Abstract: Cow’s milk allergy (CMA) is one of the most common food allergies in infants and young children, exerting significant impacts on pediatric health, nutritional intake and quality of life. Its pathogenesis mainly involves aberrant immune responses induced by allergenic components such as whey proteins and caseins, including T helper 2 (Th2) polarization, immunoglobulin E (IgE)-mediated reactions, and activation of effector cells. Impairment of epithelial barrier function and dysbiosis of the gut microbiota further promote disease progression. Regulatory T cells play a central role in maintaining oral immune tolerance, and insufficiency in their number or function is considered an important immunological basis for the persistence of CMA. Current management strategies are primarily based on food avoidance and the use of extensively hydrolyzed formulas or amino acid-based formulas. Meanwhile, emerging interventions such as human milk oligosaccharides, probiotics, and protein modification are being explored to reduce allergenicity and promote immune tolerance. This review systematically summarizes the immunological mechanisms of CMA and recent advances in the development of hypoallergenic dairy products, aiming to provide a theoretical basis for the safe and effective development of hypoallergenic dairy products and for individualized, precision management of CMA, thereby improving long-term prognosis and quality of life in affected children.