Cow's milk protein allergy, assessed properly, first time.

Prices vary by consultant, by whether component-resolved testing is added, and by whether a supervised oral food challenge is booked. We come back with a firm quote within one working day.

1. 01

   Before

   You send us the feeding and symptom history

   A short, confidential form. Breast or formula, symptom timing, GI and skin picture, family history of atopy, growth chart if you have one.

2. 02

   Before

   We come back with a recommendation

   Within one working day: which allergist and dietitian fit, whether skin-prick and specific IgE are needed, and an indicative price. An honest read either way.

3. 03

   Before

   We arrange the clinic

   Usually within one to two weeks. A 60 minute paediatric allergy consult, plus a 45 minute specialist dietitian slot for elimination and calcium planning.

4. 04

   In clinic

   Assessment and testing

   History, growth review, SCORAD for eczema, skin-prick testing and specific IgE bloods if IgE-mediated suspected. Non-IgE cases are diagnosed by elimination.

5. 05

   In clinic

   The elimination plan

   Breastfeeding mothers exclude dairy (and soy for 4-6 weeks) with calcium and vitamin D 1200 mg/day. Formula-fed infants switch to EHF, or AAF if severe.

6. 06

   In clinic

   Home the same day

   A written elimination plan, formula prescription request for your GP, weaning advice, and a symptom diary for the reintroduction.

7. 07

   After

   Supervised reintroduction and milk ladder

   At 12 to 18 months a supervised reintroduction (open OFC in clinic for IgE-mediated) and the baked-milk ladder at home over 3-6 months.

• Immediate reactions after milk (IgE-mediated)

  Urticaria, angioedema, vomiting, wheeze or anaphylaxis within 30 minutes of a milk feed - skin-prick and specific IgE positive.

• Delayed GI symptoms (non-IgE-mediated)

  Colic, reflux, vomiting, diarrhoea or constipation, blood or mucus in the stool 2 to 72 hours after milk. SPT and IgE are negative.

• Faltering growth on formula

  A formula-fed infant crossing centiles downwards with GI or skin symptoms deserves a proper CMPA assessment, not a further formula switch.

• Moderate to severe infant eczema

  Eczema before 3 months, or moderate-to-severe eczema not responding to emollients and topical steroids, may be driven by CMPA.

• Blood or mucus in the nappy

  Allergic proctocolitis is the classic non-IgE presentation in a well-looking, breastfed baby. Elimination in the mother resolves it within 2-4 weeks.

• Chronic reflux not settling on PPI

  Persistent vomiting or reflux in a baby with eczema, blood in stool or family atopy - think CMPA before escalating acid suppression.

• Family history of atopy

  Parent or sibling with asthma, eczema, hay fever or food allergy raises baseline risk - a structured allergy assessment is worthwhile.

• Red flag: anaphylaxis or FPIES

  Any collapse, breathing difficulty or profuse repetitive vomiting 1-4 hours after milk needs 999 and a specialist referral, not a private waiting list.

• Elimination diets need a dietitian

  Unsupervised maternal or infant elimination risks calcium, iodine and protein deficiency. Every case in our network is planned with a specialist paediatric dietitian.

• Growth monitoring is non-negotiable

  Weight, length and head circumference plotted at every review. Any downward centile crossing prompts an urgent AAF trial and dietitian input.

• The atopic march

  CMPA infants have a higher risk of eczema, asthma and other food allergies. We screen for these and introduce peanut early (4-11 months) per LEAP high-risk guidance.

• Anaphylaxis planning

  IgE-mediated CMPA gets a written BSACI action plan, adrenaline auto-injectors when indicated, and training for parents and nursery staff before discharge.

• Reintroduction is where reactions happen

  Baked milk at home is safe for non-IgE CMPA; supervised OFC in clinic is safer for IgE-mediated. Do not skip steps or bring reintroduction forward without your allergist.

• Calcium and vitamin D matter

  A milk-free infant or exclusively breastfeeding mother on dairy exclusion needs 1200 mg calcium and 10 micrograms vitamin D daily - checked at every review.

• Most children outgrow CMPA

  50-80% of IgE-mediated CMPA is outgrown by age 5. Most non-IgE CMPA is outgrown by 2-3 years. Annual retesting of SPT and specific IgE guides the ladder.

• Red flags after discharge

  Repeated vomiting, breathing difficulty, sudden pallor or floppiness after a milk exposure - use the action plan, give adrenaline if prescribed, and call 999.