Cow's milk alternatives for children with cow's milk protein allergy-Review of health benefits and risks of allergic reaction

Cow's milk protein allergy (CMPA) is considered as the most common food allergy in early life and may cause anaphylaxis reactions in severe cases. This review summarises recent findings in CMPA studies, especially regarding the main relevant cow's milk substitutes such as hydrolysed and plant-based (soy and rice) formulas in addition to other mammalian milk types (goat, sheep, donkey, mare and camel) to reduce allergy risks for children. Extensively hydrolysed cow's milk formulas are mainly used as an alternative for children with CMPA, despite their poor palatability. Goat's and sheep's milk and soy-based formulas are not recommended because of their high cross-reactivity with cow's milk proteins. On the contrary, equine's and camel's milk proteins are suggested as suitable alternative solutions due to their low sequence identity levels with cow's milk proteins. Nonetheless, further research needs to confirm the usefulness of these milk types as a solution in paediatric CMPA.(c) 2023 Elsevier Ltd. All rights reserved.