Managing cows' milk allergy in children

Cows’ milk allergy mainly affects young children and because it is often outgrown is less commonly seen in older children and adults. It is one of the most common childhood food allergies in the developed world, second to egg allergy,1 affecting 2-7.5% of children under 1 year of age.2 The mainstay of treatment is to remove cows’ milk protein from the diet while ensuring the nutritional adequacy of any alternative. #### Summary points Cows’ milk allergy can often be recognised and managed in primary care. Patients warranting a referral to specialist care include those with severe reactions, faltering growth, atopic comorbidities, multiple food allergies, complex symptoms, diagnostic uncertainty, and incomplete resolution after cows’ milk protein has been excluded. Although there are non-immune reactions to cows’ milk, such as primary lactose intolerance (when malabsorption of sugar can cause bloating and diarrhoea), these are extremely rare in very young children. Except after a gastrointestinal infection, infants with gastrointestinal symptoms on exposure to cows’ milk are more likely to have cows’ milk allergy than lactose intolerance. This article focuses on immune mediated reactions to cows’ milk in children and reviews the evidence on how to diagnose and manage the condition #### Sources and selection criteria Our search included PubMed, the Cochrane Collaboration using the search terms …