Register
Open Search
Open Menu

Diagnostic Elimination Diet and Food Reintroduction/Challenge

The elimination of the implicated food/s (elimination diet) followed by a challenge to the food/s is considered the gold standard method to establish if a child has CMPA or not.

The elimination of food/s that appear to trigger the allergic reaction is followed by the food challenge, or the reintroduction of those food/s back into the child’s diet (or mum’s diet if breastfeeding), while monitoring the symptoms.

The food challenge helps to confirm if the reaction is allergic in nature. It is used in practice when the IgE tests and/or the reaction history is not 100% clear, or when you want to determine if a child has outgrown their food allergy.

How it Works

Elimination Diet

Diagnostic Elimination Diet 2-6 weeks

The elimination diet is as intuitive as it sounds – cow’s milk protein (CMP) (all sources) is completely eliminated from the infant’s diet for 2-6 weeks. This includes eliminating CMP (all sources) from the mother’s diet, if they are breastfeeding.

If, after the elimination period, the symptoms do not improve, you can be confident that CMPA is highly unlikely. If symptoms do improve, an oral food challenge is usually performed. This is when CMP-based foods are re-introduced, in a controlled way, into the child’s diet to confirm the diagnosis of CMPA.

Once CMPA has been confirmed, a therapeutic elimination diet entirely free from CMP (dairy) will be required. Ideally this should be supervised by a clinically trained specialist dietician/nutritionist.

The specialist dietician/nutritionist is advised to provide the parent/caregiver with as much information as possible. This might include, for example, a complete list of the foods containing the proteins the child should avoid, or mum needs to avoid if breastfeeding. A symptom tracking chart or daily diary is also helpful, enabling the parent/caregiver to monitor symptoms while the child is on the elimination diet.

Serum Specifc IgE Test Serum Specifc IgE Test Skin Prick Test (SPT) Skin Prick Test (SPT) GOLD STANDARD Diagnostic Elimination Diet and Food Reintroduction/Challenge Diagnostic Elimination Diet and Food Reintroduction/Challenge
IgE-mediated CMPA check check check
non-IgE-mediated CMPA wrong wrong check

Guidelines for Diagnosis and Management of CMPA

You can find more detailed information about the diagnosis and management of CMPA in the different Guidelines that have been published including:

The Management Plan Next Up: The Management Plan

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their infants 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 give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect dilution can all lead to illness. Formula for special medical purposes intended for infants must be used under medical supervision.

© 2025 Nestlé Health Science All rights reserved.