For healthcare professionals only.
This formulary decision guide was developed from content provided by Mead Johnson Nutrition in a format developed by Guidelines in Practice.
- For the dietary management of infants with severe CMA, multiple food allergies, failure to respond to an eHF, or other indications requiring an elemental diet
- Nutritionally complete from birth to 6 months, and as part of a varied diet from 6 months onwards.
Tins per month
See tin label for detailed feeding guidance; HCP to determine the formula intake based on the individual situation
Preparation and storage
- Wash hands thoroughly and sterilise bottles, teats, caps, and utensils
- Boil fresh water; leave to cool for 30 minutes prior to mixing; do not use softened water
- Feed immediately or cover and store in a refrigerator at 2–4°C for ≤24 hours
- Store tin in a cool, dry place; after opening, keep tightly covered and use within 1 month.
- Do not freeze prepared formula and do not use if unrefrigerated for >2 hours
- Use formula that has been in contact with baby’s mouth within 1 hour and do not refrigerate
- Do not heat prepared formula in a microwave.
- CMA is an adverse immune reaction to cow’s milk protein presenting with immediate and/or delayed symptoms2,9
- CMA is the most common childhood food allergy affecting 2-7.5% of infants9
- Quality of life is profoundly reduced for patients with CMA and their families10
- For formula-fed infants, management comprises avoidance of cow’s milk and use of suitable hypoallergenic formulas.2
- Expert guidelines recommend AAFs for formula-fed infants with severe CMA, multiple food allergies, or when an eHF is ineffective as initial treatment for mild-to-moderate CMA1,2
- A critical expert review suggests that AAF is also warranted in the following conditions:11
- failure on an eHF
- eosinophilic oesophagitis
- faltering growth (particularly with GI tract/skin involvement and multiple food eliminations)
Evidence for use
- Nutramigen* PURAMINO* has proven efficacy in infants with severe CMA and multiple food allergies;3 it is:
- MCT oil (33%[D]) provides an easily available source of fats and energy in case of fat malabsorption:4,5
- increased MCT supply is important in patients with disturbances in digestion and absorption (e.g. SBS)12
- the balance of MCTs and LCTs is expected to provide fast energy absorption, while also stimulating gut adaptation.12,13
- Not recommended for premature babies unless directed and supervised by an HCP.
Order and contact information
UK pharmacy PIP order code
New NHS price
Nutramigen* PURAMINO* 400g
If you have any questions or comments, please call the Mead Johnson Careline +44 (0)1895 230575.
- Fox A, Brown T, Walsh J et al. An update to the milk allergy in primary care guideline. Clinical and translational allergy 2019; 9 (1): 1–7.
- Luyt D, Ball H, Makwana M et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy 2014; 44 (5): 642–672.
- Burks W, Jones S, Berseth C et al. Hypoallergenicity and effects on growth and tolerance of a new amino acid-based formula with docosahexaenoic acid and arachidonic acid J Pediatr 2008; 153 (2): 266–271.
- Bach AC, Babayan VK. Medium-chain triglycerides: an update. Am J Clin Nutr. 1982 Nov; 36 (5): 950-62
- Akoh CC (editor). Handbook of functional lipids. Boca Raton, FL. CRC Press 2005: p177.
- Birch EE, Carlson SE, et al. The DIAMOND (DHA Intake And Measurement Of Neural Development) Study: a double-masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid. Am J Clin Nutr. 2010 Apr; 91 (4): 848-59.
- Morale SE, Hoffman DR, et al. Duration of long-chain polyunsaturated fatty acids availability in the diet and visual acuity. Early Hum Dev. 2005 Feb; 81 (2): 197-203.
- Scientific opinion. DHA and ARA and visual development. EFSA J 2009;941:1–14 Available at: onlinelibrary.wiley.com/doi/pdfdirect/10.2903/j.efsa.2009.941
- Vandenplas Y, Brueton M, Dupont C et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants Arch Dis Child 2007; 92 (10): 902–908.
- Cummings A, Knibb R, King R, Lucas J. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review Allergy 2010; 65 (8): 933–945.
- Meyer R, Groetch M, Venter C. When should infants with cow’s milk protein allergy use an amino acid formula? A practical guide. J Allergy Clin Immunol Pract 2018; 6 (2): 383–399.
- Los-Rycharska E, Kieraszewicz Z, Czerwionka-Szaflarska M. Medium chain triglycerides (MCT) formulas in paediatric and allergological practice Prz Gastroenterol 2016; 11 (4): 226–231.
- Shaw V (editor). Clinical Paediatric Dietetics. 2014; John Wiley & Sons. Available at: onlinelibrary.wiley.com/doi/book/10.1002/9781118915349
*Trademark of Mead Johnson & Company, LLC. © 2020 Mead Johnson & Company, LLC. All rights reserved. Mead Johnson Nutrition is a company of Reckitt Benckiser.
Important notice: Breastfeeding provides the best nutrition for babies.
Date of preparation: October 2020