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. 2015 Feb;174(2):141-50.
doi: 10.1007/s00431-014-2422-3. Epub 2014 Sep 26.

Cow's Milk Allergy: Evidence-Based Diagnosis and Management for the Practitioner

Free PMC article

Cow's Milk Allergy: Evidence-Based Diagnosis and Management for the Practitioner

Carlos Lifschitz et al. Eur J Pediatr. .
Free PMC article


This review summarizes current evidence and recommendations regarding cow's milk allergy (CMA), the most common food allergy in young children, for the primary and secondary care providers. The diagnostic approach includes performing a medical history, physical examination, diagnostic elimination diets, skin prick tests, specific IgE measurements, and oral food challenges. Strict avoidance of the offending allergen is the only therapeutic option. Oral immunotherapy is being studied, but it is not yet recommended for routine clinical practice. For primary prevention of allergy, exclusive breastfeeding for at least 4 months and up to 6 months is desirable. Infants with a documented hereditary risk of allergy (i.e., an affected parent and/or sibling) who cannot be breastfed exclusively should receive a formula with confirmed reduced allergenicity, i.e., a partially or extensively hydrolyzed formula, as a means of preventing allergic reactions, primarily atopic dermatitis. Avoidance or delayed introduction of solid foods beyond 4-6 months for allergy prevention is not recommended.

Conclusion: For all of those involved in taking care of children's health, it is important to understand the multifaceted aspects of CMA, such as its epidemiology, presentation, diagnosis, and dietary management, as well as its primary prevention.


Fig. 1
Fig. 1
Evaluation of infants suspected of having cow’s milk protein allergy (CMP) according to the ESPGHAN criteria (Koletzko et al. [31], permission obtained). eHF extensively hydrolyzed formula AAF amino acid-based formula

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