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The clinical manifestations of cow's milk protein allergy (CMPA) in neonates are non-specific and involve multiple organ systems. CMPA may also adversely affect physical growth and central nervous system development in neonates, lead to functional disorders, and increase anxiety and stress among family members. Due to the lack of specific clinical manifestations and diagnostic methods, the diagnosis and management of CMPA in neonates continue to pose significant clinical challenges. To facilitate standardized diagnosis and treatment of CMPA in neonates, the Neonatology Group of the Pediatric Branch of the Chinese Medical Association and the Editorial Committee of the Chinese Journal of Pediatrics have jointly developed the "Expert Consensus on Diagnosis and Management of Neonatal Cow's Milk Protein Allergy (2023)". This article presents and interprets the key points of the consensus regarding dietary and nutritional management of CMPA in neonates.

Food allergy is defined as abnormal immune response elicited by food intake, in which a variety of clinical symptoms will appear as a result of physiological dysfunction and/or tissue damage. Possible mechanisms for food allergy include gastrointestinal tract barrier damage, failure to induce oral immune tolerance, intrauterine sensitization, and allergen transmission during pregnancy and breastfeeding. Hereditary and environmental factors can also contribute to the disease. Gastrointestinal disorders are the main clinical manifestations of the disease. However, hypoalbuminemia, growth retardation, and even acute circulatory failure or shock may occur in severe cases. Oral food challenges are the "gold standard" for the diagnosis of food allergy. Avoidance and replacement of the responsible food are the only effective treatment options for neonatal food allergy. The use of probiotics can offer protection against the disease.

Objective: We investigated the correlation between the in vitro immune profiling of 5 lactobacilli strains and their in vivo protective effect in a mouse beta-lactoglobulin (BLG) allergy model for selecting the candidate strains with potential anti-allergy activity., Methods: In vitro immunomodulation was assessed by measuring interleukin (IL)-4 and interferon gamma (IFN-gamma) release by primary lymphocytes stimulated with 5 active/heat-killed lactobacilli. A mice model of beta-lactoglobulin allergy was then used to evaluate the alleviating allergy capacity of the same set of strains. The rats were randomly divided into blank group, BLG allergy group and different lactobacilli strains group. The total IgE and BLG-specific IgE contents in the serum of rats were measured with ELISA. Splenic lymphocytes were isolated and cultured in vitro, the levels of Thl/Th2 type cytokine were detected by ELISA., Results: Protection of BLG-induced allergy was strain-specific. The strains displaying an in vitro capacity to induce higher levels of the Thl type cytokine (IFN-gamma) and lower levels of the Th2 type cytokine (IL-4), significantly decreased the levels of total IgE and BLG-IgE in allergic rat serum (P<0.05). In contrast, strains leading to a low IFN-gamma/IL-4 cytokine ratio could not significantly attenuate allergic symptoms., Conclusion: We could predict the in vivo protective capacity of the studied lactobacilli strains based on the cytokine profile established in vitro. Oral consumption of specific strain may be effective in preventing and alleviating BLG allergic symptoms by the improvement of the Th1/Th2 cell balance toward Th1 dominance, and the inhibition of IgE production.