Overview
Cow's milk protein enteropathy, often manifesting as cow's milk protein allergy (CMPA), is a common food allergy in infants under 12 months, characterized by gastrointestinal symptoms and potentially other allergic manifestations 13.Diagnosis
Clinical Manifestations: Diarrhea, bloody stools, vomiting, feeding refusal, eczema, atopic dermatitis, urticaria, angioedema, allergic rhinitis, coughing, wheezing, failure to thrive, and anaphylaxis 6.
Non-IgE Mediated CMPA: Diagnosis primarily based on clinical response to elimination diet followed by a positive oral food challenge 3.
IgE Mediated CMPA: Skin prick tests and specific IgE levels are generally not useful; oral food challenge remains key 3.
Diagnostic Tools: Variability noted in use of IgE-specific skin prick tests (15% for non-IgE, 57% for IgE-mediated), IgE-specific blood tests (22%, 83%), and oral food challenges (45%, 22%) across practitioners 4.Management
Dietary Elimination: Elimination of cow's milk proteins from the diet is foundational 34.
Formula Alternatives: Extensively hydrolyzed formulas recommended for non-breastfed infants 4.
Donkey Milk: Considered as an alternative due to its lower protein content and closer chemical composition to human milk 2.
Monitoring Growth: Regular monitoring of growth parameters is essential, especially in infants 6.Special Populations
Infants: Most outgrow CMPA by 12 months, but those with IgE-mediated reactions may persist 6.
Comorbidities: IgE-mediated CMPA may be associated with development of other allergens including environmental allergens causing asthmatic symptoms 6.Key Recommendations
Diagnosis via Elimination Diet and Oral Challenge: Confirm diagnosis through clinical response to cow's milk protein elimination followed by a positive oral food challenge (Evidence: Strong 3).
Use of Extensively Hydrolyzed Formulas: Prescribe extensively hydrolyzed formulas for non-breastfed infants with confirmed CMPA (Evidence: Moderate 4).
Consider Alternative Milks: Explore the use of donkey milk as a potential alternative in cases where cow's milk protein allergy is confirmed (Evidence: Expert opinion 2).References
1 Toca MC, Morais MB, Vázquez-Frias R, Becker-Cuevas DJ, Boggio-Marzet CG, Delgado-Carbajal L et al.. Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Revista de gastroenterologia de Mexico (English) 2022. link
2 Vincenzetti S, Santini G, Polzonetti V, Pucciarelli S, Klimanova Y, Polidori P. Vitamins in Human and Donkey Milk: Functional and Nutritional Role. Nutrients 2021. link
3 Matthai J, Sathiasekharan M, Poddar U, Sibal A, Srivastava A, Waikar Y et al.. Guidelines on Diagnosis and Management of Cow's Milk Protein Allergy. Indian pediatrics 2020. link
4 Toca MC, Roman-Riechmann E, Vázquez-Frías R, Batista de Morais M, Sosa P, Boggio-Marzet C et al.. A Latin American and Spanish pediatric gastroenterology group's understanding of cow's milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. Revista de gastroenterologia de Mexico (English) 2020. link
5 Yousefi R, Gaudin JC, Chobert JM, Pourpak Z, Moin M, Moosavi-Movahedi AA et al.. Micellisation and immunoreactivities of dimeric beta-caseins. Biochimica et biophysica acta 2009. link
6 Ewing WM, Allen PJ. The diagnosis and management of cow milk protein intolerance in the primary care setting. Pediatric nursing 2005. link