Paediatrics

Cow's Milk Protein Allergy

Cow's milk protein allergy is an immune-mediated reaction to milk proteins in infancy, either immediate and IgE-mediated or delayed and non-IgE-mediated; diagnosis depends on an allergy-focused history and, for non-IgE disease, a supported elimination and reintroduction plan.

Definition

Cow's milk protein allergy is a reproducible immune-mediated reaction to one or more proteins in cow's milk. It may be IgE-mediated and immediate, non-IgE-mediated and delayed, or mixed, and is distinct from lactose intolerance and other non-immune food reactions.

First principles

Protein allergy is not lactose intolerance

Cow's milk protein allergy is an immune reaction to casein or whey. Lactose intolerance is a non-immune problem with digesting the milk sugar lactose and does not explain urticaria, eczema, wheeze or anaphylaxis. The distinction matters because removing lactose does not remove milk protein.

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