Cow’s Milk Protein Allergy in Term and Preterm Infants: Clinical Manifestations, Immunologic Pathophysiology, and Management Strategies

Abstract

Cow’s milk allergy is a common food allergy among infants. Symptoms of cow’s milk allergy are wide-ranging and depend on the mechanism involved. There are immunoglobulin E (IgE)-mediated, non–IgE-mediated, and mixed mechanisms of food allergy. Symptoms of IgE-mediated cow’s milk allergy may be mild or may progress to anaphylaxis, which can be life-threatening. Non–IgE-mediated allergy includes food protein–induced allergic proctocolitis (FPIAP), food protein–induced enterocolitis syndrome, food protein–induced enteropathy, and Heiner syndrome (pulmonary hemosiderosis). These diagnoses comprise about half of all cow’s milk allergies. The most common manifestation of cow’s milk allergy in infants is FPIAP. FPIAP is commonly seen in healthy, full-term infants who present with rectal bleeding and are otherwise well-appearing. This can occur in both formula-fed and exclusively breastfed infants. Food proteins secreted in maternal breast milk can contribute to the development of these symptoms. Maternal cow’s milk elimination diet is often successful in helping resolve symptoms. A period of reintroduction of cow’s milk resulting in re-emergence of symptoms in stable asymptomatic infants is an excellent diagnostic tool to confirm a cow’s milk allergy. Preterm infants are susceptible to food allergy, as demonstrated from several case reports of necrotizing enterocolitis–like illnesses that responded clinically to cow’s milk elimination. Further study is needed about food allergy in the preterm infant population.

Causes of bloody stools in neonates: a case series report

“…The prevalence of CMPA in infants is approximately 2% to 3% (12,26,27), and it has been on a steady rise over the last years (28). Our findings were in line with previous studies suggesting that most infants with allergic colitis are symptomatic in the first month, and bloody stools were one of the most common manifestations of CMPA in infants at the time of onset (2,(29)(30)(31). Exclusive breastfeeding and avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first 6 months of life has been known to reduce and prevent CMPA (32)(33)(34)(35), and the lack of breast milk has been significantly associated with bloody stools (1,5,36).…”

Clinical Effect of Standardized Dietary Avoidance Therapy on Children with Milk Protein Allergy and Its Effect on Intestinal Flora

“…Cow milk protein allergy (CMPA) [ 1 ], an abnormal immunological reaction to cow's milk protein, is the most common allergic disease in infants [ 2 ]. According to statistics, the global incidence of CMPA in infants and young children is 1.9% to 4.9% [ 3 ], and the incidence of CMPA in infants and young children under 2 years old in China is about 2% to 3% [ 1 ], and it has shown a rising trend in recent years.…”

Effects of Formula Milk Feeding in Premature Infants: A Systematic Review

“…The FM had a similar tolerance to human milk (either BM or DHM), except in two studies [ 26 , 34 ]. In one study, a plausible explanation for this finding is the intolerance to casein milk administered in FM [ 26 , 37 ], although, in the other case, no data are provided to justify this finding. Complete enteral feeding was achieved after longer periods with FM [ 31 ] or when using liquid fortifier [ 30 ] (at 31 and 30 days, respectively) compared to BM.…”