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Nutrients
Volume 17
Issue 11
10.3390/nu17111787
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role

by
Carlo Caffarelli
1,*,
Arianna Giannetti
2,
Enrico Vito Buono
1,
Daniela Cunico
1,
Roberta Carbone
1,
Federica Tonello
3 and
Giampaolo Ricci
4
1
Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, University of Parma, 43126 Parma, Italy
2
Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
3
Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
4
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
*
Author to whom correspondence should be addressed.
Nutrients 2025, 17(11), 1787; https://doi.org/10.3390/nu17111787 (registering DOI)
Submission received: 29 April 2025 / Revised: 21 May 2025 / Accepted: 23 May 2025 / Published: 24 May 2025
(This article belongs to the Special Issue Diet and Lifestyle Factors Associated with Allergic Diseases in Early Life)
Versions Notes

Abstract

Cow’s milk allergy is one of the most prevalent food allergies in infancy. Exclusive breastfeeding is the recommended source of nutrition for the first six months of life, but some infants may develop cow’s milk allergy due to the transfer of milk proteins such as β-lactoglobulin through breast milk. There are still many uncertainties about cow’s milk allergy in breastfed babies. The purpose of this review is to summarize the latest findings mainly focused on immunological mechanisms and challenges in diagnosis. We pointed out which clinical signs in breastfed infants are associated with immediate IgE responses and which are linked to delayed non-IgE mechanisms or mixed IgE/non-IgE-mediated reactions. Since standard IgE tests are often useless in non-IgE cases, diagnosis typically involves dietary elimination and cow’s milk challenge. This study addresses the controversial topic of maternal elimination diets, assessing the nutritional risks to both mothers and infants in relation to their possible benefits. It has also been discussed whether the microbiota signature could be a potential factor in both tolerance development and the risk of cow’s milk allergy in early life. Overall, accurate diagnosis and personalized treatment plans are vital to prevent overdiagnosis and ensure proper growth while maintaining the practice of breastfeeding.
Keywords: cow’s milk allergy; breastfed infants; IgE-mediated reactions; non-IgE mediated reactions; diagnosis; microbiota cow’s milk allergy; breastfed infants; IgE-mediated reactions; non-IgE mediated reactions; diagnosis; microbiota

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MDPI and ACS Style

Caffarelli, C.; Giannetti, A.; Buono, E.V.; Cunico, D.; Carbone, R.; Tonello, F.; Ricci, G. Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role. Nutrients 2025, 17, 1787. https://doi.org/10.3390/nu17111787

AMA Style

Caffarelli C, Giannetti A, Buono EV, Cunico D, Carbone R, Tonello F, Ricci G. Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role. Nutrients. 2025; 17(11):1787. https://doi.org/10.3390/nu17111787

Chicago/Turabian Style

Caffarelli, Carlo, Arianna Giannetti, Enrico Vito Buono, Daniela Cunico, Roberta Carbone, Federica Tonello, and Giampaolo Ricci. 2025. "Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role" Nutrients 17, no. 11: 1787. https://doi.org/10.3390/nu17111787

APA Style

Caffarelli, C., Giannetti, A., Buono, E. V., Cunico, D., Carbone, R., Tonello, F., & Ricci, G. (2025). Cow’s Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role. Nutrients, 17(11), 1787. https://doi.org/10.3390/nu17111787

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