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Cow’s Milk Allergy (CMA)

Cow’s Milk Allergy (CMA) is an immune response to cow’s milk protein. CMA can present with a variety of symptoms generally affecting the respiratory tract (e.g. sneezing, wheezing), the skin (e.g. skin rash, eczema) and the gastrointestinal tract (e.g. vomiting, diarrhoea, constipation) [2]. 

It is classified according to the different immune responses, which include IgE-mediated (immediate) or cell mediated/non IgE-mediated (delayed) reactions. Whether, IgE or non IgE-mediated, the mainstay of dietary management is avoidance of cow’s milk proteins to prevent the occurrence of acute and chronic symptoms [3, 4]. Cow’s Milk Allergy (CMA) is the most common food allergy in infants and young children[2]. Cow’s milk protein (CMP) is usually one of the first complementary foods to be introduced into the infant’s diet[3]. It is a reaction to cow’s milk that results from a hypersensitive immune response to one or more proteins contained in cow’s milk. CMA generally affects children of under the age of 2 to 3 years[1].The prevalence during infancy varies from 2% to 5% in the five biggest European challenge-confirmed birth cohort studies[2]. The diagnosis of cow’s milk allergy requires an understanding of its classification and immunological basis as well as of the strengths and limitations of diagnostic tests[2]. 

References

  1. Wood R. The Natural History of Food Allergy.Pediatrics2003;111;1631-1637
  2. Fiocchi A et al. World AllergyOrganization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines.WAO Journal April 2010;57-161
  3. Du Toit G; Meyer R; Shah N; Heine RG; Thomson MA; Lack G; Fox A Identifying and managing cow’s milk protein allergy Arch Dis Child Educ Pract Ed 2010
  4. Skypala I. and Venter C. Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerance 1st edition Wiley –Blackwell 2009
  5. Hill DJ et al. The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: a systematic review. Clin Exp Allergy 2007; 37, 808-822.
  6. Høst A et al Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999 Jul;81(1):80-4. Review