The treatment of cow's milk allergy

Current approach to the treatment of food allergy is directed towards elimination diets. The treatment of choice of cow's milk allergy is complete avoidance of cow's milk antigens. In infants it is necessary to use substitute formulas. The completeness of the elimination diet is questionable since immunoreactive components of cow's milk protein can be detected in substitute formulas and even breast milk. In most cases, extensively hydrolyzed cow's milk-derived formulas can be safely introduced, and these are efficient and clinically and metabolically well tolerated. The approach to control allergic inflammation by antigen elimination, however, is not satisfactory, particularly in patients with multiple food allergies. New approaches are urgently needed for teh treatment of cow's milk allergy. These may include antigen elimination supplemented with synthetic amino acid-derived formulas, immunotherapy to counteract the immunologic dysfunction and stabilization of the gut mucosal barrier to strengthen endogenous defence mechanisms.