Cow’s milk protein allergy (CMPA) is caused by a reproducible immune-mediated response to milk proteins and tends to present during the first few months of life. This response can vary significantly from an immediate reaction within 2 hours of ingestion to a more delayed reaction, which can occur anywhere between 2 and 72 hours later. A delay in diagnosis can cause significant child and parental distress, while overdiagnosis can lead to an unnecessary elimination diet. CMPA can be confused with lactose intolerance which is a non-immune mediated response as a result of lactase enzyme deficiency. We review the diagnosis and management of CMPA in this article along with future directions.