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CMPA – extensively hydrolysed formula — RACP Paediatrics MCQ

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ModerateNeonatalCMPA – extensively hydrolysed formulaRACP Paediatrics

A 4-month-old formula-fed infant has confirmed IgE-mediated cow's milk protein allergy (positive skin prick test, immediate urticaria and vomiting with CMP exposure). What is the most appropriate formula?

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Correct answer: D — Extensively hydrolysed formula

For IgE-mediated CMPA, an extensively hydrolysed formula (eHF) is first-line. ~90% of infants with CMPA tolerate eHF. Amino acid formula (AAF) is reserved for those who react to eHF (~10%), severe CMPA (anaphylaxis), or severe non-IgE CMPA (e.g., FPIES). Soy formula can be considered from 6 months but cross-reactivity occurs in 10-15%.

Reference: RCH Melbourne – 2023 – CMPA CPG; ASCIA – 2024