Rxe9;sumxe9;
De nouvel
les donn
xe9;es ont r
xe9;cemment conduit
xe0; modifier la prise en charge des enfants ayant une al
lergie aux prot
xe9;ines du lait de vache (APLV). Le diagnostic d’APLV doit
xea;tre affirm
xe9; par l’
xe9;preuve d’
xe9;viction
et de r
xe9;introduction, test diagnostique de r
xe9;f
xe9;rence, sans
lequel
le r
xe9;gime d’exclusion est injustifi
xe9;, voire d
xe9;l
xe9;t
xe8;re. D
xe8;s
le diagnostic affirm
xe9;,
le r
xe9;gime d’exclusion strict s’impose, au moins jusqu’
xe0; l’
xe2;ge de 9–12 mois. Si l’enfant n’est pas allait
xe9; ou que la m
xe8;re ne peut plus ou ne souhaite plus allaiter,
le premier choix est une pr
xe9;paration
xe0; base d’hydrolysat extensif (eHF) de prot
xe9;ines du lait de vache (PLV), sous r
xe9;serve que son efficacit
xe9; ait
xe9;t
xe9; d
xe9;montr
xe9;e. En cas d’
xe9;chec de l’eHF, une pr
xe9;paration d’acides amin
xe9;s est justifi
xe9;e. Les eHF de prot
xe9;ines de riz constituent une alternative aux eHF d’origine anima
le. Les pr
xe9;parations pour nourrissons
xe0; base de prot
xe9;ines de soja ne peuvent
xea;tre utilis
xe9;es qu’apr
xe8;s l’
xe2;ge de 6 mois, apr
xe8;s v
xe9;rification de la bonne tol
xe9;rance clinique au soja. L’APLV gu
xe9;rit habituel
lement au cours des 2
xe0; 3 premi
xe8;res ann
xe9;es de vie. L’
xe2;ge de la gu
xe9;rison varie selon
les enfants
et le type d’APLV, IgE-m
xe9;di
xe9;e ou non, la premi
xe8;re
xe9;tant plus durab
le. Lorsque l’enfant grandit,
le test de provocation ora
le, r
xe9;alis
xe9;
xe0; l’hôpital, perm
et d’
xe9;valuer l’apparition de la tol
xe9;rance
et, si possib
le, de proposer la poursuite de la r
xe9;introduction
xe0; domici
le. Certains enfants al
lergiques ne supporteront qu’une quantit
xe9; quotidienne limit
xe9;e de PLV. Les propositions th
xe9;rapeutiques actuel
les ont pour but d’acc
xe9;l
xe9;rer l’acquisition de la tol
xe9;rance, qui semb
le facilit
xe9;e par l’exposition r
xe9;guli
xe8;re aux PLV.
Summary
New data on food allergy has recently changed the management of children with cow's milk protein allergy (CMPA). The diagnosis of CMPA first requires the elimination of cow's milk proteins and then an oral provocation test following a standard diagnostic procedure for food allergy, without which the elimination diet is unjustified and sometimes harmful. Once the diagnosis is made, the elimination diet is strict, at least until the age of 9–12 months. If the child is not breastfed or the mother cannot or no longer wishes to breastfeed, the first choice is a formula based on extensive hydrolyzate of cow's milk (eHF), provided that its effectiveness has been demonstrated. When eHF fails, a formula based on amino acids is warranted. eHF based on rice protein hydrolysates is an alternative to cow's milk eHF. Infant formulas based on soy protein can be used after the age of 6 months, after verification of good clinical tolerance to soy. Most commonly, CMPA disappears within 2 or 3 years of life. However, the age of recovery varies depending on the child and the type of CMPA, and whether or not it is IgE-mediated, the first being more sustainable. When the child grows, a hospital oral provocation test evaluates the development of tolerance and, if possible, authorizes continuing the reintroduction of milk proteins at home. Some children with CMPA will tolerate only a limited daily amount of cow's milk proteins. The current therapeutic options are designed to accelerate the acquisition of tolerance, which seems facilitated by regular exposure to cow's milk proteins.