Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 9, 2025; 14(3): 103788
Published online Sep 9, 2025. doi: 10.5409/wjcp.v14.i3.103788
Cow milk protein allergy mimics in infancy
Mohammed Al-Beltagi, Nermin Kamal Saeed, Adel Salah Bediwy, Hosameldin A Bediwy, Reem Elbeltagi
Mohammed Al-Beltagi, Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
Mohammed Al-Beltagi, Department of Paediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, ‎Governmental Hospitals, Manama 12, Manama, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Royal College of Surgeons in Ireland – Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Adel Salah Bediwy, Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
Adel Salah Bediwy, Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
Hosameldin A Bediwy, Department of Medicine, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Reem Elbeltagi, Department of Medicine, Royal College of Surgeons in Ireland – Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Co-first authors: Mohammed Al-Beltagi and Nermin Kamal Saeed.
Author contributions: Al-Beltagi M and Saeed NK contributed equally to this study as co-first authors; Al-Beltagi M, Saeed NK, Bediwy AS, and Elbeltagi R contributed equally to the conception, design, and methodology of the review article; Al-Beltagi M was involved in data collection, manuscript writing, and revising the manuscript; Saeed NK, Bediwy AS, and Elbeltagi R assisted in data collection, writing, and revising the manuscript; Al-Beltagi M served as the corresponding author and contributed to the final approval of the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to the content of this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Chief Physician, Professor, Department of Paediatrics, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Alghrabia, Egypt. mbelrem@hotmail.com
Received: December 3, 2024
Revised: March 11, 2025
Accepted: March 21, 2025
Published online: September 9, 2025
Processing time: 198 Days and 17.3 Hours
Abstract

Cow milk protein allergy (CMPA) is a prevalent food allergy in infancy. It often presents with symptoms that overlap with other conditions, such as gastroesophageal reflux disease, lactose intolerance, food protein-induced enterocolitis syndrome, and eosinophilic esophagitis. This diagnostic overlap makes distinguishing CMPA from its mimics difficult, resulting in potential misdiagnoses and unnecessary dietary restrictions. This review aims to comprehensively analyze CMPA and its mimicking conditions, highlighting their clinical presentations, diagnostic approaches, and management strategies to enhance diagnostic accuracy and optimize patient care. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies published within the last 20 years. Articles addressing CMPA and its mimicking conditions were selected, with data synthesized into comparative analyses of diagnostic methods and management strategies. Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests, serum-specific IgE, and oral food challenges. Misdiagnosis can lead to nutritional deficiencies, psychological stress, and increased healthcare costs. Emerging diagnostic technologies, including component-resolved diagnostics and cytokine profiling, offer promising avenues for improving accuracy. A multidisciplinary approach involving pediatricians, allergists, and dietitians is essential for precise diagnosis and effective management. Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.

Keywords: Cow milk protein allergy; Diagnostic challenges; Mimicking conditions; Gastroesophageal reflux disease; Lactose intolerance; Food protein-induced enterocolitis syndrome; Eosinophilic esophagitis

Core Tip: This review emphasizes the diagnostic challenges of cow milk protein allergy and its mimicking conditions in infancy, including gastroesophageal reflux disease, lactose intolerance, food protein-induced enterocolitis syndrome, and eosinophilic esophagitis. Accurate differentiation between these conditions is essential for appropriate management and preventing unnecessary dietary restrictions that can lead to nutritional deficiencies and psychological stress. A comprehensive diagnostic approach, combining clinical history, diagnostic tests, and exclusion diets, is crucial. Emerging technologies such as component-resolved diagnostics and cytokine profiling show promise in improving diagnostic accuracy. Healthcare providers must adopt a multidisciplinary approach to ensure timely, precise diagnosis and effective management for optimal patient outcomes.