Towards Optimised Management of Cow’s Milk Protein Allergy

Abstract

This symposium took place during the 2018 meeting of the European Academy of Allergy and Clinical Immunology (EAACI). Focussing on the fundamental issues of suboptimal management of patients with cow’s milk protein allergy (CMPA), the speakers discussed key themes for optimising management. Prof Madrazo-de la Garza evaluated the challenges of diagnosis and management of CMPA in infants. Nonspecific symptoms, indicative of other conditions, mean that CPMA is often misdiagnosed as lactose intolerance, a rare condition in infants. Increased awareness of CMPA symptoms and a clear distinction from lactose intolerance may facilitate earlier, accurate diagnosis and implementation of appropriate dietary interventions. Dr Nutten followed by exploring variability in the composition of commercialised extensively hydrolysed formulas (eHF) intended for the management of CMPA and the associated potential clinical impact. Large variations in peptide profiles and residual allergenicity reflect a lack of definition for eHF composition. Although the clinical trials required to confirm the efficacy of eHF by demonstrating tolerance in >90% of infants with CMPA are performed, composition analyses for characterisation, quality control, and reproducibility are crucial for ensuring safe and suitable products throughout the product lifecycle. Prof O’Mahony concluded the meeting by focussing on the importance of the gut microbiome in food allergy. The establishment of a stable gut microbial community closely tracks host growth and immune development. Delayed or altered establishment leads to microbiome immaturity, which has been associated with an increased risk of food allergies. Nutritional strategies, such as the use of eHF containing lactose, to support microbiome development complement existing CMPA treatment.