Table 1: Common clinical presentations related to CMA.

Clinical Condition Onset Mediation Severity System Clinical Presentation/Symptoms
Anaphylaxis Immediate IgE-mediated Severe Multisystemic A systemic response affecting several organs. Difficulty breathing, coughing, wheezing, severe distress, pallor, itchiness, hives, vomiting, floppiness and/or collapse15; can be fatal16
Rhinitis, asthma, wheezing, and laryngeal edema Minutes -1 hour [14] IgE-mediated [14] Mild-severe Respiratory [14] Various conditions that lead to respiratory distress [14]
Heiner syndrome Days [17] Non-IgE-mediated Severe Respiratory Chronic/recurrent upper and lower respiratory tract infection, pulmonary hemorrhage [18]; typically misdiagnosed with pulmonary bronchopneumonia and pulmonary hemosiderosis
Acute urticaria and angioedema Immediate (up to 60 min) [15] IgE-mediated Mild-moderate Integumentary
(skin)
Urticaria (lesions characterized by polymorphic, round, irregular-shaped pruritic wheals), angioedema; non-pitting, non-pruritic, well-defined edematous swelling involving subcutaneous tissues such as face, genitals, buttocks, and hands [16]
Atopic dermatitis (atopic eczema) Min/hours/days [15] Mixed1 Mild-moderate Integumentary
(skin)
Impaired skin barrier function (urticarial lesions, itching, eczematous flares) due to a combination of genetic predisposition and exposure to allergenic triggers [16, 19, 20]
Allergic contact dermatitis Min/hours/days1 Mixed1 Mild-moderate Integumentary
(skin)
Eczema, pruritus, erythema, papules, vesicles, edema [16]
Immediate GI hypersensitivity (acute immediate nausea, pain, vomiting, and diarrhea) [13] Immediate IgE-mediated Mild-severe GI Typically, a secondary manifestation of anaphylaxis[16]
Eosinophilic gastroenteritis (EoG) Min/hours/days Mixed Severe GI Pathological infiltration of eosinophils into one or more segments of the GI tract[16]
Eosinophilic esophagitis (EoE) Days[15] Mixed Severe GI Feeding disorder, vomiting, reflux, abdominal pain, abnormal histology in the esophagus (eosinophilic inflammation)[15], swallowing difficulty, poor weight gain[14]
Food protein-induced allergic-proctocolitis (FPIAP) Hours/days [15] Non-IgE-mediated Mild-moderate GI Found in exclusively breastfed infants. Caused by food proteins from the maternal diet.[21] Visible specks of blood mixed with mucus in the stool; non-systemic (absence of vomiting, diarrhea, and growth failure)[16]; eosinophilic inflammation of the lower GI tract can be a common occurrence[1, 22]
Food protein-induced enterocolitis syndrome (FPIES) 2-4 hours (typically) [15] Non-IgE-mediated Severe GI Profuse vomiting, +/− diarrhea, sudden onset of pallor and floppiness, 20% present as hypovolemic shock (with associated metabolic acidosis and methemoglobinemia), failure to thrive (FTT)[15, 16]
CMP-induced gastroesophageal reflux disease (GERD) Hours/days[15] Mixed [23] Mild-moderate GI Constant regurgitation, poor feeding, refusal to eat[15]
CMP-induced enteropathy/food protein-induced enteropathy (FPE) Hours/days Non-IgE-mediated Severe GI Vomiting, diarrhea, severe irritability, FTT, iron deficiency anemia, protein losing enteropathy[15]
Colic Hours/days[15] Non-IgE-mediated[24] Mild-moderate GI Paroxysms of unexplained, inconsolable crying[15]
Constipation Hours/days[15] Non-IgE-mediated[24] Mild-moderate GI Passage of infrequent and/or hard stools[15]

Need urgent referral (medical attention).