate symptoms/signs	Severe symptoms/signs
CMPA: cow’s milk protein allergy.
Irritability, vomiting, food refusal or aversion, diarrhea, constipation, abdominal discomfort, painful flatus, blood and/or mucus in stools in an otherwise well infant.	Diarrhea, vomiting, abdominal pain, food refusal or food aversion, significant blood and/or mucus in stools, irregular or uncomfortable stools, with or without faltering growth, pallor, lethargy, hypotonia, hypovolemia, hypotension, hypoalbuminemia, failure to thrive.

**Table 2.** Therapeutic Formula Options for Signs and Symptoms Relating to Food Allergy or Intolerance
Signs and Symptoms	Australia [10]		DRACMA [11]		ESPGHAN [12]
Signs and Symptoms	First choice	Second choice	First choice	Second choice	First choice	Second choice
^aIf infant is older than 6 months. Adapted from Reference [8], ©2017 by the author. CMPA: cow’s milk protein allergy; AAF: amino acid formula; DRACMA: Diagnosis and Rationale for Action against Cow’s Milk Allergy; eHF: extensively hydrolyzed formula; Eos eso: eosinophilic esophagitis; ESPGHAN: European Society for Pediatric Gastroenterology, Hepatology and Nutrition; FA: food allergy; FPIAP: food protein-induced allergic proctocolitis; FPIES: food protein-induced enterocolitis syndrome.
FPIAP	eHF	AAF			eHF	AAF
FPIES	eHF	AAF	eHF	AAF	eHF	AAF
Eos eso	AAF		AAF		AAF
Immediate FA	eHF/soy^a	AAF/eHF	eHF	AAF/soy	eHF	AAF
Atopic eczema	eHF/soy^a	AAF/eHF	eHF	AAF/soy	eHF	AAF
Urticaria			eHF	AAF/soy	eHF	AAF
Constipation due to suspected CMPA			eHF	AAF
Heiner syndrome			AAF	eHF
Gastrointestinal syndromes related to suspected CMPA	eHF/soy^a	AAF/eHF	eHF	AAF	eHF	AAF