The Burden of Cow’s Milk Protein Allergy in the Pediatric Age: A Systematic Review of Costs and Challenges

Background. Cow’s Milk Protein Allergy (CMPA) is a prevalent pediatric food allergy affecting 2–5% of infants globally. CMPA presents significant clinical and economic challenges, requiring specialized diagnostic procedures, dietary management with hypoallergenic formulas, and multidisciplinary care. The financial burden on families and healthcare systems includes direct costs (e.g., diagnostic tests, medical consultations, and formula expenses), indirect costs (e.g., caregiver absenteeism and productivity loss), and intangible costs (e.g., psychological distress and impaired quality of life). Economic disparities further exacerbate these challenges, particularly in low-resource settings where access to specialized care is limited. Methods. A systematic review was conducted following PRISMA guidelines using PubMed, CINAHL, Scopus, and Cochrane databases to identify studies on the economic and psychosocial burden of CMPA. Studies published between 2010 and 2024 were analyzed. From an initial search of 11,565 articles, 802 duplicates were removed, leaving 10,763 articles for title and abstract screening. Twenty full-text articles meeting the inclusion criteria were included in the final analysis. Thematic categories focused on direct, indirect, and intangible costs, with findings synthesized to highlight global disparities and policy gaps. Results. CMPA management imposes substantial economic burdens, with hypoallergenic formulas alone accounting for up to 15% of household income in some regions. Indirect costs, including lost workdays and additional childcare expenses, further strain families. Intangible costs, such as heightened caregiver anxiety and reduced social participation, are significant yet frequently overlooked. Healthcare system disparities, particularly regarding insurance coverage for diagnostic tests and therapeutic formulas, contribute to financial inequities. The use of extensively hydrolyzed casein formulas with probiotics has demonstrated cost-effectiveness in promoting immune tolerance while reducing healthcare utilization. Conclusions. Addressing the economic impact of CMPA would benefit from standardized cost assessment frameworks and equitable access to cost-effective therapeutic options. Further analysis of reimbursement policies across diverse healthcare systems may provide insights into optimizing support for essential treatments. Integrating clinical and economic strategies can alleviate the burden on affected families and optimize healthcare resource allocation. Future research should prioritize longitudinal analyses and cross-regional comparisons to guide sustainable and equitable management strategies.