Cow's milk allergy is the most common form of food allergy, affecting around 1%-4% of young children in Europe and other Western countries. 1-3 Milk allergy is caused by an adverse immune reaction to one or more of the proteins in cow's milk. Approximately 50% of these reactions are IgE-mediated and, in the most severe cases, are associated with anaphylaxis. Although it is arguable whether the prevalence of childhood milk allergy has increased in recent years, there is some evidence that allergic reactions to cow's milk have become more persistent. 4,5 Most milk-allergic children (80%) outgrow the condition by the time of school age and develop clinical tolerance to cow's milk allergens. However, some children have more severe phenotypes associated with high IgE levels and IgE antibodies to casein and may not develop tolerance until adolescence or, in the most severe cases, into adulthood. 6 The patterns of sensitization to individual cow's milk proteins varies significantly by study population and age. 6,7 Approximately 61% of cow's milk reactive individuals
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