Treatment of Cow Milk Allergy

Amino acid-based formulas (AAF) and extensively hydrolysed formulas (eHF) are the only products that are regarded as “hypoallergenic” and suitable for the treatment of cow milk allergy. Only AAF are suitable for the treatment of both mild-moderate and severed cow milk allergy.

Currently the only treatment for cow milk allergy is total avoidance of cow's milk proteins.

If a milk allergy is diagnosed, the healthcare professional can prescribe a formula milk that is easy to use, palatable and enables optimal growth and development, that is also free from cow’s milk proteins.

Initially, if the infants are breastfed, a strict elimination of the causal protein from the diet of the lactating mother should be tried. If symptoms do not resolve or the infants are bottlefed, cow's milk substitute formulas are used to provide the infant with a complete source of nutrition, which does not provoke immune mediated symptoms.

Cow's milk substitutes include soybean formulas (but many infants with milk allergy are also allergic to soy milk) and hypoallergenic formulas based on hydrolysed proteins and amino acid-based formulas.

To be regarded as hypoallergenic, the American Academy of Pediatrics Nutritional Committee (AAPNC) has recommended that hypoallergenic formula be tolerated by 90% of children with proven cow’s milk allergy, with 95% confidence.
However, several studies have identified a group of infants with chronic symptoms due to intolerance of extensively hydrolysed formula (eHF). The use of amino acids-based formulas is safe in children intolerant to extensively hydrolysed formula and results in the resolution of even serious symptoms.

In some countries, milk from other animals such as goats, sheep and mares have traditionally been used for patients with cow milk allergy. But other species’ milk is not recommended for treatment of infants with CMA: these milks are not nutritionally complete, are poor sources of certain vitamins (especially folic acid and vitamins B6, B12, C and D) and is only tolerated in a handful of infants with cow milk allergy.