CLINICAL COMPLEXITY OF COW’S MILK PROTEIN ALLERGY: AN ANALYSIS OF EVIDENCE IN PEDIATRICS

Abstract

Objective: To critically analyze the scientific production on cow's milk protein allergy (CMPA), with emphasis on identifying the main clinical manifestations, as well as the diagnostic methods and therapeutic strategies used in pediatric clinical practice. Methodology: This is a systematic literature review, conducted based on the following guiding question: "What are the main clinical manifestations of CMPA in the pediatric population and what are the most commonly used diagnostic methods and therapeutic approaches in clinical practice?". The search was conducted in the PubMed Central database, using the descriptors Pediatrics, Milk Hypersensitivity, Signs and Symptoms, Digestive, Clinical Diagnosis and Diagnosis, combined by the Boolean operator "AND". Initially, 198 studies were identified, of which 34 were selected for full-text reading and, in the end, 11 articles comprised the sample for this review, according to previously established eligibility criteria. Results: Cow's milk protein allergy (CMPA) has a high prevalence in childhood, especially in the first years of life, characterized by heterogeneous clinical manifestations that may involve the cutaneous, gastrointestinal, and respiratory systems, with distinct immunological mechanisms, including IgE-mediated and non-IgE-mediated forms. Diagnosis remains challenging, requiring an individualized approach based on clinical-laboratory correlation, with the oral food challenge test considered the gold standard. Therapeutic management is based on the exclusion of cow's milk proteins, the use of hypoallergenic formulas, and adequate nutritional supplementation, measures associated with clinical improvement and prevention of complications. Conclusion: Emerging diagnostic methods, such as tests based on allergenic components and inflammatory biomarkers, show promising potential, although they still lack robust clinical validation. Early identification and appropriate intervention are fundamental to optimizing clinical outcomes and the quality of life of patients. The need for further studies with greater methodological standardization is highlighted in order to strengthen the evidence and guide evidence-based clinical practice.