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Abstract Over the past decade, the incidence of food allergy has increased significantly to be a major health problem worldwide. Cow‘s milk protein allergy (CMPA) is the most common type of food allergy in infants and young children. The increased incidence of CMPA is attributed to the excessive use of cow milk-based infant formulae as a replacement for human milk. Increasing rates of cesarean sections and urbanized lifestyle may also contribute to the global increase in the incidence of CMPA (1). CMPA presents with a spectrum of clinical phenotypes from mild to life-threatening symptoms driven by IgE, non-IgE or both immunologic mechanisms (38). The diagnosis of CMPA is a challenging task, especially in infants with delayed gastrointestinal manifestations because the symptoms are usually non-specific and may be caused by other disorders The cornerstone of diagnosis is a positive response to an elimination diet with improvement of the presenting symptoms and recurrence of the same symptoms upon re-challenge with cow‘s milk (4). The strict avoidance of CMP is the safest strategy for managing CMPA in exclusive breastfeeding, any food containing milk protein must be removed from the mother‘s diet. And in formula feeding, treatment is to replace the formula with extensively hydrolyzed formula (eHF) or amino acid–based formula (AAF) (43). |