Abstract
The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
Highlights
Food allergy constitutes the second phase of increases in the prevalence of allergic diseases that have occurred over the last 60 years
The Enquiring About Tolerance (EAT) study collected data on parental reporting of non-immunoglobulin E (IgE) mediated symptoms such as colic, vomiting, diarrhea and constipation. They found that infants who were encouraged to introduce cow milk and other food allergens from 4 months of age, reported significantly more non-IgE type symptoms such as eczema flares and colic, than the group which introduced allergens to complementary feeding after 6 months of exclusive breast-feeding (8.6% compared with 3.8%, respectively (p
A recent study showed that early continuous exposure to cow’s milk protein (CMP) may reduce the risk of cow milk allergy (CMA); while an introduction to CMP formulae during the first 3 days of life followed by complete CMP avoidance until the child is weaned may have the opposite effect [62]
Summary
Food allergy constitutes the second phase of increases in the prevalence of allergic diseases that have occurred over the last 60 years. Cow’s milk protein allergy (CMA) can be considered as an umbrella term for different diseases with distinct symptoms, pathophysiology and treatment and can be further classified as immunoglobulin E (IgE)-mediated food allergy, non-IgE mediated food allergy, or mixed IgE and non-IgE mediated food allergy [10] These immunologically mediated allergic reactions to cow milk must be distinguished from milk intolerance where a non-immune mechanism is involved, such as lactose intolerance, and from milk aversion or psychological intolerance. The Enquiring About Tolerance (EAT) study collected data on parental reporting of non-IgE mediated symptoms such as colic, vomiting, diarrhea and constipation They found that infants who were encouraged to introduce cow milk and other food allergens from 4 months of age, reported significantly more non-IgE type symptoms such as eczema flares and colic, than the group which introduced allergens to complementary feeding after 6 months of exclusive breast-feeding (8.6% compared with 3.8%, respectively (p
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