New data on
food allergy has recently changed the management of children with
cow's milk protein allergy (CMPA). The diagnosis of CMPA first requires the elimination of cow's milk
proteins and then an oral provocation test following a standard diagnostic procedure for
food allergy, without which the elimination diet is unjustified and sometimes harmful. Once the diagnosis is made, the elimination diet is strict, at least until the age of 9-12 months. If the child is not breastfed or the mother cannot or no longer wishes to breastfeed, the first choice is a formula based on extensive hydrolyzate of cow's milk (eHF), provided that its effectiveness has been demonstrated. When eHF fails, a formula based on
amino acids is warranted. eHF based on rice
protein hydrolysates is an alternative to cow's milk eHF. Infant formulas based on
soy protein can be used after the age of 6 months, after verification of good clinical tolerance to soy. Most commonly, CMPA disappears within 2 or 3 years of life. However, the age of recovery varies depending on the child and the type of CMPA, and whether or not it is
IgE-mediated, the first being more sustainable. When the child grows, a hospital oral provocation test evaluates the development of tolerance and, if possible, authorizes continuing the reintroduction of
milk proteins at home. Some children with CMPA will tolerate only a limited daily amount of cow's milk
proteins. The current therapeutic options are designed to accelerate the acquisition of tolerance, which seems facilitated by regular exposure to cow's milk
proteins.