The Multiple Facets of Cow's Milk Allergy

Area of Science:

• Pediatrics
• Allergology
• Immunology

Background:

• Cow's milk allergy (CMA) is a prevalent food allergy in early childhood.
• CMA exhibits diverse clinical manifestations and diagnostic complexities.
• Accurate classification of CMA is essential for appropriate management.

Purpose of the Study:

• To provide a comprehensive overview of cow's milk allergy (CMA) diagnosis and management.
• To differentiate between IgE-mediated and non-IgE-mediated CMA.
• To highlight current evidence-based guidelines for CMA evaluation and treatment.

Main Methods:

• Review of clinical history for CMA classification.
• Diagnostic utility of skin prick testing and serum specific IgE for IgE-mediated CMA.
• Clinical history and esophageal biopsy for non-IgE-mediated CMA diagnoses.

Main Results:

• IgE-mediated CMA diagnosis may involve skin prick testing, serum specific IgE, and oral food challenges.
• Non-IgE-mediated CMA includes food protein-induced allergic proctocolitis, enterocolitis syndrome, and eosinophilic esophagitis.
• Atopy patch testing, IgG, and IgG4 testing are not recommended for CMA evaluation.

Conclusions:

• Extensively hydrolyzed formulas are the primary alternative for CMA.
• Oral immunotherapy and omalizumab offer alternative strategies for IgE-mediated CMA.
• Nutritional evaluation is crucial for children with CMA due to growth risks.