Cow's milk allergy affects approximately 2% of infants under 2 years of age. This review summarizes the recent advances in understanding its pathophysiology and immunological mechanisms. Apart from IgE-mediated atopic manifestations, T cell-mediated reactions have been demonstrated in infants with cow's milk allergy. The clinical spectrum ranges from immediate-type reactions, presenting with urticaria and angioedema to intermediate and late-onset reactions, including atopic dermatitis, infantile colic, gastro-oesophageal reflux, oesophagitis, infantile proctocolitis, food-associated enterocolitis and constipation. The exact mechanisms of these disorders are still poorly understood. Double-blind, placebo controlled food challenge, the definitive diagnostic test for cow's milk allergy, is increasingly being replaced by the measurement of food-specific antibodies, in combination with skin-prick or atopy patch testing. The treatment of cow's milk allergy relies on allergen avoidance and hypoallergenic formulae, or maternal elimination diets in breast-fed infants.
Departments of aAllergy and bGastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia; and cAllergy Research Group, Department of Clinical Biochemistry, Haukeland Hospital, Bergen, Norway
Correspondence to Dr Ralf G. Heine, Department of Allergy, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. Tel: +613 9345 5701; fax: +613 9326 6418; e-mail: email@example.com