Clinical Manifestation of Cow’s Milk Protein Allergy as a Complex Disorders

Clinical Manifestation of cow’s milk protein allergy

Cow’s milk is a leading cause of food allergy especially in infants and children. Symptoms of cow’s milk allergy are non-specific; as a result, suspected cow’s milk allergy is far more common than proven allergy to cow’s milk. Cow’s milk allergy in infants is therefore most probably a fairly uncommon clinical picture; cow’s milk allergy is estimated to occur in less than one per cent of infants. The only valuable additional diagnostic tool is food challenge, preferably double blind.

A significant association between early neonatal exposure to cow’s milk formula feeding and subsequent development of CMPA/CMPI has been documented. The small amounts of ‘foreign’ protein in human milk may rather induce tolerance than allergic sensitization. The findings of specific IgE to individual cow’s milk proteins in cord blood of the majority of infants who later develop CMPA/CMPI suggests a prenatal sensitization may play a role in the pathogenesis of CMPA/CMPI. Perhaps a weak intrauterine education of low IgE-response may need to ‘boosted’ neonatally in order to cause clinical disease. The prognosis of CMPA/CMPI is good with a recovery of about 45-56% at one year, 60-77% at two years and 71-87% at three years. Associated adverse reactions to other foods, especially egg, soy, peanut and citrus develop in about 41-54%. Allergy to potential environmental inhalant allergens has been reported in up to 28% by three years and up to 80% before the age of puberty. Especially, infants with an early increased IgE response to cow’s milk protein have an increased risk of persisting CMPA, development of persistent adverse reactions to other foods and development of allergy against environmental inhalant allergens. Cow’s milk protein/intolerance (CMPA/CMPI), meaning reproducible adverse reactions to cow’s milk protein(s) may be due to the interaction between one or more milk proteins and one or more immune mechanisms, possible any of the four basic types of hypersensitivity reactions. Immunologically mediated reactions are defined as CMPA. Mostly, CMPA is caused by IgE-mediated (type I) reactions, but evidence for type III (immune complex) reactions and type IV (cell mediated reactions) have been demonstrated. Non immunologically reactions against cow’s milk protein(s) are defined as CMPI. However, it should be stressed that many studies on ‘cow’s milk allergy’ have not investigated the immunological basis of the clinical reactions. In most instances of cow’s milk protein hypersensitivity only diagnostic investigations such as skin prick test and RAST indicative of IgE-mediated reactions are performed. In fact, CMPA cannot be ruled out unless extensive diagnostic tests for type II-III-IV reactions have proved negative. Thus, the classification of adverse reactions to cow’s milk proteins depends on the extent and the quality of performed diagnostic tests for immune mediated reactions. At present, no single laboratory test is diagnostic of CMPA/CMPI, and differentiation between CMPA and CMPI cannot be based solely on clinical symptoms. Therefore the diagnosis has to be based on strict well-defined elimination and milk challenge procedure. Preferably, double-blind placebo-controlled challenges (DBPCFC) should be carried out in children older than 1-2 years of age. In infants open controlled challenges have been shown to be reliable when performed under professional observation in a hospital setting

Between 5% and 15% of infants show symptoms suggesting adverse reactions to cow’s milk protein (CMP),1 while estimates of the prevalence of cow’s milk protein allergy (CMPA) vary from 2% to 7.5%.2 Differences in diagnostic criteria and study design contribute to the wide range of prevalence estimates and underline the importance of an accurate diagnosis, which will reduce the number of infants on inappropriate elimination diets. CMPA is easily missed in primary care settings and needs to be considered as a cause of infant distress and diverse clinical symptoms. Accurate diagnosis and management will reassure parents. CMPA can develop in exclusively and partially breast-fed infants, and when CMP is introduced into the feeding regimen. Early diagnosis and adequate treatment decrease the risk of impaired growth

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.


A comprehensive history (including a family history of atopy) and careful physical examination form the foundation of both algorithms. The risk of atopy increases if a parent or sibling has atopic disease (20–40% and 25–35%, respectively), and is higher still if both parents are atopic (40–60%). In comparison to cow’s milk formula-fed infants, exclusive breast feeding during the first 4–6 months of life reduces the risk for CMPA and most severe allergic manifestations during early infancy. The distinction between breast-fed and formula-fed infants reflects the importance of ensuring an adequate duration of breast feeding. Management principles also differ. The management of breast-fed infants depends on reducing the maternal allergen load and strict avoidance of CMP in supplementary feeding. It is recommended that exclusive or partial breast feeding is continued, unless alarm symptoms require a different management.The earlier CMPA develops, the greater the risk of growth retardation

Clinical manifestations of CMA

I. Gastrointestinal reactions
• Oral allergy syndrome (rare in pediatric patients) • Lip swelling is a commonly observed manifestation during food challenge procedures.
Immediate gastrointestinal allergy
• Vomiting (described in children both isolated and as part of allergic/anaphylactic reactions) • Diarrhea (usually in, but not limited to, delayed reactions)
CMA in short bowel syndrome
• Greater than 50% of these patients are also allergic to cow’s milk, according to 1 case study.
II. IgE-mediated respiratory reactions
• Rhinitis occurs in ±70% of patients during oral cow’s milk challenge, and asthma occurs in less than 8%. • Reactions rarely occur in isolation. • Reactions correlate with severe CMA. • Asthma makes for the worst prognosis in children with anaphylaxis. • Asthma in patients with CMA is of particular severity. • Respiratory symptoms in patients with CMA can progress to respiratory allergy. • Inhalation of milk vapor has been associated with severe respiratory tract reactions.
III. IgE-mediated skin reactions
Acute urticaria or angioedema
• Urticaria is a feature of most anaphylactic reactions to cow’s milk. • Urticaria with inhalation or accidental skin contact is often severe.
Contact urticaria
• Pattern varies from irritant to allergic contact dermatitis. • Generalized eczematous rash (systemic contact dermatitis) is present. • Contact reactions are frequent in patients with AD.
IV. Late-onset reactions
• Symptoms not IgE mediated • Mostly localized in the gastrointestinal tract • Typically develop 1 to several hours or even days after ingestion • No reliable laboratory tests to diagnose late-onset CMA: IgE test results are negative
Skin • AD
Gastrointestinal tract • Gastroesophageal reflux disease
• Allergic eosinophilic esophagitis
• Food protein–induced enterocolitis syndrome
• Cow’s milk protein–induced enteropathy
• Constipation
• Severe irritability (colic)
• Food protein–induced gastroenteritis and proctocolitis
Respiratory system • Milk-induced chronic pulmonary disease
• Heiner syndrome
• AD is most often present as an eczematous lesion (after ingestion or contact). • AD can involve both IgE-mediated and non–IgE-mediated skin responses. • Less than 30% of children with moderate-to-severe AD have food allergy, and CMA is the second most common food allergy in this population. • The earlier the age of onset, the greater the severity and frequency of high of cow’s milk sIgE levels.67 • Appropriate diagnosis and elimination diets frequently lead to symptom improvement.
VI. Gastrointestinal syndromes
Symptoms frequently include nausea, vomiting, abdominal pain, diarrhea, and, with chronic disease, malabsorption and failure to thrive or weight loss.
• Food protein–induced enterocolitis syndrome, the primary cause of which is CMA • Cow’s milk–induced enteropathy syndrome and secondary lactose malabsorption • Cow’s milk–induced proctocolitis syndrome (relatively benign disorder) • Gastroesophageal reflux disease–like symptoms • Eosinophilic esophagitis • Constipation • Irritable bowel syndrom
VII. Milk-induced chronic pulmonary disease
• Heiner syndrome is a very rare form of pulmonary hemosiderosis caused by CMA. • Young children typically present with recurrent pulmonary infiltrates associated with chronic cough, tachypnea, wheezing, rales, recurrent fevers, and failure to thrive. • Milk-precipitating antibodies are found in the serum. • Symptoms generally resolve after an elimination diet.
Organ involvement Symptoms
Gastrointestinal tract Frequent regurgitation
Constipation (with/without perianal rash)
Blood in stool
Iron deficiency anaemia
Skin Atopic dermatitis
Swelling of lips or eye lids (angio-oedema)
Urticaria unrelated to acute infections, drug intake or other causes
Respiratory tract Runny nose (otitis media)20 21
(unrelated to infection) Chronic cough
General Persistent distress or colic (wailing/irritable for ⩾3 h per day) at least 3 days/week over a period of >3 weeks
  • *Infants with CMPA in general show one or more of the listed symptoms.

Alarm symptoms and findings indicating severe CMPA as the possible cause

Organ involvement Symptoms and findings
Gastrointestinal tract Failure to thrive due to chronic diarrhoea and/or refusal to feed and/or vomiting
Iron deficiency anaemia due to occult or macroscopic blood loss
Endoscopic/histologically confirmed enteropathy or severe colitis
Skin Exudative or severe atopic dermatitis with hypoalbuminaemia or failure to thrive or iron deficiency anaemia
Respiratory tract Acute laryngoedema or bronchial
(unrelated to infection) obstruction with difficulty breathing
General Anaphylaxis

Unusual clinical presentations of CMA

Unusual clinical presentations are as much a feature of CMA as one might expect from such a ubiquitous allergen source in food and the environment as milk

Unusual clinical manifestations and routes of exposure

Constipation See Table I Iacono et al
Heiner syndrome Moissidis et al
Unusual routes of exposure
Skin contact Direct or indirect contact in bathtub into which a few drops of milk were spilled by a younger brother Liccardi et al
Mucous membrane contact Kiss Hallett et al
Vaginal contact Liccardi et al
Inhalation Milk vapor or casein powder Bonadonna et al,Vargiu et al
Environmental exposure
Poor food labeling Labeling of commercially prepared foods might not be accurate Joshi et al
Hidden or contamination in other foods Contamination in restaurants or factories Ignorance of catering personnel Muñoz-Furlong et al
Hidden or contamination in medications In lactose Nowak-Wegrzyn et al
In dermatologic preparations or injectable corticosteroids Eda et al


  • Brand PL, Rijk-van Gent H.Cow’s milk allergy in infants: new insights. Ned Tijdschr Geneeskd. 2011;155(27):A3508.
  • Yvan Vandenplas1. Martin Brueton. Christophe. Dupont. David Hill. ErikaIsolauri. Sibylle Koletzko. Arnold P Oranje. Annamaria Staiano. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child2007;92:902-908
  • American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006;96(Suppl 2):S1–S68.
  • Cow’s milk allergy in infancy. Heine RG, Elsayed S, Hosking CS, Hill DJ. Curr Opin Allergy Clin Immunol. 2002 Jun;2(3):217-25. Review.PMID: 12045418 [PubMed – indexed for MEDLINE]Related citations
  • Gastrointestinal allergy to food: a review. Ahmed T, Fuchs GJ. J Diarrhoeal Dis Res. 1997 Dec;15(4):211-23. Review.PMID: 9661317
  • Gastroesophageal reflux associated with cow’s milk allergy in infants: which diagnostic examinations are useful? Cavataio F, Iacono G, Montalto G, Soresi M, Tumminello M, Campagna P, Notarbartolo A, Carroccio A. Am J Gastroenterol. 1996 Jun;91(6):1215-20.
  • Clinical course and prognosis of cow’s milk allergy are dependent on milk-specific IgE status. Saarinen KM, Pelkonen AS, Mäkelä MJ, Savilahti E. J Allergy Clin Immunol. 2005 Oct;116(4):869-75.
  • Cow’s milk allergy: guidelines for the diagnostic evaluation] Kirchlechner V, Dehlink E, Szepfalusi Z. Klin Padiatr. 2007 Jul-Aug;219(4):201-5. Epub 2006 Mar 15.
  • The natural history of IgE-mediated cow’s milk allergy. Skripak JM, Matsui EC, Mudd K, Wood RA. J Allergy Clin Immunol. 2007 Nov;120(5):1172-7.
  • WITHDRAWN: Cow’s milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Ram FS, Ducharme FM, Scarlett J. Cochrane Database Syst Rev. 2007 Jul 18;(2):CD003795. Review.
  • Accidental allergic reactions in children allergic to cow’s milk proteins. Boyano-Martínez T, García-Ara C, Pedrosa M, Díaz-Pena JM, Quirce S. J Allergy Clin Immunol. 2009 Apr;123(4):883-8.
  • The spectrum of cow’s milk allergy in childhood. Clinical, gastroenterological and immunological studies. Hill DJ, Davidson GP, Cameron DJ, Barnes GL. Acta Paediatr Scand. 1979 Nov;68(6):847-52.
  • Milk allergy and vitamin D deficiency rickets: a common disorder associated with an uncommon disease. Yu JW, Pekeles G, Legault L, McCusker CT. Ann Allergy Asthma Immunol. 2006 Apr;96(4):615-9
  • Cow’s milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Ram FS, Ducharme FM, Scarlett J. Cochrane Database Syst Rev. 2002;(3):CD003795. Review. Update in: Cochrane Database Syst Rev. 2007;(2):CD003795.
  • Lymphocyte response to cow’s milk proteins in patients with cow’s milk allergy: relationship to antigen exposure. Suomalainen H, Soppi E, Isolauri E. Pediatr Allergy Immunol. 1994 Feb;5(1):20-6.
  • The spectrum of cow’s milk allergy. Eigenmann PA. Pediatr Allergy Immunol. 2007 May;18(3):265-71.
  • Clinical practice. Diagnosis and treatment of cow’s milk allergy. Kneepkens CM, Meijer Y. Eur J Pediatr. 2009 Aug;168(8):891-6. Epub 2009 Mar 7.
  • Growth in infants with cow’s milk allergy] Moreno Villares JM, Oliveros Leal L, Torres Peral R, Luna Paredes C, Martínez-Gimeno A, García-Hernández G. An Pediatr (Barc). 2006 Mar;64(3):244-7. Spanish.
  • Diagnosis of food allergy in children] Dupont C, Barau E. Ann Pediatr (Paris). 1992 Jan;39(1):5-12.
  • Cow’s milk formula as a cause of infantile colic: a double-blind study. Lothe L, Lindberg T, Jakobsson I. Pediatrics. 1982 Jul;70(1):7-10.
  • Feeding a soy formula to children with cow’s milk allergy: the development of immunoglobulin E-mediated allergy to soy and peanuts. Klemola T, Kalimo K, Poussa T, Juntunen-Backman K, Korpela R, Valovirta E, Vanto T.Pediatr Allergy Immunol. 2005 Dec;16(8):641-6.
  • Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis. Niggemann B, Binder C, Dupont C, Hadji S, Arvola T, Isolauri E. Pediatr Allergy Immunol. 2001 Apr;12(2):78-82.
  • Persistent cow’s milk protein intolerance in infants: the changing faces of the same disease. Iacono G, Cavataio F, Montalto G, Soresi M, Notarbartolo A, Carroccio A. Clin Exp Allergy. 1998 Jul;28(7):817-23.
  • Adequacy and tolerance to ass’s milk in an Italian cohort of children with cow’s milk allergy. Tesse R, Paglialunga C, Braccio S, Armenio L.Ital J Pediatr. 2009 Jul 9;35:19.- in process]
  • Multiple food allergy: a possible diagnosis in breastfed infants. de Boissieu D, Matarazzo P, Rocchiccioli F, Dupont C. Acta Paediatr. 1997 Oct;86(10):1042-6.PMID: 9350880
  • [Could whey be responsible for the development of cow’s milk allergy in newborns and infants?]Thaller T, Mutz I, Girardi L. Klin Padiatr. 2004 Mar-Apr;216(2):87-90.
  • Oral desensitization in children with cow’s milk allergy. Zapatero L, Alonso E, Fuentes V, Martínez MI. J Investig Allergol Clin Immunol. 2008;18(5):389-96.PMID: 18973104
  • Modified proteins in allergy prevention. von Berg A. Nestle Nutr Workshop Ser Pediatr Program. 2009;64:239-47; discussion 247-57.
  • [Favorable effect of breast feeding and late introduction of cow’s milk on the prevention of suspected allergic symptoms in infancy] Arató A, Szalai K, Tausz I, Szönyi L. Orv Hetil. 1996 Sep 8;137(36):1979-82. Review.
  • Maintenance of tolerance to cow’s milk in atopic individuals is characterized by high levels of specific immunoglobulin G4. Ruiter B, Knol EF, van Neerven RJ, Garssen J, Bruijnzeel-Koomen CA, Knulst AC, van Hoffen E. Clin Exp Allergy. 2007 Jul;37(7):1103-10.
  • [Use of an amino-acid-based formula in the treatment of cow’s milk protein allergy and multiple food allergy syndrome] Kanny G, Moneret-Vautrin DA, Flabbee J, Hatahet R, Virion JM, Morisset M, Guenard L. Allerg Immunol (Paris). 2002 Mar;34(3):82-4.
  • [Severe and unusual clinical manifestations of intolerance to cow’s milk protein in 3 patients under 12 months of age]Pela I, Materassi D, Chiappini E, Silberhorn H, Zammarchi E. Pediatr Med Chir. 2001 Jan-Feb;23(1):65-7.
  • Supplementary feeding in maternity hospitals and the risk of cow’s milk allergy: A prospective study of 6209 infants. Saarinen KM, Juntunen-Backman K, Järvenpää AL, Kuitunen P, Lope L, Renlund M, Siivola M, Savilahti E. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):457-61.
  • Higher serum eosinophil cationic protein levels in children with cow’s milk allergy. Hidvégi E, Cserháti E, Kereki E, Arató A. J Pediatr Gastroenterol Nutr. 2001 Apr;32(4):475-9.
  • Frequency of cow’s milk allergy in childhood. Høst A. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):33-7. Review.
  • Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Høst A. Pediatr Allergy Immunol. 1994;5(5 Suppl):1-36. Review.
  • The natural history of cow’s milk protein allergy/intolerance. Høst A, Jacobsen HP, Halken S, Holmenlund D. Eur J Clin Nutr. 1995 Sep;49 Suppl 1:S13-8. Review.
  • Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Høst A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Pediatr Allergy Immunol. 2002;13 Suppl 15:23-8.
  • Natural course of cow’s milk allergy in childhood atopic eczema/dermatitis syndrome. Oranje AP, Wolkerstorfer A, de Waard-van der Spek FB. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):52-5. Review.
  • Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Osborn DA, Sinn J. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003664. Review.
  • Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Osborn DA, Sinn J. Cochrane Database Syst Rev. 2003;(4):CD003664. Review. Update in: Cochrane Database Syst Rev. 2006;(4):CD003664.
  • Cow’s milk protein allergy. A multi-centre study: clinical and epidemiological aspects. Martorell A, Plaza AM, Boné J, Nevot S, García Ara MC, Echeverria L, Alonso E, Garde J, Vila B, Alvaro M, Tauler E, Hernando V, Fernández M. Allergol Immunopathol (Madr). 2006 Mar-Apr;34(2):46-53.
  • Prevention of allergic disease in childhood: clinical and epidemiological aspects of primary and secondary allergy prevention. Halken S. Pediatr Allergy Immunol. 2004 Jun;15 Suppl 16:4-5, 9-32. Review.
  • Anaphylaxis to cow’s milk and beef meat proteins. Eigenmann PA. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):61-4. Review.
  • A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Høst A, Halken S. Allergy. 1990 Nov;45(8):587-96.
  • Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Novembre E, Vierucci A. Allergy. 2001;56 Suppl 67:105-8. Review.
  • Cow’s milk protein allergy after neonatal intestinal surgery.] El Hassani A, Michaud L, Chartier A, Penel-Capelle D, Sfeir R, Besson R, Turck D, Gottrand F. Arch Pediatr. 2005 Feb;12(2):134-9. French.
  • Rectal bleeding in infancy: clinical, allergological, and microbiological examination. Arvola T, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E. Pediatrics. 2006 Apr;117(4):e760-8.PMID: 16585287
  • Cow’s milk allergy: a new understanding from immunology. Walker-Smith J. Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):81-3. Review
  • Development of food allergies with special reference to cow’s milk allergy. Foucard T. Pediatrics. 1985 Jan;75(1 Pt 2):177-81. Review.
  • Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Hill DJ, Hosking CS, Heine RG. Ann Med. 1999 Aug;31(4):272-81. Review.
  • Double-blind, placebo-controlled cow’s milk challenge in children with alleged cow’s milk allergies, performed in a general hospital: diagnosis rejected in two-thirds of the children] Hospers IC, de Vries-Vrolijk K, Brand PL. Ned Tijdschr Geneeskd. 2006 Jun 10;150(23):1292-7. Dutch.
  • Incidence of IgE-mediated allergy to cow’s milk proteins in the first year of life] Sanz Ortega J, Martorell Aragonés A, Michavila Gómez A, Nieto García A; Grupo de Trabajo para el Estudio de la Alergia Alimentaria. An Esp Pediatr. 2001 Jun;54(6):536-9.
  • Adverse reactions to milk in infants. Kvenshagen B, Halvorsen R, Jacobsen M. Acta Paediatr. 2008 Feb;97(2):196-200.
  • Epidemiology, incidence and clinical aspects of food allergy. Businco L, Benincori N, Cantani A. Ann Allergy. 1984 Dec;53(6 Pt 2):615-22. Review.
  • Infant feeding patterns affect the subsequent immunological features in cow’s milk allergy. Saarinen KM, Savilahti E. Clin Exp Allergy. 2000 Mar;30(3):400-6.
  • Importance of the first meal on the development of cow’s milk allergy and intolerance. Høst A. Allergy Proc. 1991 Jul-Aug;12(4):227-32.
  • Concurrent cereal allergy in children with cow’s milk allergy manifested with atopic dermatitis. Järvinen KM, Turpeinen M, Suomalainen H. Clin Exp Allergy. 2003 Aug;33(8):1060-6.
  • Cow’s milk allergy in the first year of life. An Italian Collaborative Study. [No authors listed] Acta Paediatr Scand Suppl. 1988;348:1-14.
  • Challenge testing in children with allergy to cow’s milk proteins. Plaza Martín AM, Martín Mateos MA, Giner Muñoz MT, Sierra Martínez JI. Allergol Immunopathol (Madr). 2001 Mar-Apr;29(2):50-4.
  • Beef allergy in children with cow’s milk allergy; cow’s milk allergy in children with beef allergy. Martelli A, De Chiara A, Corvo M, Restani P, Fiocchi A. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):38-43. Review.
  • Persistent forms of cow’s milk allergy. Report of 6 cases] Ben Halima N, Krichen A, Mekki MA, Ben ML, Chabchoub I, Chaabouni M, Triki A, Karray A. Tunis Med. 2003 Sep;81(9):731-7.
  • A hydrolysed rice-based formula is tolerated by children with cow’s milk allergy: a multi-centre study. Fiocchi A, Restani P, Bernardini R, Lucarelli S, Lombardi G, Magazzù G, Marseglia GL, Pittschieler K, Tripodi S, Troncone R, Ranzini C. Clin Exp Allergy. 2006 Mar;36(3):311-6.
  • Markers of inflammation in the feces of infants with cow’s milk allergy. Saarinen KM, Sarnesto A, Savilahti E. Pediatr Allergy Immunol. 2002 Jun;13(3):188-94.
  • A prospective study of cow’s milk protein intolerance in Swedish infants. Jakobsson I, Lindberg T. Acta Paediatr Scand. 1979 Nov;68(6):853-9.
  • Natural history of cow’s milk allergy. An eight-year follow-up study in 115 atopic children. Cantani A, Micera M. Eur Rev Med Pharmacol Sci. 2004 Jul-Aug;8(4):153-64.
  • Cow’s milk protein-specific IgE concentrations in two age groups of milk-allergic children and in children achieving clinical tolerance. Sicherer SH, Sampson HA. Clin Exp Allergy. 1999 Apr;29(4):507-12.
  • Vomiting and gastric motility in infants with cow’s milk allergy. Ravelli AM, Tobanelli P, Volpi S, Ugazio AG. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):59-64.
  • Accuracy of specific IgE antibody assays for diagnosis of cow’s milk allergy. Ahlstedt S, Holmquist I, Kober A, Perborn H. Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):21-5.
  • Clinical evaluation of the tolerance for a soy-based special milk formula in children with cow’s milk protein intolerance/allergy (CMPI/CMPA)] Buts JP, Di Sano C, Hansdorffer S. Minerva Pediatr. 1993 May;45(5):209-13. Italian.
  • Double blind placebo controlled cow’s milk provocation for the diagnosis of cow’s milk allergy in infants and children] Schade RP, Meijer Y, Pasmans SG, Knulst AC, Kimpen JL, Bruijnzeel-Koomen CA. Ned Tijdschr Geneeskd. 2002 Sep 14;146(37):1739-42.
  • Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow’s milk allergy. Maloney J, Nowak-Wegrzyn A. Pediatr Allergy Immunol. 2007 Jun;18(4):360-7. Review.
  • Cow’s milk allergy, incidence and pathogenetic role of early exposure to cow’s milk formula. Stintzing G, Zetterström R. Acta Paediatr Scand. 1979 May;68(3):383-7.
  • Bahna SL. Cow’s milk allergy versus cow milk intolerance.Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):56-60. Review.
  • The predictive value of specific immunoglobulin E on the outcome of milk allergy. Rottem M, Shostak D, Foldi S. Isr Med Assoc J. 2008 Dec;10(12):862-4.
  • Evidence of very delayed clinical reactions to cow’s milk in cow’s milk-intolerant patients. Carroccio A, Montalto G, Custro N, Notarbartolo A, Cavataio F, D’Amico D, Alabrese D, Iacono G. Allergy. 2000 Jun;55(6):574-9.
  • Exposure to cow’s milk during the first 3 months of life is associated with increased levels of IgG subclass antibodies to beta-lactoglobulin to 8 years. Jenmalm MC, Björkstén B. J Allergy Clin Immunol. 1998 Oct;102(4 Pt 1):671-8.
  • The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: a systematic review. Hill DJ, Murch SH, Rafferty K, Wallis P, Green CJ. Clin Exp Allergy. 2007 Jun;37(6):808-22. Review.
  • Gastroesophageal reflux and cow’s milk allergy in infants: a prospective study. Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, Soresi M, Notarbartolo A. J Allergy Clin Immunol. 1996 Mar;97(3):822-7.
  • Gastrointestinal manifestations of cow’s milk protein allergy during the first year of life. Yimyaem P, Chongsrisawat V, Vivatvakin B, Wisedopas N. J Med Assoc Thai. 2003 Feb;86(2):116-23.
  • acono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998;339:1100–1104
  • Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL. Milk-induced pulmonary disease in infants (Heiner syndrome). Pediatr Allergy Immunol. 2005;16:545–552
  • Liccardi G, De Falco F, Gilder JA, D’Amato M, D’Amato G. Severe systemic allergic reaction induced by accidental skin contact with cow milk in a 16-year-old boy. A case report. J Investig Allergol Clin Immunol. 2004;14:168–171
  • Hallett R, Haapanen LA, Teuber SS. Food allergies and kissing. N Engl J Med. 2002;346:1833–1834
  • Liccardi G, Senna G, Rotiroti G, D’Amato G, Passalacqua G. Intimate behavior and allergy: a narrative review. Ann Allergy Asthma Immunol. 2007;99:394–400
  • Bonadonna P, Senna G, Passalacqua G. Dermatological powder as hidden cause of occupational allergy due to casein: a case report. Occup Environ Med. 2003;60:609–610
  • Vargiu A, Vargiu G, Locci F, Del Giacco S, Del Giacco GS. Hypersensitivity reactions from inhalation of milk proteins. Allergy. 1994;49:386–387
  • Joshi P, Mofidi S, Sicherer SH. Interpretation of commercial food ingredient labels by parents of food-allergic children. J Allergy Clin Immunol. 2002;109:1019–1021
  • Muñoz-Furlong A, Weiss CC. Characteristics of food-allergic patients placing them at risk for a fatal anaphylactic episode. Curr Allergy Asthma Rep. 2009;9:57–63
  • Nowak-Wegrzyn A, Shapiro GG, Beyer K, Bardina L, Sampson HA. Contamination of dry powder inhalers for asthma with milk proteins containing lactose. J Allergy Clin Immunol. 2004;113:558–560
  • Eda A, Sugai K, Shioya H, Fujitsuka A, Ito S, Iwata T, et al. Acute allergic reaction due to milk proteins contaminating lactose added to corticosteroid for injection. Allergol Int. 2009;58:137–139
  • de Boissieu D, Matarazzo P, Rocchiccioli F, Dupont C. Multiple food allergy—a possible diagnosis in breastfed infants. Acta Pediatr. 1997;86:1042–1046

Links Article Cow’s Milk Allergy

Provided by


Yudhasmara Foundation htpp://

WORKING TOGETHER FOR STRONGER, SMARTER AND HEALTHIER CHILDREN BY EDUCATION, CLINICAL INTERVENTION, RESEARCH AND INFORMATION NETWORKING. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult



  • Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation
  • Dr Widodo Judarwanto SpA, Pediatrician
  • Fisioterapis

Clinical and Editor in Chief :

Dr Widodo Judarwanto, pediatrician email :, Curiculum Vitae

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Copyright © 2012, Children Allergy Clinic Online Information Education Network. All rights reserved

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:


You are commenting using your account. Logout /  Ubah )

Foto Google

You are commenting using your Google account. Logout /  Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout /  Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout /  Ubah )

Connecting to %s