Cow's milk protein allergy in infants: Clinical presentations and outcomes

Cow's milk protein allergy (CMPA) is the most common food allergy in infants, with significant clinical, nutritional, and economic consequences. In Jordan, the Ministry of Health (MoH) provides specialized formulas for affected infants; however, local data on clinical presentation, treatment duration, costs, and breastfeeding barriers are scarce.

To evaluate the clinical manifestations and outcomes of infants diagnosed with CMPA in a public hospital in Jordan and to assess treatment costs and maternal breastfeeding barriers.

This retrospective cross-sectional study included 38 infants aged < 1 year diagnosed with CMPA at a MoH tertiary hospital in Salt, Jordan, between 2020 and 2023. Data were collected from medical records and caregiver phone interviews. Infants who were exclusively breastfed or received mixed formulas (extensively hydrolyzed formula and amino acid-based formula) were excluded. Statistical analysis included descriptive statistics and Fisher's exact test to determine associations between breastfeeding barriers and maternal factors.

Constipation (47.4%) and diarrhea (44.7%) were among the most frequent symptoms. One-third of the infants had coexisting food allergies, and elevated liver enzyme levels or isolated jaundice was noted in 21%. The average treatment duration was 13.89 months, with a mean cost of JD 1802 ($2523) per child. Maternal perception of milk insufficiency (36.8%) was the most reported breastfeeding barrier. Maternal employment, but not education (P = 0.22), was significantly associated with breastfeeding challenges (OR = 7.20, P = 0.03).

CMPA in Jordanian infants was associated with delayed diagnosis, high treatment costs, and significant breastfeeding barriers, particularly among employed mothers. These findings highlight the need for improved awareness, earlier diagnosis, and supportive policies to promote breastfeeding and reduce the disease burden.