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Inicio Allergologia et Immunopathologia Position document: IgE-mediated cow's milk allergy
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Vol. 43. Issue 5.
Pages 507-526 (September - October 2015)
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Vol. 43. Issue 5.
Pages 507-526 (September - October 2015)
DOI: 10.1016/j.aller.2015.01.003
Position document: IgE-mediated cow's milk allergy
A. Martorell-Aragonésa, L. Echeverría-Zudaireb,
Corresponding author

Corresponding author.
, E. Alonso-Lebreroc, J. Boné-Calvod, M.F. Martín-Muñoze, S. Nevot-Falcóf, M. Piquer-Gibertg, L. Valdesoiro-Navarreteh, Food allergy committee of SEICAP (Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology)
a Allergy Department, H General Universitario, Valencia, Spain
b Pediatric Allergy Department, H Universitario Severo Ochoa, Leganés, Madrid, Spain
c Pediatric Allergy Department, H Universitario Gregorio Marañon, Madrid, Spain
d Pediatric Allergy Department, H Miguel Servet, Zaragoza, Spain
e Allergy Department, H Universitario La Paz, Madrid, Spain
f Allergy Department, H General Manresa, Barcelona, Spain
g Allergy and Clinical Immunology Department, H Universitario Sant Joan de Déu, Barcelona, Spain
h Pediatric Allergy Department, Hospital Universitario Parc Taulí, Sabadell, Spain
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Table 1. Substitution formulas for the dietetic treatment of allergy to cow's milk proteins.

The present document offers an update on the recommendations for managing patients with cow's milk allergy – a disorder that manifests in the first year of life, with an estimated prevalence of 1.6–3% in this paediatric age group.

The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis.

The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk.

Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice.

Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.

Food allergy
Cow's milk allergy
Cow's milk protein hydrolysates
Oral immunotherapy


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