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Milk protein allergy (MPA) affects up to 17% of infants under one year of age, presenting primarily as a non-IgE-mediated immune response to cow’s milk proteins. This gastrointestinal disorder requires careful diagnosis through clinical history and physical examination, as no specific diagnostic tests exist. The condition typically resolves by age one, with treatment focusing on dietary protein elimination.
Key Points:
- Clinical presentation includes bloody stool, mucous in stool, loose bowel movements, fussiness, feeding problems, and slow weight gain. These symptoms stem from intestinal inflammation caused by immune response to food proteins.
- Distinguish between IgE-mediated (immediate) and non-IgE-mediated (delayed) reactions. Most infant MPA cases are non-IgE-mediated, causing delayed gastrointestinal symptoms rather than immediate allergic reactions.
- Diagnostic approach relies on clinical history and physical examination. Blood tests and skin allergy testing only detect IgE-mediated reactions and are not useful for most MPA cases.
- Treatment requires removing trigger proteins from infant’s diet. For breastfed infants, maternal dietary restrictions apply. Formula-fed infants need hypoallergenic options: extensively hydrolyzed formulas (>90% effective) or amino acid-based formulas for resistant cases.
- Avoid soy formulas and other mammalian milk-based formulas due to high cross-reactivity with cow’s milk proteins. Dietary changes may take up to two weeks to show improvement.
Cow’s milk allergy (CMA) is one of the most common food allergies in early life with an estimated prevalence in developed countries ranging from 0.5% to 3% at age 1 year. (Nutrients)
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