BACKGROUND: Although breast milk is ideal for newborns, in some cases, it is replaced with cow's milk, which contains proteins that increase the risk of cow's milk protein allergy (CMPA). AIM: To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E (IgE)- and non-IgE-mediated CMPA. METHODS: This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex, Bahrain, between 2014 and 2022, and assessed CMPA prevalence. Clinical presentations, laboratory findings, dietary modifications, and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA. Categorical variables were compared using Fisher's exact test or Pearson's RESULTS: Of 8332 patients, 6022 (72.3%) adhered to their appointment. Of them, 618 (10.3%) were suggested of having CMPA and 595 (96.3%) were included
CMPA prevalence was 2%. Most patients were Bahraini (93.8%) and males (55.3%). Non-IgE-mediated type accounted for 77.3% cases and IgE-mediated type, 22.7%. IgE-mediated CMPA presented more in boys ( CONCLUSION: This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment. AAF was most prescribed, while breastfeeding with dietary modification is rarely applied.