Cow's milk protein allergy: A comprehensive review of epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies

Abstract

Cow's milk protein allergy is an adverse immune reaction to proteins found in cow's milk, primarily casein and whey, affecting artificially fed, breastfed and mixed-fed infants. The immunological mechanisms involved lead to diverse clinical presentations, most commonly affecting the digestive, respiratory, and integumentary systems. Diagnosis relies primarily on clinical evaluation due to the absence of specific diagnostic tests, making accurate identification crucial to prevent misdiagnosis or underdiagnosis. Treatment requires strict avoidance of cow's milk proteins in the diets of both children and breastfeeding mothers, with close monitoring of nutritional status during long-term management. Recent advancements in treatment, including the use of probiotics, provide new options for improving clinical outcomes. This narrative review aims to provide clinicians with evidence to standardise diagnosis and treatment, improve food allergy management by non-allergy specialists and develop accurate feeding recommendations.

Keywords: prognosis and prevention; treatment; clinical manifestations; cow’s milk protein allergy; diagnosis.

Figure 1

The types of cow's milk protein allergy

Figure 2

The molecular mechanisms of cow's milk protein allergy. IL: Interleukin, TNF-α: Tumor Necrosis Factor-alpha, IFN-γ: Interferon-gamma, Th: T helper