Children < 1 year fed with regular cow’s milk formula and suspected severe CMPA Immediate reactions: Laryngeal edema Acute asthma with severe respiratory distress Anaphylaxis Late reactions: Chronic diarrhoea,chronic vomiting, food refusal,with poor growth Bloody stools with iron deficiency anaemia Protido-losing enteropathy with hypoalbuminemia Eosinophilic esophagogastroenteropathy confirmed by biopsy Infants should be referred to a specialized clinic. SPT and/or specific IgE should be performed Elimination diet: soy (if >6 months) or extensively hydrolyzed formula or amino acid formula (for 2 wks then continue with soy or extensively hydrolyzed formula) *. Cow’s milk challenge test in a clinical setting after 12 months of age and not before 6-12 months from the reaction. *Introduce extensively hydrolyzed formula or soy under medical supervision. Amino acid formula should be given if this is not feasible. Extensively hydrolised formula or amino acid formula. In case of poor growth, anaemia, hypoabuminemia: elimination diet for 10 days-6 weeks with amino acid formula (to switch to extensively hydrolyzed formula). Improves ? No Yes Regular cow’s milk formula Cow’s milk challenge test after 6-12 months of avoidance and 1year of age in a clinical setting.