Cow's milk allergy: a critical review

Area of Science:

• Immunology
• Allergology
• Clinical Nutrition

Background:

• Cow's milk is a frequent trigger for delayed-onset food allergies.
• Diagnosing milk allergy is challenging due to unreliable skin tests and delayed, non-specific symptoms.
• Milk allergy is often IgE-independent and affects all age groups, including adults.

Purpose of the Study:

• To highlight the diagnostic difficulties associated with cow's milk allergy.
• To emphasize that milk allergy is not limited to infancy and can persist into adulthood.
• To present the most reliable diagnostic approach for milk allergy.

Main Methods:

• Review of diagnostic challenges in milk allergy.
• Discussion of the non-IgE mediated nature of most milk allergies.
• Description of a trial elimination diet as a diagnostic tool.

Main Results:

• Skin tests are unreliable for diagnosing milk allergy.
• Symptoms of milk allergy often appear delayed and may not suggest an allergic cause.
• Milk antigens can be present in unexpected food products.
• Milk allergy is frequently familial and can persist throughout life.

Conclusions:

• A two-to-three-week milk elimination diet with dietary instructions is the sole reliable diagnostic method.
• Physicians should consider milk allergy in familial cases.
• Milk allergy is a common, persistent condition requiring accurate diagnosis.