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

Posted:  Wednesday, February 18, 2015

Current evidence and recommendations for managing Cow’s milk allergy  

Cow’s milk allergy (CMA) is a common diagnosis in infants and children. 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.

Elimination diets are not always the most effective and can even result in malnutrition and/or specific nutrient deficiencies at a time when infants and children are growing.

Recommended therapeutic modalities should be based on evidence. This is possible whenever enough studies in one particular area, in homogenous populations, help prove or disprove a certain diagnostic or therapeutic approach.

In the report – Cow’s milk allergy: evidence-based diagnosis and management for the practitioner by Carlos Lifschitz and Hania Szajewska recently published in the European Journal of Pediatrics, the authors discuss current evidence and recommendations on the prevalence, natural history, clinical manifestations, diagnosis and management of CMA aimed at the primary and secondary care providers.

Their report is based on a search of MEDLINE in May 2014, with preference given to evidence and recommendations from scientific societies published in the last 4 years (2010–2014).

The authors recommend that a medical history, including history of allergy in close relatives, physical examination, and diagnostic elimination diets are the first steps for the accurate diagnosis and management of CMA patients.

Recommendations for the primary prevention of allergy include exclusive breastfeeding for at least 4 months and up to 6 months if possible. Where infants with a documented hereditary risk of allergy cannot be exclusively breastfed the authors recommend a formula with confirmed reduced allergenicity, i.e., a partially or extensively hydrolyzed as a way to minimize the risk of allergic reactions, primarily atopic dermatitis. There is no evidence that avoidance or delayed introduction of solid foods beyond 4– 6 months has a positive effect for allergy prevention.

For further information, read the full report: Cow’s milk allergy: evidence-based diagnosis and management for the practitioner