Management of bovine protein allergy: new perspectives and nutritional aspects

Objectives Awareness of the considerable incidence of bovine protein allergy in infancy makes it necessary to eliminate cow's milk antigens from the diet in special cases. The primary objective of this review is to discuss the nutritional aspects and appropriate use of hypoallergenic formulas as a substitute for cow's milk formulas and to present new alternative feeding modalities in this field. Data Sources Related articles in PubMed (National Library of Medicine) were reviewed. This review is a synthesis of these sources along with the discussions with experts in this field and the expert opinion of the authors. Results Soy protein-based and hydrolyzed milk protein formulas are the most commonly used alternative protein sources in the case of bovine protein allergy. Despite the adequacy of their nutritional values, there are still some problems to be solved regarding these formulas. In addition, a considerable percentage of the infants with bovine protein allergy may also present allergenic reactions to soy proteins as well as to hydrolyzed milk proteins. Thus, there still exists chaos in the selection of the most appropriate formula for infants sensitized to cow's milk protein. Rice protein-based formulas, probiotics, and prebiotics are expected to be new effective alternatives. Conclusions Bovine protein allergy constitutes an important place in childhood food allergies. Soy protein-based and hydrolyzed protein formulas have some disadvantages and risk of allergenic activity that is not to be underestimated. So, substitution of cow's milk protein with an alternative protein source in sensitized infants has become an art rather than a science. Rice protein, prebiotics, and probiotics appear to be valuable alternatives giving hope for the future.