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Cow’s Milk Protein Allergy (CMPA)

CMPA is an abnormal reaction that occurs when our body is exposed to cow’s milk protein. This reaction is caused by our immune system and affects multiple sites in our body : eg. Skin, lungs, intestine.

CMPA is different from lactose intolerance. Lactose intolerence occurs when our intestine is unable to digest lactose, which is a type of sugar contained in milk.

Cow’s milk is the most common breast milk substitute. It is not surprising therefore, that it is also one of the more common causes of allergies in infants. Most of these infants with CMPA will recover by 3 to 4 years old.

However, the following infants have a higher risk for developing persistent CMPA :

  • There are other family members with allergic conditions.
  • The infant also has other concurrent allergic conditions (eg. Eczema, asthma, rhinitis).

Common symptoms of CMPA

  1. Skin :

    • Eczema – dry skin, rash, itching. Usually at the neck, cheeks, front of elbow and behind the knees.
    • Swelling of lips, face and eyes, associated with rash and itching (hives). These occur immediately or shortly after ingestion of cow’s milk.
  2. Lungs
    • Difficulty in breathing, noisy breathing (wheezing).
  3. Intestine
    • Diarrhoea.
    • Vomiting.
    • Blood in stools.

Complications and Warning Signs of CMPA

If your child experiences the following symptoms : difficulty in breathing, becoming pale or blue, swelling of lips or tongue or fainting, he/she may be experiencing an “anaphylaxis shock”. This condition is life-threatening, and you should seek urgent medical treatment for your child.

Growth failure can be a complication of CMPA – your child’s weight gain may be very slow; or sometimes there is no weight gain at all.


The best way to avoid CMPA is exclusive breastfeeding which is recommended for the first 6 months.

If you suspect your child to have CMPA, you should consult a doctor before attempting any treatment (eg. change of formula). This is because there are many other conditions that may cause the symptoms listed above.

If your child is allergic to cow’s milk, it is often that he is also allergic to goat’s milk protein or soy protein. Therefore, infants with CMPA require special formulas, which should only be started after consulting a doctor.

Soy-based infant formulas are not recommended for children less than 6 months old.

Last Reviewed : 28 August 2020
Writer : Dr. Alvin Khoh Kim Mun
Reviewer : Dr. Zainab bt. Kusiar