title: Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics.
abstract: The diagnosis of cows' milk protein allergy (CMPA) requires first the suspicion of diagnosis based on symptoms described in the medical history, and, second, the elimination of cows' milk proteins (CMP) from the infant's diet. Without such rigorous analysis, the elimination of CMP is unjustified, and sometimes harmful. The elimination diet should be strictly followed, at least until 9-12 months of age. If the child is not breast fed or the mother cannot or no longer wishes to breast feed, the first choice is an extensively hydrolysed formula (eHF) of CMP, the efficacy of which has been demonstrated by scientifically sound studies. If it is not tolerated, an amino acid-based formula is warranted. A rice protein-based eHF can be an alternative to a CMP-based eHF. Soya protein-based infant formulae are also a suitable alternative for infants >6 months, after establishing tolerance to soya protein by clinical challenge. CMPA usually resolves during the first 2-3 years. However, the age of recovery varies depending on the child and the type of CMPA, especially whether it is IgE-mediated or not, with the former being more persistent. Once the child reaches the age of 9-12 months, an oral food challenge is carried out in the hospital ward to assess the development of tolerance and, if possible, to allow for the continued reintroduction of CMP at home. Some children with CMPA will tolerate only a limited daily amount of CMP. The current therapeutic options are designed to accelerate the acquisition of tolerance thereof, which seems to be facilitated by repeated exposure to CMP.
authors: Service d'Explorations Fonctionnelles Digestives Pédiatriques, Hôpital Necker-Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, Paris, France. christophe.dupont@nck.aphp.fr
authors: C
authors: C
authors: Dupont
authors: J P
authors: JP
authors: Chouraqui
authors: D
authors: D
authors: de Boissieu
authors: A
authors: A
authors: Bocquet
authors: J L
authors: JL
authors: Bresson
authors: A
authors: A
authors: Briend
authors: D
authors: D
authors: Darmaun
authors: M L
authors: ML
authors: Frelut
authors: J
authors: J
authors: Ghisolfi
authors: J P
authors: JP
authors: Girardet
authors: O
authors: O
authors: Goulet
authors: R
authors: R
authors: Hankard
authors: D
authors: D
authors: Rieu
authors: M
authors: M
authors: Vidailhet
authors: D
authors: D
authors: Turck
mesh_terms: D000596:Amino Acids / Q000627:therapeutic use; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D005062:European Union; D005602:France; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D007225:Infant Food / Q000009:adverse effects; D041943:Infant Formula / Q000737:chemistry*; D016269:Milk Hypersensitivity / Q000178:diet therapy* / Q000276:immunology; D008894:Milk Proteins / Q000009:adverse effects*; D009753:Nutritive Value; D010940:Plant Proteins / Q000627:therapeutic use; D011492:Protein Hydrolysates / Q000627:therapeutic use; D012075:Remission, Spontaneous
chemical_list: D000596:Amino Acids; D008894:Milk Proteins; D010940:Plant Proteins; D011492:Protein Hydrolysates