The effects of cow's milk protein allergy in children and newborns: from etiology to treatment

Abstract

Cow's milk protein allergy (CMPA) is the most common food allergy in children under 3 years of age, involving immunological reactions against milk proteins, especially alpha-lactalbumin and casein. Cow's milk is part of "The Big-8", eight main allergens that include egg, soy, wheat, peanuts, tree nuts, fish and shellfish.

The manifestations of CMPA can be: IgE-mediated, non-IgE-mediated and mixed. Those mediated by IgE antibodies are well characterized reactions. The process by which non-IgE-mediated allergy develops is not yet fully established. It includes all manifestations of hypersensitivity in which IgE antibodies do not play a role, with gastrointestinal symptoms being the main examples of this mechanism.

A detailed clinical history, combined with the immediate hypersensitivity skin test (prick test) and adequate interpretation of specific serum IgE, is essential to diagnose cow's milk protein allergy (CMPA). In specific cases, the oral challenge test may be necessary. When the reaction is mediated by IgE, the prick test is usually the starting point. A negative result practically excludes IgE-mediated CMPA, while a positive result suggests the possibility but requires confirmation.

CMPA treatment is based on the exclusion of cow's milk proteins from the diet, inhalation and contact with the skin must also be avoided, and the patient's nutritional needs must be maintained. For newborns and breast-fed infants, a restricted diet is recommended for the nursing mother. This work is an integrative literature review. The databases of scientific articles were used to carry out the searches: Us National Library of Medicine (PUBMED) and Scientific Electronic Library (Scielo). Therefore, this magazine's main objective is to address the causes, clinical manifestations and treatment of allergy to cow's milk protein.