Challenges and Pitfalls in the Diagnosis and Management of Non-IgE Cows Milk Protein Allergy: Two Cases

Nicolaos Nicolaou, Amir H. Abdul Latiff, Urszula Kudla, Leilani Muhardi


As the incidence of cows milk protein allergy (CMPA) has increased in the last decades in both breastfed and formula fed infants, possible pitfalls in its diagnosis and management are also increasing. This is especially evident in non-IgE milk allergy due to the considerable delay between the appearance of clinical symptoms after ingestion of the allergen, and the non-specific gastrointestinal symptoms that characterize it. The misdiagnosis could often be combined with inappropriate use of either partially hydrolyzed or amino acid-based infant formula for the management of symptoms. The aim of the paper is to present two cases to illustrate common pitfalls in diagnosis and management of CMPA with divergent gastrointestinal syndrome manifestations: food protein-induced allergic proctocolitis and food protein-induced enterocolitis syndrome, in an effort to increase awareness of these conditions and to guide clinicians in day-to-day practice when facing suspected cases of CMPA.

Int J Clin Pediatr. 2020;9(3):98-102


Cow’s milk protein allergy; Non-IgE-mediated; Food protein-induced enterocolitis syndrome; Food protein-induced allergic proctocolitis; Extensive hydrolysate formula

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