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Approach to milk protein allergy in infants

Correspondence to: Dr Herbert Brill, Division of Gastroenterology and Nutrition, Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON L8S 3Z5; telephone 905 521-2100, extension 75637; fax 905 521-2655; e-mailbrillh{at}mcmaster.ca

OBJECTIVE To provide a practical, evidence-based approach to the diagnosis and management of milk protein allergy in infants.

SOURCES OF INFORMATION MEDLINE was searched from 1950 to March 2008 using the MeSH heading milk-hypersensitivity. Additional sources were derived from reviews found with the initial search strategy. Evidence was levels I, II, and III.

MAIN MESSAGE Milk protein allergy is a recognized problem in the first year of life; cow’s milk protein allergy is the most common such allergy. Diagnosis is suspected on history alone, with laboratory evaluations playing a supporting role. Confirmation requires elimination and reintroduction of the suspected allergen. Management includes diet modification for nursing mothers and hydrolyzed formulas for formula-fed infants. Assessing the underlying immunopathology can aid in determining prognosis.

CONCLUSION The therapeutic model presented allows rapid assessment of the presence of allergy, timely management, and surveillance for recurrence of symptoms. Breastfeeding can be continued with attentive diet modification by motivated mothers.