Allergic Reaction to Cow’s Milk Protein in Children – Nutritional Deficiencies and Diet

Immunologically mediated hypersensitivity to cow’s milk proteins represents one of the most prevalent allergic conditions among infants and young children, with initial clinical manifestations typically emerging between 6 and 12 months of age. Epidemiological evidence suggests that this condition affects approximately 2–3% of the pediatric population within the 0–24-month age range. Biochemical research has identified over forty distinct protein fractions in cow’s milk with potential allergenic properties, among which caseins (comprising roughly 80% of total milk proteins) and whey proteins (approximately 20%) play dominant roles. What warning signs should prompt caregivers to seek specialist evaluation? In mild to moderate cases of cow’s milk protein allergy, the following symptoms may be observed: recurrent episodes of food regurgitation, persistent posseting, vomiting, disturbances in bowel habits (diarrhea or chronic constipation), the presence of blood in stool, the development of microcytic anemia due to iron deficiency, heightened irritability, severe colicky abdominal pain, and dermatological manifestations such as atopic dermatitis (AD). Conversely, severe allergic reactions may present with: compromised nutritional status (stemming from chronic diarrhea, frequent vomiting, and loss of appetite), blood in stool, exacerbation of skin lesions characteristic of AD, decreased hemoglobin levels, hypoproteinemia, and the onset of enteropathy with impaired nutrient absorption. Additionally, respiratory symptoms—such as wheezing or chronic cough—may occur in certain cases.

The initial 1000-day window—spanning from conception through the first two years of life—constitutes a pivotal phase of accelerated psychomotor and physiological maturation, during which an infant’s body exhibits an elevated demand for high-quality nutritional components: macronutrients (proteins, fats, carbohydrates), micronutrients (minerals, vitamins), electrolytes, and fluids. A confirmed diagnosis of **cow’s milk protein allergy (CMPA)** necessitates the implementation of a **strict elimination diet**, which excludes not only dairy products *per se* but also processed foods containing concealed allergenic traces—such as pre-packaged meals, commercial baked goods, or confectionery. Such stringent dietary restrictions carry a substantial risk of inducing both **quantitative undernutrition** (inadequate caloric intake leading to weight deficiency) and **qualitative undernutrition** (specific nutrient deficiencies despite sufficient energy supply). Children with CMPA frequently exhibit growth retardation and reduced body weight, attributable to multifaceted disruptions: diminished appetite, chronic diarrhea, and vomiting (compromising nutrient retention), alongside impaired intestinal absorption due to mucosal inflammation. The most clinically significant deficiencies include: **protein** (critical for tissue synthesis), **calcium and phosphorus** (vital for bone mineralization), **vitamin A** (governing visual adaptation), **vitamin D** (facilitating calcium-phosphorus homeostasis), **B-complex vitamins**—notably **riboflavin (B2)** and **pantothenic acid (B5)** (involved in energy metabolism), **cyanocobalamin (B12)** (essential for erythropoiesis), and **DHA fatty acids** (pivotal for neurogenesis and cognitive development).

In the case of breastfed infants, the mother should follow a restrictive lactose-free diet for a period of 26 weeks in order to confirm the child's allergy at the time of diagnosis and after further diagnosis. It is recommended that, in agreement with a healthcare professional, the use of an elimination diet, which excludes the consumption of products that are a source of cow's milk protein, etc. In addition, in case of infants who are breast-fed, a restricted diet should be followed for 2 6 weeks to confirm their allergy during and after diagnosis.