Introduction: The diagnosis and management of cow’s milk allergy (CMA) is a topic of debate
because there are no specific symptoms and reliable diagnostic tests.
Method: Literature was searched using databases to find original papers and reviews on this topic.
Results: A "challenge test" is still recommended as the most specific and sensitive diagnostic test, although
a positive challenge test does not proof the involvement of the immune system. Only in the
rare case of anaphylaxis, the challenge tests is not recommended.
The Cow’s Milk Symptom Score (CoMiSS) is an awareness tool for health care professionals to better
recognize symptoms caused by the ingestion of cow's milk, but still needs validation. Today, the recommended diagnostic
approach consists of an elimination diet with an extensive cow's milk based hydrolysate, followed by a challenge test.
Amino acid based formula is reserved for the severe cases. Rice hydrolysates are gaining popularity, because they have
been shown to be effective, have a better acceptability, and to be cheaper than the extensive cow’s milk based hydrolysates.
Soy infant formula may offer an additional alternative option as reviews concluded that about 10-15% of infants allergic
to cow's milk will also react to soy.
Gastro-intestinal microbiota manipulation may be of additional benefit in the treatment of CMA.
Conclusion: The development of rice hydrolysates challenge the use of Today, extensive cow’s milk based extensive hydrolysates
remain the first option for the majority of patients and amino acid formula for the most severe cases. Rice hydrolysates
and soy infant formula are considered as second choice options.