New approaches to Cow's Milk Protein Allergy (CMPA) in Adults

Abstract

Objective: To analyze the main available articles on Cow’s Milk Protein Allergy (CMPA) in adults, addressing its immunological bases, clinical manifestations, diagnostic challenges, nutritional management, future perspectives, and new therapeutic approaches. Literature review: CMPA is traditionally associated with childhood; however, evidence demonstrates its persistence or onset in adulthood, often presenting with more severe and heterogeneous clinical manifestations. Its pathophysiology involves failures in oral tolerance mechanisms, intestinal barrier dysfunction, and immune response dysregulation, which may be IgE-mediated, non-IgE-mediated, or mixed. Diagnosis in adults is challenging due to overlap with food intolerances and other gastrointestinal diseases, requiring detailed clinical history, specific laboratory tests, and, when indicated, oral food challenge, considered the gold standard. Management is based on strict exclusion of milk proteins, with nutritional follow-up to prevent deficiencies. Additionally, therapeutic strategies such as oral immunotherapy and the use of omalizumab appear promising, although they present limitations and higher risk in this population. Final considerations: CMPA in adults is a rare but often severe and underdiagnosed condition, requiring individualized diagnostic and therapeutic strategies. The scarcity of robust evidence in this age group reinforces the need for studies to guide safe and effective management.