Information intended for healthcare professionals only.

This formulary decision guide was developed from content provided by Mead Johnson Nutrition Ltd in a format developed by Guidelines in Practice.

Key points

Puramino FDG image final

  • Cow’s milk allergy (CMA) is a common yet complex food allergy, seen in early childhood, with mild to moderate or severe presentation1
  • Clinical guidelines recommend an amino acid formula (AAF) in formula-fed infants with severe CMA, multiple food allergies, or when an eHF is ineffective1­,2
  • Nutramigen PURAMINO is an AAF with medium chain triglyceride (MCT) oil (33%*), which provides an easily available source of fats and energy in case of fat malabsorption:3
    • it has proven efficacy in infants with severe CMA and multiple food allergies, supporting normal growth, with no allergic reactions or adverse events.‡ 4

Click here to download a PDF of the formulary decision guide


Product name

Nutramigen™ PURAMINO™


  • 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.

Feeding guide

AgeTins per month 
0–6 months 9–10
6–12 months  6–8 
≥1 year  6–8 

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 water5
  • 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.

About CMA

  • CMA is an adverse immune reaction to cow’s milk protein presenting with immediate and delayed symptoms2,6
  • CMA is the most common childhood food allergy affecting 1.9–4.9% of infants1,7
  • Quality of life is profoundly reduced for patients with CMA and their families8
  • Management of CMA comprises avoidance of cow’s milk and use of suitable hypoallergenic formulas.2

Guideline recommendations

  • 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:9
    • failure on an eHF
    • eosinophilic oesophagitis
    • faltering growth (particularly with GI tract/skin involvement and multiple food eliminations)
    • anaphylaxis.

Evidence for use

  • Nutramigen PURAMINO has proven efficacy in infants with severe CMA and multiple food allergies; it is:4
    • proven to support normal growth
    • well accepted: 100% of infants had no allergic reactions or adverse events
  • MCT oil (33%*) provides an easily available source of fats and energy in case of fat malabsorption:3
    • increased MCT supply is important in patients with disturbances in digestion and absorption (e.g. SBS)3
    • the balance of MCTs and LCTs is expected to provide fast energy absorption, while also stimulating gut adaptation.3,10


  • Not recommended for premature babies unless directed and supervised by an HCP.

Order and contact information

Puramino tin image

UK pharmacy PIP order codeDescription New NHS price 
338-3304 Nutramigen PURAMINO 400g £23.00

If you have any questions or comments, please call the Mead Johnson Careline +44 (0)1895 230575.

Important notice

  • Breastfeeding provides the best nutrition for babies
  • This material is for HCPs only

AAF=amino acid-based formula; CMA=cow’s milk allergy; eHF=extensively hydrolysed formula; GI=gastrointestinal; HCP=healthcare professional; MCT=medium chain triglycerides; LCT=long chain triglycerides; SBS=short bowel syndrome.

* of total fatty acids; in healthy, full-term infants, before the addition of MCT; in infants with CMA, before the addition of MCT.


  1. Venter C, Brown T, Meyer R et al. Better recognition, diagnosis and management of non‑IgE‑mediated cow’s milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy 2017; 7: 26.
  2. 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.
  3. 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.
  4. 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.
  5. BDA.Guidelines for the preparation and handling of expressed and donor breast milk and special feeds for infants and children in neonatal and paediatric health care settings. British Dietetic Association. 2016. Available at: (accesssed November 2018)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.
  6. Fiocchi A, Brozek J, Schunemann H et al. World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. World Allergy Organ J 2010; 3 (4): 57–161.
  7. 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.
  8. 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.
  9. Shaw V (editor). Clinical Paediatric Dietetics. 2014; John Wiley & Sons. Available at:


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All rights reserved.

Date of preparation: February 2019