Areas of expertise / Cow’s milk protein allergy

Cow’s milk protein allergy

What are we talking about?

Cow’s milk protein allergy is a response of the immune system to the proteins found in cow’s milk – mainly casein and whey. This allergy can manifest itself in different forms and degrees of severity, from mild symptoms such as hives and itching, to more severe reactions such as difficulty breathing and anaphylaxis (1,2).

Prevalence and consequences

Milk protein allergy is one of the most common food allergies worldwide, affecting both children and adults. It is estimated to affect about 1% of adults and approximately 3% of children under three years of age, although most children outgrow it over time (1,2).

The consequences of this allergy can be significant, as even small amounts of milk protein can trigger severe allergic reactions in sensitive individuals. These reactions can range from mild skin symptoms to more severe respiratory and gastrointestinal symptoms, and even a life-threatening reaction (2).

Milk protein allergy can also have an emotional and social impact on sufferers, as it requires constant dietary monitoring and can affect quality of life and social interactions (1).

The role of oral nutritional supplements

With cow’s milk protein allergy, oral nutritional supplements are vital, offering essential nutrients often scarce in the limited diets of those affected. These supplements guarantee nutritional needs are met, even with severe dietary restrictions.

For infants and children who not breastfed and are diagnosed with this allergy, several customized formula options are available to cater to their specific needs. These include partially hydrolyzed formulas for enhanced digestibility, extensively hydrolyzed formulas consisting of small peptides, and amino acid-based formulas designed for the most severe allergic reactions (2,3).

Frequent questions

1. How is cow's milk protein allergy different from lactose intolerance?

Lactose intolerance occurs when the small intestine cannot digest milk sugar (lactose) due to a lack of an enzyme called lactase. It is usually genetic in origin or may be related to inflammatory diseases of the small intestine.

It mainly affects adults and is rare in children. Symptoms include abdominal bloating, abdominal cramps, flatulence, diarrhea, nausea and vomiting.

In short, lactose intolerance is related to the inability to digest milk sugar, while cow’s milk protein allergy is an immunological reaction to the proteins present in milk (1).

2. Is it possible to overcome milk protein allergy over time or is it a permanent condition?

The ability to overcome a dairy protein allergy varies from person to person. In some cases, especially in children, the allergy may disappear over time as the immune system develops and adapts. However, in other cases, the allergy may persist into adulthood. The possibility of overcoming the allergy depends on several factors, such as the severity of the allergy, the patient’s age, and other genetic and environmental factors. It is important to evaluate the individual condition and determine the best long-term management approach (2).

3. What are the amino acid-based formulas?

Amino acid-based formulas represent the most hypoallergenic option as they contain individual amino acids rather than whole proteins. These formulas are suitable for individuals with the most severe allergic reactions to cow’s milk protein, ensuring they receive essential nutrients without triggering adverse reactions (1).


  1. Rev. chil. pediatr. Update on management of cow’s milk protein allergy: Available milk formulas and other juices. 2018.
  2. Vandenplas Y, Brough HA, Fiocchi A, Miqdady M et al. Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy. J Asthma Allergy. 2021.
  3. Fox A, Lovis MT. The Milk Allergy in Primary Care (MAP) Guideline 2019. GPIFN.

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