Modern Pediatrics. Ukraine. (2025).8(152): 79-86. doi: 10.15574/SP.2025.8(152).7986
Shulhai O. M.¹, Hlushko K. T.¹, Mochulska O. M.¹, Shostak I. Y.²
¹I. Horbachevsky Ternopil National Medical University, Ukraine
²Ternopil Regional Children’s Clinical Hospital, Ukraine

For citation: Shulhai OM, Hlushko KT, Mochulska OM, Shostak IY. (2025). Cow’s milk protein allergy in children: a contemporary approach to diagnosis and management (literature review). Modern Pediatrics. Ukraine. 8(152): 79-86. doi: 10.15574/SP.2025.8(152).7986.
Article received: Jun 18, 2025. Accepted for publication: Dec 15, 2025.

Cow’s milk protein allergy (CMPA) is an allergic reaction to the proteins found in cow’s milk. Diagnosing this condition can be challenging, as it is primarily based on clinical history and physical examination. It is important for physicians to differentiate between milk allergy and milk intolerance, as the approaches to diagnosis and treatment of these two conditions differ.
Aim – to summarize the literature on the epidemiology, clinical manifestations, diagnostic methods, and treatment of cow’s milk allergy.
Immune-mediated adverse food reactions are classified as IgE-mediated, non-IgE-mediated (with the latter being most commonly responsible for CMPA), and mixed forms (involving both IgE- and non-IgE-mediated mechanisms). CMPA should be suspected in children who develop immediate symptoms such as anaphylaxis, laryngeal edema, acute urticaria or angioedema, as well as acute asthma with severe respiratory distress. Delayed reactions may include blood in stools, atopic dermatitis, chronic diarrhea, iron deficiency anemia, gastroesophageal reflux disease, chronic vomiting, colic, constipation, failure to thrive, food refusal, enterocolitis syndrome, enteropathy with hypoalbuminemia, and eosinophilic esophagogastroenteritis. The Cow’s Milk-related Symptom Score (CoMiSS™) is a modern clinical screening tool developed to aid healthcare professionals in the early diagnosis of CMPA and to raise awareness about this condition. The use of food antigen-specific IgG testing panels should be avoided, as they are not evidence-based and may lead to overdiagnosis of presumed food intolerance.
Conclusions. CMPA should not be confused with cow’s milk intolerance, which is relatively rare in infants. For breastfed infants, formula supplementation during the first 24 hours of life is not recommended, as it increases the risk of developing CMPA. Mothers and healthcare providers should be aware of the benefits of exclusive breastfeeding and be supported with appropriate resources to avoid unnecessary formula supplementation and reduce the risk of CMPA.
The authors declare no conflict of interest.
Keywords: cow’s milk protein allergy, IgE-mediated reaction, non-IgE-mediated reaction, diagnosis, treatment.

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