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Identifying and managing cow's milk protein allergy
  1. George du Toit1,
  2. Rosan Meyer2,
  3. Neil Shah3,
  4. Ralf G Heine4,
  5. Michael A Thomson5,
  6. Gideon Lack1,
  7. Adam T Fox1
  1. 1King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma. Division of Asthma, Allergy and Lung Biology. Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2Department of Paediatrics, Imperial College, Norfolk Place, London, UK
  3. 3Great Ormond Street Hospital, London, UK
  4. 4Department of Allergy and Immunology, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Parkville, Melbourne, Australia
  5. 5Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Western Bank, Sheffield, UK
  1. Correspondence to Dr George du Toit, Children's Allergy Service, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH; george.dutoit{at}


Cow's milk protein (CMP) is usually one of the first complementary foods to be introduced into the infant's diet and is commonly consumed throughout childhood as part of a balanced diet. CMP is capable of inducing a multitude of adverse reactions in children, which may involve organs like the skin, gastrointestinal (GI) tract or respiratory system. The diagnosis of CMP-induced adverse reactions requires an understanding of their classification and immunological basis as well as the strengths and limitations of diagnostic modalities. In addition to the well-recognised, immediate-onset IgE-mediated allergies, there is increasing evidence to support the role of CMP-induced allergy in a spectrum of delayed-onset disorders ranging from GI symptoms to chronic eczema. The mainstay of treatment is avoidance of CMP; this requires dietetic input to ensure that this does not lead to any nutritional compromise. This review is intended to highlight the broad spectrum of manifestations of CMP allergy and to offer an approach to the diagnosis and treatment thereof.

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  • Competing interests Companies that produce infant milk formulae, including SHS Nutricia, Danone, Nestle and Mead Johnson have supported one or more authors through honoraria for lectures, honoraria for membership on scientific advisory boards, research funding or support to attend scientific meetings. ATF, NS and RM received funding for Educational Consultancy performed on behalf of SHS Nutricia. ATF, GLdT and GL are directors for the Kings College London Allergy Academy, which is part sponsored by Danone and SHS Nutricia.

  • Provenance and peer review Commissioned; externally peer reviewed.