Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

Dermatological (50-60%)Respiratory (20-30%) ㆍAnaphylaxis (flaccidity/floppiness; pallor/cyanosis) ㆍShock-like symptoms with severe metabolic acidosis, vomiting & diarrhea (FPIES) ㆍInfantile colic ㆍOral allergy syndrome ㆍVomiting, regurgitation, reflux ㆍDysphagia; food impaction ㆍDelayed gastric emptying ㆍAbdominal pain ㆍDiarrhea (bloody stools, protein loosing enteropathy) ㆍProctocolitis ㆍConstipation +/-perianal rash ㆍAnorexia, failure to thrive, early satiety ㆍFPIES ㆍEosinophil infiltration (eosinophilic esophagitis, gastritis, enterocolitis) ㆍUrticaria (unrelated to infections, drug intake, or other causes) ㆍAtopic dermatitis ㆍAngioedema ㆍRunny nose (rhinitis) ㆍWheezing, stridor ㆍChronic coughing (all unrelated to infections)The common manifestations of cow's milk protein allergy (CMPA) ordered by organ system. Adapted with permission from Lippincott Williams and Wilkins/Wolters Kluwer Health: Koletzko et al., J Pediatr Gastroenterol Nutr, 2012;55:221-9 [7]. Adapted by permission from BMJ Publishing Group Limited: Vandenplas et al., Arch Dis Child, 2007;92:902-8 [40]. FPIES, food protein-induced enterocolitis syndrome.