title: [Diagnosis and management of cow's protein milk allergy in infant].
abstract: BACKGROUND
  Cow's milk protein allergy (CMPA) can be responsible of a variety of symptoms and can be caused by IgE or non-IgEmediated reactions. The remaining questions concern the diagnosis (what are the most suggestive clinical manifestations, the laboratory evaluations which play a supporting role, and the management of CMPA in breast fed infants and formula-fed infants.
  
  
  METHODS
  Review of the pub med, science direct, Cochrane library, using the key words cow's milk protein allergy, guideline, and child. Evidence was levelled A, B, C.
  
  
  RESULTS
  No symptom is pathognomonic. A thorough history and careful clinical examination are necessary to suspect the disease. Skin prick tests, and serum specific IgE are only indicative of sensitivation to CMP. A double-blind placebo-controlled challenge is considered the gold standard in diagnosis, but in practice only an open challenge is performed. The patient with suspected pathology will follow a cow's milk free diet for 2-4 weeks. Formula-fed infants get an extensively hydrolyzed formula .If the allergy is present, clinical manifestations will disappear. If symptoms do not improve, an amino acid based formula should be considered. In severe Cow's milk protein allergy with life-threatening symptoms, an amino-acid formula is recommended. The infant should be maintained on an elimination diet until the infant is between 9-12 months or at least for 6 months. The overall natural evolution of the disease is favorable with most patients achieving tolerance to milk by the age of five years.
  
  
  CONCLUSIONS
  The importance of defined diagnostic criteria needs to be emphasized. It precludes infants from an unnecessary diet and avoids delay in diagnosis, which can lead to malnutrition.
authors.forename: Sonia
authors.initials: S
authors.lastname: Mazigh
authors.forename: Salem
authors.initials: S
authors.lastname: Yahiaoui
authors.forename: Rania
authors.initials: R
authors.lastname: Ben Rabeh
authors.forename: Ilhem
authors.initials: I
authors.lastname: Fetni
authors.forename: Azza
authors.initials: A
authors.lastname: Sammoud
mesh_terms: D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D007223:Infant; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D008894:Milk Proteins / Q000009:adverse effects / Q000276:immunology*; D012882:Skin Tests / Q000379:methods
chemical_list: D008894:Milk Proteins; D007073:Immunoglobulin E