Overview
Cow's milk allergy (CMA) involves adverse immune reactions to proteins in cow's milk, though similar considerations can extend to other mammalian milks, including goats' milk, due to potential cross-reactivity and residual antigenicity 3.Diagnosis
Detailed clinical history focusing on gastrointestinal symptoms, feeding aversion, and stool characteristics 1.
Allergy tests including skin prick testing (SPT) and specific immunoglobulin E (IgE) levels 2.
Supervised incremental milk challenges when necessary, though often not feasible in primary care settings 2.Management
Elimination of cow's milk protein from the diet; alternative hypoallergenic formulas or extensively hydrolyzed milk proteins may be considered 12.
For infants, exclusive breastfeeding or use of extensively hydrolyzed formulas if breastfeeding is not possible 1.
Monitoring for resolution or persistence of symptoms, with gradual reintroduction under medical supervision 2.Special Populations
Pediatrics: Exclusive breastfeeding and use of hypoallergenic formulas are prioritized in infants 1.
Comorbidities: Specific management adjustments for those with coexisting gastrointestinal conditions may be necessary, though detailed guidance is not provided in the abstracts 1.Key Recommendations
Diagnosis should primarily rely on clinical history and allergy testing, with supervised challenges reserved for specialist settings (Evidence: Moderate 2).
Exclusively breastfed infants with suspected CMA should be managed with continued breastfeeding, while formula-fed infants should switch to extensively hydrolyzed formulas (Evidence: Strong 1).
Extensively hydrolyzed milk substitutes are preferred due to reduced residual allergenicity, though monitoring for specific IgE binding to peptides is advised (Evidence: Moderate 3).References
1 Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C et al.. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. Journal of pediatric gastroenterology and nutrition 2024. link
2 Meyer R. New guidelines for managing cow's milk allergy in infants. The journal of family health care 2008. link
3 Docena G, Rozenfeld P, Fernández R, Fossati CA. Evaluation of the residual antigenicity and allergenicity of cow's milk substitutes by in vitro tests. Allergy 2002. link
4 Chatel JM, Bernard H, Clement G, Frobert Y, Batt CA, Gavalchin J et al.. Expression, purification and immunochemical characterization of recombinant bovine beta-lactoglobulin, a major cow milk allergen. Molecular immunology 1996. link00070-3)