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Arch Pediatr. 2018 Apr;25(3):236-243. doi: 10.1016/j.arcped.2018.01.007. Epub 2018 Mar 22.

Nutritional management of cow's milk allergy in children: An update.

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Université Paris Descartes, 75006 Paris, France. Electronic address:
Université Joseph-Fourier, 38000 Grenoble, France.
Service d'endocrinologie-diabète de l'enfant, CHU de Bicêtre, 94275 Kremlin-Bicêtre, France.
Université de Franche-Comté, 25000 Besançon, France.
Université Nantes-Atlantique, 44300 Nantes, France.
Université de Lorraine, 54000 Nancy, France.
Endocrinologie-diabète de l'enfant, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France.
Université Pierre-et-Marie-Curie Paris-6, 75005 Paris, France.
Inserm U 1069, université de Tours, CHU de Tours, 37000 Tours, France.
Université de Lausanne, 1011 Lausanne, Switzerland.
Institut de recherche pour le développement, 13572 Marseille, France.


Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term.


Allergy; Baked milk; Cow's milk; Enterocolitis; Eosinophilic esophagitis; Nutrition

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