Allergic reactions to cow’s milk: pathomechanism, diagnostic and therapeutic strategies, possibilities of food tolerance induction

Abstract

Cow’s milk is one of the most common causes of allergic reactions in children. Present review summarizes the current knowledge on the pathogenesis, diagnostics and possible therapeutic strategies in this type of allergic immune response. Hypersensitivity reaction to milk components can be mediated by humoral or cell mediated response. There are also mixed types of reactions, in which both, cells and IgE antibodies are involved. The pathomechanism of delayed-type hypersensitivity to cow’s milk is still not clear, but possibly it involves Th1 lymphocytes and macrophages. Clinical manifestations of allergy to cow’s milk may be different, depending on the underlying mechanism. Routine diagnostic methods are based on specific IgE-antibodies detection in patients serum, but, if food allergy is suspected, it’s necessary to also conduct other tests for eventual exclusion of non-IgE-mediated allergy. Immediate and accurate diagnosis allows to avoid serious gastro-intestinal complications, which may lead to children developmental disabilities and also weakening of the intestinal epithelium. Other potential food allergens may penetrate through impaired intestinal barrier to bloodstream, where they can induce allergic reaction. Recommended therapeutic strategy consists of elimination of offending food from child diet. Currently, it’s possible to identify the specific protein responsible for hypersensitivity reaction. It could be especially important if one of them is bovine serum albumin, because it may be necessary to also exclude beef from diet. Safety and effectiveness of alternative immunotherapies are still being investigated. The majority of children acquire tolerance to cow’s milk by the age of 5.