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. 2024 Aug 12;17(8):100931. doi: 10.1016/j.waojou.2024.100931

Table 1.

Different presentations of cow's milk allergy

Mechanism IgE-mediated CMA Non-IgE, cell mediated or mixed pathophysiology CMA
Symptoms Skin: urticaria, angioedema; GI: throat swelling, crampy abdominal pain, immediate emesis, diarrhea; Respiratory: rhinorrhea, sneezing, laryngospasm, cough, bronchspasm; CV: tachycardia, low blood pressure; Generalized: anaphylaxis Chronic:
Skin: eczematous skin rash; GI: nausea, emesis, reflux, abdominal pain, diarrhea, malabsorption, rectal bleeding
Generalized: poor weight gain, failure to thrive, stunting
Acute-FPIES:
GI: projectile emesis, abdominal pain, diarrhea;
CV: tachycardia, hypotension, hypovolemic/distributive shock; Generalized: pallor, lethargy
Onset of symptoms following food ingestion Within minutes to 2 h Generally within hours to days; exception acute FPIES-onset of emesis within 2–4 h
Diagnosis Detection of food-sIgE by skin prick test and serologic tests, oral food challenge Recognition of symptoms, response to diagnostic elimination diet (2–4 weeks); FPIES-meeting the diagnostic criteria
Management -acute symptoms Antihistamines, epinephrine, inhaled bronchodilator, oxygen, intravenous fluids FPIES: rehydration (oral or intravenous), ondansetron (oral or parenteral), single dose of a steroid for severe symptoms
Management-dietary Dietary food avoidance, majority tolerate cow's milk in the form of baked foods Dietary food avoidance; a subset of patients might tolerate cow's milk in the form of baked foods
Natural history Favorable, generally outgrown before school age; children reacting to baked milk or with peak cow's milk-sIgE >50 kUa/L tend to have a more prolonged course Favorable, usually outgrown by age 1–3 years
HHS Vulnerability Disclosure