The role of elimination diet in reducing allergy symptoms and improving cow's milk protein tolerance in children

Abstract

Cow's milk allergy (CMA) is an adverse immunological response to cow's milk proteins, primarily involving immunoglobulin E (IgE)-mediated type I hypersensitivity reactions, although non-IgE-mediated and mixed responses may also occur. In Indonesia, CMA represents the second most common food allergy, with a prevalence of 2–7.5%, and allergic responses have been reported in up to 0.5% of exclusively breastfed infants. This condition poses significant health concerns in children, with symptoms affecting the gastrointestinal tract (50–70%), skin (50–60%), and respiratory system (20–30%), and may lead to growth failure due to inadequate nutritional intake if not properly managed. This literature review aims to examine the role of an elimination diet in reducing allergy symptoms and improving tolerance to cow's milk protein in children. Literature was retrieved from international databases, including PubMed, Google Scholar, and ScienceDirect, restricted to articles published between 2013 and 2023 in English and Indonesian. The review found that an elimination diet—defined as the strict avoidance of all cow's milk and its derivatives—is the primary management strategy for CMA. Its effectiveness is influenced by diagnostic accuracy, parental adherence, and appropriate nutritional substitution. Gradual reintroduction of cow's milk protein under medical supervision may promote immune tolerance over time. However, an elimination diet carries potential contraindications and nutritional risks that must be carefully monitored. In conclusion, an elimination diet, when properly implemented with adequate nutritional support, can effectively reduce CMA symptoms and facilitate tolerance development in affected children.