Comparison of IgE-Mediated Cow’s Milk Protein Allergy (CMPA) Management Strategies (COWS)


Cow’s milk protein allergy (CMPA) is one of the first and most common food allergies reported in the paediatric population. It is also one of the main causes of anaphylaxis in the first two years if life. However, the management of CMPA is debated around the world. The majority of CMPA resolves spontaneously in childhood and hence many European countries recommend strict avoidance of all milk products. In Ireland, CMPA is treated using oral immunotherapy (OIT), also known as the milk ladder, with good results. However, novel treatments have been published recently that could lead to a different approach in the management of CMPA. One of these treatments is the use of early OIT immediately at diagnosis. This treatment option has been found to be safe and successful, and is suggestive of the  possibility of a new management strategy for IgE-mediated CMPA in the future.

This study will compare three cohorts of paediatric patients diagnosed with CMPA from the three hospitals and one family health care clinic participating in this study. This retrospective analysis will compare the effectiveness of each management plan. The results of this study will help guide the future management of CMPA.

Objectives and Endpoints:

The primary objective is to compare the rate of acquired tolerance of the three different IgE-mediated CMPA treatment strategies. The primary outcome is to determine the tolerance acquisition to cow’s milk proteins, which will be defined as the intake of 200ml of cow’s milk or the equivalent intake of 6g of milk protein daily without any symptomatology.

The secondary objectives are to conduct an anthropometric comparison of the three cohorts, to compare the difference in outcome of the three treatments in CMPA IgE-mediated in patients who have other food allergies and to conduct an analysis of immunological values between the three cohorts.

Principal Investigator: Juan Trujillo-Wurttele

Sub-Investigators: Tessa Ah Heng, Sarah Joy Hanley, Roberto Velasco Zuñiga, Cristina Blasco,  Cristina Muñoz, Caoimhe Cronin, Laura Flores Villarta, Anne Marie McGinley, Mark Sexton