The cow milk allergy complex: overlapping disease profiles in infancy

Area of Science:

• Pediatric Allergy and Immunology
• Gastroenterology
• Immunology

Background:

• Reported reactions to cow's milk are common in infants, but many are not reproducible on challenge.
• Recent studies identify three distinct infant groups with cow milk allergy (CMA) based on symptom and laboratory profiles.
• Severe CMA may be linked to broader food intolerances and associated conditions like eczema, asthma, and rhinitis.

Purpose of the Study:

• To differentiate infant cow milk allergy (CMA) phenotypes.
• To highlight the importance of accurate diagnosis and medical supervision for CMA.
• To advise against empirical dietary interventions without confirmed CMA diagnosis.

Main Methods:

• Categorization of infants into IgE-sensitized, non-IgE sensitized (immediate gastrointestinal reaction), and late-reacting non-IgE sensitized groups.
• In vitro assessment of T-cell reactivity to milk proteins in late-reacting patients.
• Review of clinical observations from community and hospital-based studies.

Main Results:

• IgE-sensitized infants exhibit immediate reactions (eruptions, anaphylaxis).
• Non-IgE sensitized infants show gastrointestinal symptoms within hours or over days.
• Late-reacting non-IgE sensitized CMA patients display elevated in vitro T-cell reactivity.
• Persistent CMA is associated with eczema, asthma, and rhinitis.
• Severe cases may involve intolerance to multiple foods.

Conclusions:

• Accurate diagnosis of cow milk allergy (CMA) is crucial, differentiating between IgE-mediated and non-IgE-mediated responses.
• Children with CMA require long-term medical management by experienced practitioners.
• Empirical dietary restrictions without confirmed CMA diagnosis should be avoided to prevent nutritional deficiencies and unnecessary food avoidance.