We believe breast milk is the best food for infants. When in consultation with their healthcare professional, mothers and families find that optimal breastfeeding is not possible due to their infant’s medical condition, formulas for special medical purposes play a vital role in providing essential nutrients to infants. We have a global commitment to market breast-milk substitutes responsibly.
This website is about the management of cow’s milk protein allergy and nutritional solutions intended for infants. By continuing on this website, you accept that Nestlé supplies the information at your own request.
Are you a healthcare professional or a parent ?
The following content is restricted for healthcare professional only. You will be redirected.
The following content is restricted for healthcare professional only. You will be redirected.

Key facts about cow’s milk protein allergy (CMPA)

Food allergy or non-allergic food hypersensitivity

Top 8 food allergens

Non-allergic food hypersensitivities, such as intolerances, result from the inability to digest certain components of foods i.e. lactose or fructose, or, less commonly, food coloring, additives or preservatives. Non-allergic food hypersensitivities do not involve the immune system and are much more common than food allergies.


Food allergies arise through an immunological reaction to certain allergens in food. These allergens are almost always proteins. Other components in food, such as lactose and other carbohydrates, do not commonly act as allergens.


Certain allergens cause more reactions than others. Here are the eight most common allergens accounting for approximately 90 percent of all allergic reactions to food in children.1


Allergy is on the increase among infants and young children.2

Cow’s milk protein allergy

CMPA is one of the most common food allergies in the first year of life. It occurs when an infant’s immune system reacts abnormally to the proteins in cow’s milk, which are either transferred from the mother while breastfeeding or from cow’s milk protein-containing formulas and complementary food. The immune reaction may be immunoglobulin (Ig)E-mediated, non-IgE-mediated, or mixed. The reactions can be immediate (early) reactions, occurring from minutes to hours after exposure, and/or delayed (late) reactions, which can manifest 48 hours or even a week following ingestion. Immediate reactions are more likely to involve IgE, but combinations of immediate and delayed reactions can occur in some infants.

Lactose intolerance

Lactose intolerance results from a decreased ability to digest and absorb lactose (the sugar present in milk) due to a lack of the enzyme lactase. It is very rare in infants younger than 5 years,3 even in those with CMPA. Breast milk naturally contains a high amount of lactose, which is beneficial for healthy infant growth and development.2


Lactose intolerance

3% of infants ≤1 year 2,7

Very rare in children ≤5 years3

65% of people globally have lactose intolerance in adulthood8

Importance of lactose for gut microbiota

Lactose is a disaccharide comprising glucose and galactose.3 As a key component of breast milk, lactose is important for healthy growth and development, providing energy and supporting the absorption of calcium. Lactose inhibits putrefactive bacteria and promotes the development of healthy gut microbiota.4 Therefore, lactose should not be eliminated from the infant’s diet.


Lactose also has another important benefit: it improves the flavor of specialty formulas. The pleasant taste and aroma of lactose contributes toward improved acceptance of extensively hydrolyzed formulas (eHFs) intended for the management of CMPA in infants. This reinforces the need for lactose in the infant’s diet.

Incidence and prevalence of CMPA
% of infants outgrowing CMPA from 1 year onwards

Prospective cohort studies in Europe suggest a 10-year prevalence of 1.9% to 4.9% for CMPA in infancy.5 The results of a meta-analysis of 229 articles published between 1967 and 2001 support this, with incidence rates of CMPA shown to be between 2% and 3% in infants less than 1 year old.6

The majority of children outgrow CMPA: 60–75% children outgrow CMPA by 2 years, this increases to 85–90% before the age of 3. The incidence of CMPA is just 1% among 5-year-old children.6

Signs & Symptoms of cow’s milk protein allergy

The non-specific signs and symptoms of CMPA, ranging from colic and reflux to constipation, insomnia, eczema, diarrhea and crying, make diagnosis a real challenge. The symptoms involve many different organ systems, predominantly the skin and the gastrointestinal and respiratory tracts. The involvement of two or more organ systems increases the likelihood of CMPA.

Digestive symptoms of cow’s milk protein allergy



Prevalence of digestive symptoms

Up to 60% of affected infants have digestive symptoms.

Respiratory symptoms of cow’s milk protein allergy



Prevalence of respiratory symptoms

Up to 30% of affected infants have respiratory symptoms.

Skin-related symptoms of cow’s milk protein allergy



Prevalence of skin-related symptoms

Up to 70% of affected infants have skin-related symptoms.

General symptoms of cow’s milk protein allergy




Inconsolable crying is very common in infants with CMPA, while anaphylaxis is very rare.

Diagnosis of CMPA should always be made by a healthcare professional



  1. US FDA. Food Allergies: What You Need to Know. Available at: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm079311.htm (accessed Jan 2017).
  2. Koletzko S, et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN Gl Committee Practical Guidelines. JPGN. 2012;55:221–9.
  3. Heyman MB, et al. Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118(3):1279–86.
  4. Francavilla R, et al. Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy. Pediatr Allergy Immunol. 2012;23(5):420–7.
  5. Prescott SL, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J. 2013;6(1):21.
  6. Høst A. Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol. 1994;5:1–36.
  7. NIH. https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics (accessed February 2017).
  8. NIH. Lactose intolerance. Available at: https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics (accessed February 2017).
IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.