Contemporary strategies in the management of cow’s milk protein allergy

Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and young children, with a prevalence estimated between 2% and 4.9%. This paper reviews the latest data on the diagnosis and management of CMPA, covering both IgE-mediated and non-IgE-mediated forms. The diagnosis of IgE-mediated CMPA involves skin prick testing, the measurement of specific IgE levels and, if necessary, basophil activation tests, confirmed by oral food challenge. For non-IgE-mediated CMPA, the diagnosis is based on clinical response to elimination and reintroduction diets. The management of IgE-mediated forms includes avoidance of the implicated food, individualized dietary counseling, education regarding the use of adrenaline autoinjectors, and the potential use of oral immunotherapy. In non-IgE-mediated forms, the main treatment consists of dietary exclusion, continued breastfeeding where possible, and the use of extensively hydrolyzed or amino acid-based formulas when necessary. Oral immunotherapy and biological therapies offer new perspectives, but their application is currently limited to specialized centers and carefully selected patients.