CMPA is the most common food allergy in infants. Milk is ranked among the top eight offenders for food allergies, Between 5% and 15% of infants show symptoms suggesting adverse reactions to cow’s milk protein (CMP). Differences in diagnostic criteria and study design contribute to the wide range of prevalence estimates and underline the importance of an accurate diagnosis.

It is an immunological reaction to one or more milk proteins. This happens due to the lack of the immune system ( IS) to learn to recognize milk proteins as being harmless. (IS) is falsely alerted that a harmful body has entered the body and tries to eliminate it as if it were a bacteria, a virus, or a harmful chemical

According to the guidelines from the national institute of Allergy and infectious disease: IgE-mediated, Non IgE-mediated, and Mixed mediated.Also can be classified according to the onset of symptoms to immediate reaction within 45 minutes, intermediate reaction between 45 minutes to 20 hours, and late reaction after 20 hours.

More than 25 proteins in cow’s milk can induce antibody production in humans, reactions have occurred to all the major cow’s milk antigensβ-lactoglobulin (in whey), casein, and bovine serum albumin are the most important antigens. Human milk lacks αs1 and αs2 caseins and β – lactoglobulin, These tend to be the most frequent allergens in cow’s milk. Many goat’s milk proteins cross-react with cow’s milk proteins

Predisposing factors to cow milk protein allergy are Genetic predisposition – family history of CMA, Early exposure to cow’s milk – in utero – in the newborn nursery, and Exposure to cow’s milk allergens – in mother’s milk, 68% breast-fed infants with IgE-mediated CMA had received some CMA in the newborn nursery.

It can be clinically presented with The involvement of 2 or more systems of skin, GIT, and respiratory increases the probability of CMPA, Studies on infants with CMPA showed that half of them have atopic eczema, and 25-50% are affected by GIT manifestations whereas other clinical manifestations are less common

Without an appropriate diagnostic workup, including milk challenge procedures, there is a high risk of both over- and underdiagnosis and thus over-and undertreatment. The challenge remains to make a correct diagnosis while minimizing the burden to patient and family, A correct diagnosis allows the appropriate diet to be given to affected infants, thus supporting normal growth and development.

If symptoms are relevant and CMPA is likely, a diagnostic elimination of CMP should be initiated for a limited period of time, even in cases with negative results, If there is no improvement within the timelines, then CMPA is unlikely. For the formula feed infants avoid all cow’s milk-based formula and supplementary foods containing it. Start eHFm In severe symptoms start AAF.

Treatment by Strict avoidance of CMP is the safest strategy, Choosing the substitute formula. In babies below one year: use the therapeutic formula for 12 months. Children with severe immediate IgE-mediated reactions keep the elimination for 12 or even 18 months.

The prognosis is dependent on the patient’s age ( early presentation is more risky), Titre of specific IgE at the time of diagnosis ( high titer is more risky). The good things are that 50% of children develop tolerance by age 1 yr, 75% by age 3 yrs, and 90% by age 6 yrs but the bad things are that 25% will develop respiratory allergies, 50% of children with CMPA were also allergic to egg and soy and 30% to peanut.

Biography:

Dr. Wael Abdelaal is Pediatrician whose experience in the field spans 22 years, backed by a higher education degree from royal college of paediatrics’ child health in UK,in addition to master degree from Zagazig university in Egypt, Ph, D. Degree from Ain shams university which is one of the oldest and top ranking universities in the MENArea, Hospital managment and total quality managment from American university. He is pioneering an open and contextual evaluation model based on constructive responses, which has led in the creation of new methods  to  improve  pediatric  healthcare, neonatology  and  pediatric  nutrition.  Dr.Wael has established this model following his years of experiences in  medical  practice,  research  and  evaluation,  and  teaching  and  administration  in hospitals and medical universities in the region, including Egypt, Kuwait, Qatar and the UAE Dr. Wael had published  several studies in reputable international journals in neonatology and paediatric nutrition. He has also presented his findings in prestigious international conferences and symposia. Cueently he is working as pediatrician in NMC Royal hospital Abu Dhabi and responsible for teaching program for interns.and auditingthe local pediatrics guidlines.