Courses

From Formula Selection to Reintroduction: Nutritional Strategies for Managing Pediatric Cow’s Milk Allergy

What are the current best practices for managing cow’s milk allergy in children?

Presenter(s): Carina Venter, PhD, RD; Yvan Vandenplas, MD, PhD

Program Date: 15 May 2025

Publication Date: 12 November 2025

Continuing Education Credits: Dietitian 0.5 CPEU

Course Description

This course provides an overview of cow’s milk allergy (CMA) in pediatric populations, focusing on its impact on growth and nutritional status. Participants will explore the clinical presentation and diagnosis of both IgE and non-IgE-mediated CMA and learn practical strategies for nutritional management. The course emphasizes evidence-based approaches to reintroducing cow’s milk, including the structured use of culturally adapted milk ladders.

Course Objectives:
  • Examine the prevalence and clinical implications of cow’s milk allergy (CMA), including its impact on growth and nutritional status.
  • Explain why effective identification and nutrition management are critical for the child with CMA.
  • Review evidence-based principles, protocols, and best clinical practices for the reintroduction of cow’s milk in children with CMA.
  • Discuss the concept and application of a milk ladder as part of the reintroduction process for both IgE and non-IgE-mediated CMA.
Key Takeaways:
  • DRACMA and ESPGHAN support the use of milk ladders for reintroduction of cow’s milk.
  • Ladders are safe to use for milder forms of non-IgE-mediated cow’s milk allergy.
  • Use of ladders in IgE-mediated cow’s milk allergy and FPIES should be carefully considered.
  • Ladders should be nutritionally sound.

Performance Indicators: 5.2.6, 9.1.1, 11.3.3

Activity Code: 190500

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Related Questions:
  • What are the nutritional risks and growth implications of delayed cow’s milk reintroduction in children with milk allergy?
    Delayed reintroduction of cow’s milk in children with milk allergy can lead to significant nutritional risks, including growth faltering and micronutrient deficiencies. These delays may also contribute to persistent allergic inflammation, reduced quality of life, and increased healthcare burden for families.
  • What are evidence-based approaches to cow’s milk allergy diagnosis and treatment?
    Diagnosis involves clinical history, IgE testing, and food challenges. Treatment includes elimination diets, hypoallergenic formulas, and structured reintroduction using milk ladders, per ESPGHAN and DRACMA guidelines.
  • What is the role of milk ladders in pediatric allergy management?
    Milk ladders provide a structured, stepwise approach to reintroducing cow’s milk, helping identify tolerance levels while minimizing allergic reactions. They are especially useful in non-IgE-mediated CMA (excluding FPIES) and selected IgE cases. 

Course Instructor Bio(s)

Carina Venter, PhD, RD

Professor of Pediatrics, Allergy & Immunology
Children's Hospital Colorado 
University of Colorado Denver School of Medicine
Aurora, CO, USA

Carina Venter is a Professor of Pediatrics, Section of Allergy/Immunology at the Children's Hospital Colorado and the University of Colorado Denver School of Medicine, where she is conducting research in allergy prevention and working with children with food allergies. Dr. Venter is a member of the World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. She is currently the chair of the European Academy of Allergy and Clinical Immunology (EAACI) work group on Immunomodulation and nutrition.

Yvan Vandenplas, MD, PhD

Professor 
University Hospital Brussels (UZ Brussel) 
Brussels, Belgium

Yvan Vandenplas, MD, PhD, did his medical studies at the “Vrije Universiteit Brussel” (Free University of Brussels) and trained in pediatrics (1981-1986) at the same University. He became Head of the Unit for Pediatric Gastroenterology and Nutrition in 1987 and created the Pediatric Hospital, the KidZ Health Castle, at the University Hospital Brussels (UZ Brussel) of the same university, where he had been the Chair of Pediatrics since 1994 up to 2021. He is now Prof. Emeritus and a consultant at the same hospital. He has over 500 publications listed in Medline, including many papers on infant nutrition. He is associate editor of the Journal of Pediatric Gastroenterology and Nutrition and Nutrients.

Category
CPEU Pediatric Allergies & Food Intolerance
Highlighted References:
  • Vandenplas Y, et al. Arch Dis Child. 2007;92(10):902-908. 
  • Vandenplas Y, et al. J Pediatr Gastroenterol Nutr. 2024;78(2):386-413.
  • Meyer R, et al. J Hum Nutr Diet. 2019;32(2):175-184.
  • Meyer R, et al. Pediatr Allergy Immunol. 2025;36(3):e70060.
  • Meyer R, Venter C, et al. World Allergy Organ J. 2023;16(7):100785. 
  • Venter C, et al. World Allergy Organ J. 2024;17(8):100931. 
  • Jensen SA, et al. World Allergy Organ J. 2022;15(9):100668.

Abbott Nutrition’s Statement for Dietitian CPEUs:

This educational activity has been prior-approved by the Commission on Dietetic Registration (CDR). CDR credentialed practitioners will receive the specified continuing professional education units (CPEUs) for completion of this program/material.