World Journal of Pediatrics

, Volume 8, Issue 1, pp 19–24 | Cite as

Diagnosis and management of cow’s milk protein allergy in infants

  • Elisabeth De Greef
  • Bruno Hauser
  • Thierry Devreker
  • Gigi Veereman-Wauters
  • Yvan VandenplasEmail author
Review Article



Cow’s milk protein allergy (CMPA) is frequently suspected in infants with a variety of symptoms. A thorough history and careful clinical examination are necessary to exclude other underlying diseases and to evaluate the severity of the suspected allergy. Care should be taken to diagnose CMPA adequately to avoid an unnecessary diet.

Data sources

We make recommendations based on systematic literature searches using the best-available evidence from PubMed, Cumulative Index to Nursing and Allied Health Literature, and bibliographies.


Skin prick tests, patch tests and serum specific IgE are only indicative of CMPA. Breastfed infants have a decreased risk of developing CMPA; an elimination diet for the mother is indicated if CMPA is confirmed. If a food challenge is positive in formula fed infants, an extensively hydrolysed formula and cow’s milk-free diet is recommended. If symptoms do not improve, an amino acid based formula should be considered. In severe CMPA with life-threatening symptoms, an amino-acid formula is recommended.


Elimination diet by a double-blind placebo controlled food challenge is the gold standard for diagnosis. Elimination of the offending allergen from the infants’ diet is the main treatment principle.

Key words

amino acid formula cow’s milk protein allergy extensive hydrolysate partial hydrolysate soy formula 


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Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Elisabeth De Greef
    • 1
  • Bruno Hauser
    • 1
  • Thierry Devreker
    • 1
  • Gigi Veereman-Wauters
    • 1
  • Yvan Vandenplas
    • 1
    • 2
    Email author
  1. 1.Department of PediatricsUZ BrusselBrusselsBelgium
  2. 2.Department of Pediatrics, UZ BrusselVrije Universiteit BrusselBrusselsBelgium

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