Position document: IgE-mediated cow's milk allergy

• A. Martorell-Aragonés ^[1] ; L. Echeverría-Zudaire ^[2] ; E. Alonso-Lebrero ^[3] ; J. Boné-Calvo ^[4] ; M.F. Martín-Muñoz ^[5] ; S. Nevot-Falcó ^[6] ; M. Piquer-Gibert ^[7] ; L. Valdesoiro-Navarrete ^[8]
  1. [1] Hospital General Universitario de Valencia

     Hospital General Universitario de Valencia

     Valencia, España

     
  2. [2] Hospital Severo Ochoa

     Hospital Severo Ochoa

     Madrid, España

     
  3. [3] Hospital General Universitario Gregorio Marañón

     Hospital General Universitario Gregorio Marañón

     Madrid, España

     
  4. [4] Hospital Miguel Servet

     Hospital Miguel Servet

     Zaragoza, España

     
  5. [5] Hospital Universitario La Paz

     Hospital Universitario La Paz

     Madrid, España

     
  6. [6] Hospital General Manresa
  7. [7] Hospital Universitario Sant Joan de Déu, Barcelona
  8. [8] Hospital Universitario Parc Taulí, Sabadell

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• Localización: Allergologia et immunopathologia: International journal for clinical and investigate allergology and clinical immunology, ISSN-e 1578-1267, ISSN 0301-0546, Vol. 43, Nº. 5, 2015, págs. 507-526
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • The present document offers an update on the recommendations for managing patients with cow's milk allergy – a disorder that manifests in the first year of life, with an estimated prevalence of 1.6–3% in this paediatric age group.

    The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis.

    The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk.

    Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice.

    Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.