The European Society for Clinical Nutrition and Metabolism’s journal, Clinical Nutrition ESPEN, has recently published a seminal article authored by a formidable team of researchers led by Prof. Yvan Vandenplas, a reputed paediatric gastroenterologist affiliated with the KidZ Health Castle, UZ Brussel, and the Vrije Universiteit Brussel (VUB) in Brussels, Belgium. The article, titled “Food allergy: Prevention and treatment of Cow’s milk allergy,” presents novel insights into the ongoing challenges and emerging strategies in the management of cow’s milk allergy (CMA).

DOI: 10.1016/j.clnesp.2023.11.007

Cow’s milk allergy, a Food Hypersensitivity condition that affects infants and young children, has significant health implications. With a comprehensive analysis authored by experts including Prof. Vandenplas, Dr. Rosan Meyer from Imperial College London and Winchester University, and Dr. Koen Huysentruyt, also from KidZ Health Castle and VUB, this article serves as a valuable resource for clinicians and researchers alike.

The prevalence of CMA has been a growing concern internationally, urging medical professionals to explore innovative, evidence-based avenues for prevention and treatment. As outlined in the journal, the authors discuss the role of genetic predisposition, early-life environmental exposures, and the importance of recognizing nuances in clinical presentations of CMA.

Prevention of Cow’s Milk Allergy: Strategies for Risk Reduction

The Clinical Nutrition ESPEN article posits that proactive strategies can mitigate CMA risk. Breastfeeding serves as a primary intervention; however, in cases where it is not feasible, the use of hydrolyzed infant formulas is recommended. Research indicates that exposing infants to hydrolyzed proteins can modulate the immune system and potentially prevent the onset of food allergies.

Another frontier highlighted in the article is early dietary diversification. The introduction of solid foods, including potential allergens like cow’s milk, between the ages of 4 to 6 months may be considered to promote tolerance. This approach, however, must be carefully managed and personalized based on an infant’s risk profile.

Treatment of Cow’s Milk Allergy: Emerging Perspectives

Key recommendations for CMA management center on eliminating cow’s milk protein from the diet. Alternative options with meticulously balanced nutritional profiles are essential to ensure the infant’s optimal growth and development. This includes extensively hydrolyzed formulas (eHFs) and amino acid-based formulas (AAFs) for those with a severe allergy or who do not tolerate eHFs.

Oral immunotherapy (OIT), a method by which small, gradually increasing doses of cow’s milk are administered under medical supervision, is a therapeutic avenue gaining traction. Though it holds promise, the article underscores that OIT harbors risks such as adverse reactions and is not yet universally recommended as a standard treatment.

Advancing Research and Practice: The Future Landscape of Cow’s Milk Allergy

The comprehensive synthesis of current knowledge in Clinical Nutrition ESPEN accentuates the necessity for continued interdisciplinary research into CMA’s genetic, immunological, and environmental dimensions. The authors advocate for a personalized approach to prevention and treatment, tailored according to individual risk factors, severity of allergy, and response to treatment.

Future studies will be crucial to enhance understanding of CMA’s pathophysiology and to evaluate novel therapeutic agents that may induce tolerance more effectively and safely. Moreover, the establishment of clear guidelines that delineate protocols for weaning children with CMA from alternative formulas to cow’s milk is very much a needed development in pediatric allergy practice.


Prof. Vandenplas and his colleagues provide a lucid, evidence-driven analysis of CMA in the article published in Clinical Nutrition ESPEN. Their findings are a testament to the intricate interplay between preventive strategies and therapeutic interventions in managing food hypersensitivities. They emphasize the dynamic nature of CMA management, necessitating ongoing vigilance, adaptation, and research-led practice.

For primary care physicians, paediatricians, gastroenterologists, allergists, dietitians, and other healthcare professionals dealing with CMA, this article constitutes a significant advancement in comprehending and addressing this widespread condition, with potential to enhance the quality of life of affected individuals and their families.


1. Vandenplas, Y., Meyer, R. M., & Huysentruyt, K. (2024). Food allergy: Prevention and treatment of Cow’s milk allergy. Clinical Nutrition ESPEN, 59, 9-20.
2. Ho, M. H., Wong, W. H., & Chang, C. (2014). Clinical spectrum of food allergies: a comprehensive review. Clinical Reviews in Allergy & Immunology, 46(3), 225-240.
3. Sicherer, S. H., & Sampson, H. A. (2014). Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical Immunology, 133(2), 291-307.
4. Nowak-Węgrzyn, A., & Warren, C. M. (2017). Food allergies: Guidelines, practice parameters, and update from the NIAID. Pediatric Clinics of North America, 64(4), 881-897.
5. Fiocchi, A., Brozek, J., Schünemann, H., Bahna, S. L., von Berg, A., Beyer, K., … & Bindslev-Jensen, C. (2018). World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. World Allergy Organization Journal, 4(1), 1-17.


1. Cow’s Milk Allergy
2. Food Hypersensitivity
3.Infant Allergy Prevention
4. Clinical Nutrition ESPEN
5. Oral Immunotherapy for Allergies