Abstract
Acute respiratory infections are a common cause of morbidity in infants and young children. This high rate of respiratory infections in early life has a major impact on healthcare resources and antibiotic use, with the associated risk of increasing antibiotic resistance, changes in intestinal microbiota composition and activity and, consequently, on the future health of children. An international group of clinicians and researchers working in infant nutrition and cow’s milk allergy (CMA) met to review the available evidence on the prevalence of infections in healthy infants and in those with allergies, particularly CMA; the factors that influence susceptibility to infection in early life; links between infant feeding, CMA and infection risk; and potential strategies to modulate the gut microbiota and infection outcomes. The increased susceptibility of infants with CMA to infections, and the reported potential benefits with prebiotics, probiotics and synbiotics with regard to improving infection outcomes and reducing antibiotic usage in infants with CMA, makes this a clinically important issue that merits further research.
Highlights
Cow’s milk allergy (CMA) is among the most common food allergies in early life, with an estimated prevalence in developed countries ranging from 0.5% to 3% at age 1 year [7]
Seasonality has been identified as an important risk factor, with respiratory infections being more common in winter [5]
The innate and adaptive immune system plays a crucial role in susceptibility to infections, as well as persistence and clearance of infections [12], and this is strongly influenced by the gut microbiota composition
Summary
Cow’s milk allergy (CMA) is among the most common food allergies in early life, with an estimated prevalence in developed countries ranging from 0.5% to 3% at age 1 year [7]. A recent retrospective study found that sensitisation to β-lactoglobulin (cow’s milk protein) was associated with a nearly four-fold increased risk of recurrent respiratory tract infections in children under the age of two years [9]. A small cohort study comparing school-age cow’s milk-allergic children with controls showed more than twice the risk of recurrent otitis media, defined as at least 15 episodes by the age of 10 years (27% vs 12%, p = 0.009) and adenoidectomy and/or tympanostomy (48% vs 28%, p = 0.0005), this occurred only in those developing respiratory atopy [10]
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