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Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Published in Journal of Asthma and Allergy, October 2021 

 OPEN ACCESS  View online here

Cow’s milk allergy (CMA) is the most common food allergy in infancy, a timely diagnosis and treatment is essential to enable adequate nutrition for growth and development. This review by an international panel of experts summarises the current evidence and guidelines on the nutritional management of CMA and appraises different feeding options, looking at the pros and cons of each option. 

Exclusive breast feeding in all guidelines is first choice, and this requires strict dietary elimination of cow’s milk protein from the infants and mothers diet. If breastmilk is not available or insufficient, most guidelines advise an extensively hydrolysed formula (EHF) as first choice in mild-moderate CMA, moving to amino acid formula (AAH) if EHF fails. The review looks at the evidence in support of EHF and AAF. 

The review goes on to assess the following formulas/ milks in detail and offers recommendations on when they are appropriate or not:

-partial hydrolysate formulas (pHFs)

-other mammalian milks (goat, sheep, pig, horse, donkey, camel)

-plant based infant formula (rice-based, soy-based, other-plant based)

The authors touch on oral immunotherapy and the long term management including the use of milk challenges and when they are appropriate to start. 

Overall this is an excellent and concise review of a complicated topic. It offers practical recommendations on when each milk/formula may or may not be indicated to use.