Milk Allergy Research Articles

Safety of Oral Food Challenges for Individuals with Low Levels of Cow's Milk-Specific Immunoglobulin E Antibodies.

Cow's milk (CM) is one of the most common food allergens in Japan. The oral food challenge (OFC) of CM is important for the definite diagnosis of children with CM allergy and it is recommended to be actively and safely performed in individuals with low CM-sIgE levels. This study aimed to investigate the safety of low-dose CM-OFC in individuals with low CM-sIgE levels and discuss the prognostic factors and appropriate approaches for assessing the starting doses of CM-OFC in these individuals. We retrospectively analyzed 6,929 OFC tests conducted between January 1, 2017 and December 31, 2021; of which, 1,390 were CM-OFC tests. The characteristics, OFC-positive rates, CM loading, and related factors were analyzed in 138 cases involving low CM-sIgE levels. Stepwise OFC tests were conducted according to the FA guidelines in Japan using an open and unblinded method. Among 138 individuals with low CM-sIgE levels, 110 (79.7%) passed the OFC test without any symptoms. Among the cases with OFC-positive status, 50.0% (14/28) cases showed symptoms with low-dose OFC (30-105 mg CM protein). Moreover, complete CM elimination was associated with a significantly high OFC-positive rate, and 60.0% (12/20) of the cases involving complete CM elimination showed symptoms with low-dose OFC. Eighty percent of the patients with low CM-sIgE levels safely completed the OFC test. Nevertheless, careful observation is essential during low-dose OFC test in cases with low CM-sIgE levels, especially in the cases with complete elimination. The starting dose of the OFC test should be re-evaluated and modified using baked milk or a lower dose of CM to ensure safety and early outgrowth of CM allergy.

Cow's milk protein allergy in infants and children.

Cow's milk protein allergy (CMPA) is an immune-mediated reaction to cow's milk proteins, which can involve multiple organ systems including the gastrointestinal tract. Immunoglobulin E (IgE)-mediated response results in rapid onset of allergic symptoms that are easily recognizable. However, delayed (i.e., non-IgE/cell-mediated) or mixed (IgE- and cell-mediated) reactions produce a host of symptoms that overlap with other conditions and vary widely in onset and severity. Determining whether symptoms represent immune-mediated CMPA, non-immunologic reaction to cow's milk, or are unrelated to cow's milk exposure is challenging yet essential for effective management. While the clinical presentation of non-IgE-mediated CMPA can vary, this condition is usually self-limited and resolves by 1 to 6 years of age. Food antigen-specific immunoglobulin G (IgG) panels that are not evidence-based should be avoided because they can lead to overdiagnosis of presumed food intolerances. Overdiagnosis of CMPA can result in overuse of extensively hydrolyzed formulas and have significant cost implications for families. This statement focuses on delayed non-IgE/cell-mediated CMPA and assists health care providers to distinguish between and identify varied reactions to cow's milk, discusses the role of diagnostic testing, and provides management recommendations based on best evidence.

Immunoglobulin-coating patterns reveal altered humoral responses to gut bacteria in pediatric cow milk allergies.

Pediatric cow milk allergies (CMA) can occur in immunoglobulin (Ig) E and non-IgE-mediated forms. Unlike IgE-mediated allergies, the mechanisms of disease pathogenesis in non-IgE-mediated food allergy and an association with microbiome has not been well established. Previous studies have identified the presence of altered humoral responses to gut bacteria in IgE mediated allergies. Here, we analyzed IgA, IgE and IgG responses to gut bacteria in subjects with either IgE or non-IgE mediated CMA to identify relative proportions of Ig-coated bacteria and characterize unique disease specific microbial signatures. Multi-parametric flow cytometry analysis was used to identify IgA, IgE and IgG responses to gut bacteria in CMA patients. Cell sorting of Ig coated gut bacteria was subsequently performed followed by high throughput 16S rRNA gene sequencing and specific patterns of humoral responses to gut bacteria assessed in each study group. We identified significant alterations in IgA and IgG gut bacterial coating patterns in CMA subjects. Proportions of IgA-coated bacteria were decreased in IgE mediated CMA subjects without atopic dermatitis (ALL) and non-IgE mediated CMA subjects (ENP), compared to healthy controls (CON). In comparison, IgG-coated bacteria was significantly elevated in CMA subjects with atopic dermatitis (AD). Alpha and beta diversities displayed significant differences in IgA-, IgE-, and IgG-coated bacteria in AD and ENP groups. Significant differences in bacteria coated by IgA, IgE and IgG were detected at Phyla, Genus and Species levels and associated bacterial dysbiosis in IgE and non-IgE mediated allergies were identified. Linear discriminant analysis (LDA) effect size (LEFse) revealed unique disease associated bacterial signatures, including several pathogenic bacteria namely Bacteroides fragilis, Ruminococcus gnavus, Eubacterium dolichum, Fusobacterium, Clostridium neonatale and Robinsoniella peoriensis. Receiver operating characteristic curve analysis confirmed the efficiency of using the bacterial signatures identified as biomarkers for disease. Altered IgA and IgG responses to gut bacteria were identified in CMA subjects. The disease-specific responses were associated with alterations in bacterial diversity and concomitant dysbiosis of Ig-coated bacteria in IgE-mediated and non-IgE-mediated CMA pediatric subjects. The identification of pathogenic bacteria uniquely associated with different classes of allergic disease indicates a role of these bacteria in driving disease-specific pathological phenotypes.

Safety, Tolerability, and Feasibility of the Milk Ladder for Reintroduction of Cow's Milk in Infants With IgE-Mediated Cow's Milk Allergy.

Safety, Tolerability, and Feasibility of the Milk Ladder for Reintroduction of Cow's Milk in Infants With IgE-Mediated Cow's Milk Allergy.

Evaluating the influence of parental atopy on the effectiveness of a maternal dairy-free diet in alleviating infantile colic: a before-and-after study

BackgroundInfantile Colic (IC) poses a significant challenge for parents as it manifests through repeated and extended episodes of fussiness, crying, or irritability occurring before the age of 5 months. The precise cause of IC is currently unknown. The association between IC, a family history of atopy, and the development of individual atopy in the future remains uncertain, given conflicting findings from prior studies.ObjectivesThis study aimed to investigate the impact of parental atopy on IC severity and the effectiveness of the mother’s hypoallergenic Dairy-Free Diet in alleviating pain in infants with colic.MethodsThis non-randomized trial conducted at Amirkabir Hospital in Arak, Iran, from January 2023 to October 2023, involving 206 eligible IC patients non-randomly assigned to two groups based on parental atopy history. Breastfed infants were prescribed a dairy-free diet, involving the removal of dairy products from the mother’s diet. Pain severity was assessed using the FLACC scale at baseline and after one-month of intervention.ResultsThe research initially involved 206 subjects with an average age of 28.77 ± 9.99 days, evenly distributed based on parental atopy history. However, there was a 28.6% loss to follow-up, resulting in a final analyzed population of 147 individuals. The intervention, a maternal dairy-free diet, demonstrated a significant reduction in pain symptoms within both groups and overall (P = 0.001), with no significant difference in efficacy between infants with and without parental atopy history (P = 0.219). Parental history of atopy did not exhibit a significant association with colic pain severity (P = 0.404). The study revealed that the impact of the diet on colic severity varied, with more pronounced effects observed in cases of severe and moderate colic compared to mild cases.ConclusionsAdopting a Dairy-Free Diet significantly reduced colic symptoms, irrespective of parental atopy history. The severity of colic appears unrelated to parental atopy, and the observed improvement with a Dairy-Free diet is potentially attributed to milk intolerance rather than milk allergy.

Anaphylactic Reaction With The Measles-Mumps-Rubella Vaccine In A Patient With Cow's Milk Allergy

The most common food allergy in children worldwide is cow's milk allergy. The most known allergens from cow's milk proteins are casein, alpha-lactalbumin, and beta-lactoglobulin. Lactalbumin hydrolysate is used as a stabilizer in the measles mumps rubella (MMR) vaccine originating in India. Different commercial forms of the MMR vaccine are available. While neomycin stabilizes, lactalbumin hydrolysate is used in the other form. We present a patient who was followed up for cow's milk allergy and developed anaphylaxis after the MMR vaccine originating from India. A 4-year-old girl with a history of anaphylaxis with cow's milk whose vaccinations were applied by the routine vaccination schedule in the family health center. Sneezing and urticaria started 1 minute after immunization. The patient presented to the emergency department (within 10 minutes after vaccination) with severe respiratory distress and intercostal retractions. The patient was administered three doses of intramuscular adrenaline, 5 minutes apart, intravenous pheniramine and methylprednisolone, and a nebulizer short-acting beta agonist. Symptoms regressed approximately 40 minutes after hospitalization. In our patient with a history of cow's milk anaphylaxis and lactalbumin-specific immunoglobulin E value of 61.3 kU/L, anaphylactic reaction with MMR vaccine seems to be related to the lactalbumin contained in the vaccine. Families and physicians should be meticulous about reading labels in the follow-up of patients with known food allergies.

The multiple facets of cow’s milk allergy

Cow’s milk allergy (CMA) is one of the most common food allergies in early childhood. CMA has varied presentations and multiple facets. A detailed clinical history is key for classification. In IgE-mediated CMA skin prick testing and serum specific IgE testing are useful in the diagnosis, but an oral food challenge (OFC) may still be necessary if there is doubt or to assess tolerance. Non-IgE-mediated CMA presentations include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome (FPIES), and eosinophilic esophagitis (EoE). The diagnosis of FPIAP and FPIES is based on the clinical history. An esophageal biopsy is required for the diagnosis of EoE. Atopy patch testing, IgG or IgG4 testing are not helpful in any CMA evaluation. Children with CMA (except those with FPIAP) are at risk for poor growth and a nutritional evaluation should be part of routine care. Extensively hydrolyzed formulas are the recommended first choice alternative formula for CMA. For IgE-mediated CMA, alternative approaches to traditional strict avoidance include oral immunotherapy (OIT) and omalizumab (both as monotherapy and as an adjunct to OIT). Multiple international guidelines have addressed evaluation and management of CMA providing key information, support and guidance for clinicians in daily practice.

Epitope profiling of cow's milk allergen-specific antibodies with determining IgE content in epitopes-ALL, a 14-epitopes mixture

Allergen-specific antibodies (Abs), IgE, and IgG4 increase during the early phase of oral immunotherapy (OIT) of allergen food in patients; subsequently, IgE levels decrease and specific IgG4 levels increase after successful OIT treatment. The detailed profile of these Abs during OIT remains largely unclear. We developed a diagnostic tool to assess the OIT efficacy and extent of responsiveness based on a profiling method by identifying epitopes recognized by the Ab classes of IgE or IgG4.A peptide microarray followed by microplate analysis using synthetic peptides was used to identify 14 epitopes widely recognized by IgE and/or IgG4 in the serum samples of patients with OIT among the amino acid sequences of five major cow's milk allergens. The set of defined 14 epitopes clarified different epitope profiles of allergen-specific IgE and IgG4 in each patient's serum samples. Moreover, the total signal of Abs recognizing all 14 epitopes was equal to the sum of all individual epitope-specific Abs. It was further observed that the quantitative value of IgE concentrations of 14 epitopes-ALL correlated with the ImmunoCAP IgE value.These findings strongly imply that the quantity of IgE and IgG4 recognizing epitopes-ALL may easily be used to measure allergy severity. To investigate this potential, we developed an immunochromatographic method that can detect IgE and IgG4 levels in patient samples.This study clearly demonstrated the usefulness of the defined 14 epitopes and their mixture, “epitopes-ALL,” and that the simple and reliable methods of immunochromatography and microplate analyses demonstrating the epitope profile of allergen-specific Abs are applicable for diagnostic use at multiple disease stages and the OIT-treatment course in patients with cow's milk allergy.

Clinical Presentations of IgE-Mediated Cow’s Milk Allergy in Children and Factors Affecting the Development of Tolerance

Clinical Presentations of IgE-Mediated Cow’s Milk Allergy in Children and Factors Affecting the Development of Tolerance

EAACI guidelines on the management of IgE-mediated food allergy.

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE-mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto-injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE-mediated food allergy in children from the age of 1 and adults; and oral allergen-specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE-mediated food allergy are highly needed, with standardised and patient-focused protocols and outcomes.

Factors Associated with Weaning in Infants with Cow's Milk Allergy: A Cohort Study.

Objective: To analyze the factors associated with weaning in infants with cow's milk allergy (CMA) treated at a food allergy reference center in a state in the northeast of Brazil. Method: A prospective cohort study, with a case group (children with CMA) and two control groups (symptomatic nonallergic children [SC] and asymptomatic [AC]). At the beginning of the study, 30 children comprised the CMA group, 84 the SC group, and 52 the AC group. Survival analysis was performed to compare breastfeeding time between the three groups and an adjusted linear regression model to verify the factors associated with breastfeeding time. Results: At the beginning of the study, 33.3% of children in the CMA group, 17.1% in the SC group, and 69.6% in the AC group were exclusively breastfeeding (p = 0.005). The most common factors for weaning in children with CMA were the cow's milk elimination diet (30%), allergic symptoms in the child (20%), and breast engorgement (20%). Children who used a cup as a means of offering infant formula spent 281 more days breastfeeding compared with those who used a baby bottle (Bstd = 1.39; p = 0.031). Conclusion: Children with CMA and nonallergic gastrointestinal complaints weaned earlier compared with asymptomatic children. The main causes of weaning in CMA children were maternal difficulty adhering to the elimination diet, breast engorgement, and allergic symptoms in the child. Using a cup was the main factor associated with longer breastfeeding duration, regardless of gastrointestinal symptoms and socioeconomic factors.

Regional differences in diagnosis and management of cow's milk allergy.

: Various guidelines for the diagnosis and management of cow's milk allergy (CMA) have been pu- blished. : This study aimed to compare voting outcomes of experts from Mexico, the Middle East, and the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on statements regarding CMA. : The 3 expert groups voted on the same 10 state- ments. Each participant voted anonymously using a score of 0-9 (≥6 meant agreement; <5 reflected disagreement). If <75% of the participants agreed with the statement, it was rejected. None of the groups was aware of the voting outcomes of another group. : There was broad consensus amongst the 3 groups. Agreement was reached that infant colic as a sin- gle manifestation is not suggestive of CMA. All groups confirmed that an extensively hydrolysed formula is the preferred elimination diet in mild/moderate CMA cases; however, hydrolysed rice formula is an alternative. Amino acid-based formulas should be reserved for infants with severe symptoms. The discrepancy in voting outcomes re- garding soy formulas highlights the differences in opinions. Two of 13 ESPGHAN experts (15%), 1 of 14 Middle East experts (7%), and 6 of 26 Mexican experts (23%) disagreed with the statement that soy formula should not be the first choice for the diagnostic elimination diet but can be considered in some cases for economic, cultural, and pala- tability reasons. All of the ESPGHAN and Mexican ex- perts agreed that there was no added value of probiotics, prebiotics, or synbiotics to the efficacy of elimination diets on CMA, whereas 3 of 14 Middle East experts (21%) deter- mined that there was sufficient evidence. : Although all statements were accepted by the 3 groups, there were relevant differences illustrating va- riations according to geography, culture, cost, and formula availability. These findings emphasize the need for region-specific guidelines.

Impact of two human milk oligosaccharides and lactose on the faecal microbiome of infants with probable cow's milk allergy.

Cow's milk protein allergy (CMPA) in infancy is associated with intestinal microbial dysbiosis, characterised by low Bifidobacteriaceae levels. The present study aimed to investigate the impact of two human milk oligosaccharides (HMO), lactose (L), and their combination on the faecal microbiome and metabolome of infants with CMPA. Stool samples of 12 term infants with probable CMPA (mean age 4.3 months) were analysed using a validated intestinal fermentation assay (SIFR® technology). For each substrate (i.e. HMO (2'-fucosyllactose [2'-FL] and lacto-N-neotetraose [LNnT]), L and HMO + L), taxonomic microbiome characterisation and untargeted metabolite profiling were performed at multiple timepoints. At baseline, the tested faecal microbiota overall displayed low abundances of Bifidobacteriaceae. Fermentation with either HMO or lactose significantly enriched Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium pseudocatenulatum and, for HMO + L, also Bifidobacterium bifidum. The increase in HMO-utilising bifidobacteria was associated with a significant rise in levels of short-chain fatty acids, aromatic lactic acids and N-acetylated amino acids, with additive effects being observed for HMO + L. The above data suggest that the combination of 2'-FL, LNnT and lactose helps to alleviate the previously reported CMPA-associated intestinal bacterial dysbiosis and induces the production of several beneficial metabolites. The clinical significance of these findings for infants with CMPA requires further investigation.

The Efficacy and Safety of Stepwise Oral Food Challenge in Children with Cow’s Milk Allergy

Plain Language SummaryStepwise oral food challenge (OFC) tests begin with low doses of allergens, progressing to full doses. This is one of the strategies used to avoid anaphylactic reactions to the reintroduction of allergens. We previously reported the safety and efficacy of hen egg OFC. In this study, we discuss it for cow’s milk (CM) allergy. We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When the participants reacted to low doses, they underwent very low-dose OFC using baked milk or <1 mL of CM. Positive reactions developed in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results and anaphylaxis. Multivariate analysis indicated that only in low-dose OFCs, higher CM-specific IgE (CM-sIgE) levels, younger age, and complete CM elimination were associated with positive OFC results. Food ladders, an approach to reintroduce allergens, are becoming increasingly popular. Although we believe that OFC is a safer strategy to reintroduce CM to children with CM allergy, our CM-OFCs appeared to develop more anaphylactic reactions than milk ladders. The stepwise OFC reintroduced small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at a younger age, preferably from infancy, with very low doses, similar to milk ladders, may facilitate the safe reintroduction of CM.

Lactobacillus rhamnosus Helps to Reduce the Duration of Bleeding in Breastfed Infants with Allergic Proctocolitis.

Background: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. The current standard of care (SOC) involves eliminating the allergen from both the infant's and mother's diet for 2-4 weeks. The purpose of this study is to assess the effectiveness of Lactobacillus rhamnosus (Ramnoflor) in reducing the duration of bleeding in these infants. Methods: This randomized clinical trial was conducted at Bahrami Children's Hospital on breastfed infants who were diagnosed with CMPA and had a positive occult blood (OB) test. Patients were randomly assigned to either the control or case groups. All patients received SOC therapy, with the case group receiving Ramnoflor and the control group receiving a placebo. Data were recorded on the checklist, and the children were followed and visited three times during the study, with an OB assessment at each visit. Results: The study enrolled 48 infants. Among the infants in the case group, the OB test was positive in four cases (8.3%) on the fifth day. However, there were no positive cases on the 14th and 30th days. The prevalence of this test was significantly lower in patients who received probiotics compared to the control group on the fifth day (p < 0.001). There were no positive OB tests on the 14th and 30th days in any of the groups, and no significant difference was observed between the groups. Conclusion: The addition of L. rhamnosus to SOC therapy led to a decrease in the duration of rectal bleeding in infants with CMPA compared to the control group.

Plant-based milk substitutes as probiotic vehicles: Health effect and survival, a review

The use of plant extracts or nondairy milk alternatives as a substitute for Cow's milk in the formulation of foods that function as vehicles for the consumption of probiotics has become popular. This substitution aims to formulate food products without lactose, low in fat, and, therefore, low in calories. Additionally, they can enter vegan or vegetarian markets. The use of these vegetable extracts has been explored for the development of probiotic foods that confer health benefits without cow milk allergy. However, few studies support that replacing Cow's milk in these foods allows probiotics to remain viable during storage, survive the digestive tract sufficiently, and reach their colonization site. Additionally, even fewer clinical studies in human or animal model assays have analyzed the impact of probiotic foods formulated with plant extracts.

Enhanced Effect of β-Lactoglobulin Immunization in Mice with Mild Intestinal Deterioration Caused by Low-Dose Dextran Sulphate Sodium: A New Experimental Approach to Allergy Studies.

Cow's milk allergy is one of the most common food allergies in children, and its pathomechanism is still under investigation. Recently, an increasing number of studies have linked food allergy to intestinal barrier dysfunction. The present study aimed to investigate changes in the intestinal microenvironment during the development of β-lactoglobulin (β-lg) allergy under conditions of early intestinal dysfunction. BALB/c mice received intraperitoneal β-lg with Freund's adjuvant, followed by oral β-lg while receiving dextran sulphate sodium salt (DSS) in their drinking water (0.2% w/v). The immunized group without DSS and the groups receiving saline, oral β-lg, or DSS served as controls. The study showed that the immunization effect was greater in mice with mild intestinal barrier dysfunction. Although DSS did not affect the mice's humoral response to β-lg, in combination with β-lg, it significantly altered their cellular response, affecting the induction and distribution of T cells in the inductive and peripheral tissues and the activation of immune mediators. Administration of β-lg to sensitized mice receiving DSS increased disease activity index (DAI) scores and pro-inflammatory cytokine activity, altered the distribution of claudins and zonulin 1 (ZO-1) in the colonic tissue, and negatively affected the balance and activity of the gut microbiota. The research model used appears attractive for studying food allergen sensitization, particularly in relation to the initial events leading to mucosal inflammation and the development of food hypersensitivity.

Influence of Brown Rice, Pea, and Soy Proteins on the Physicochemical Properties and Sensory Acceptance of Dairy‐Free Frozen Dessert

ABSTRACTFat and protein derived from milk are prime ingredients in a frozen dessert such as ice cream conferring multiple desirable functionalities. However, this frozen dairy dessert is not suitable for individuals having lactose intolerance, cow milk allergy, or vegans. Hence, the study aimed to formulate dairy‐free frozen desserts using plant oils and plant proteins and compare their physicochemical characteristics and sensory acceptance against an ice cream containing milk fat and milk protein. Results indicated that the types of protein significantly influenced the physicochemical properties and sensory acceptance of the frozen dessert samples. Frozen desserts containing brown rice, pea, and soy protein showed greater resistance to melting (0.29, 0.12, and 0.19%/min vs. 1.95%/min), but they scored lower in sensory quality than ice cream made with milk protein; although they remained at an acceptable level. When compared among the plant proteins, the physicochemical characteristics of frozen desserts containing brown rice, pea, and soy protein varied because of the differences in the respective protein composition. Frozen dessert with brown rice protein showed higher overrun (47.50% vs. 40.78% and 37.8%), lower hardness (20.02 N vs. 22.24 and 26.37 N), and higher melting rate (0.29%/min vs. 0.19 and 0.12%/min) than frozen desserts containing soy and pea protein. Additionally, the brown rice protein frozen dessert received lower sensory acceptance than soy and pea protein frozen desserts. In summary, brown rice, pea, and soy proteins showed potential to be used as viable alternatives to milk protein for dairy‐free frozen dessert applications.

Diagnostic Accuracy of Skin Prick Test, Food-Specific IgE and Component Testing for IgE-Mediated Peanut, Egg, Milk and Wheat Allergy.

Diagnostic Accuracy of Skin Prick Test, Food-Specific IgE and Component Testing for IgE-Mediated Peanut, Egg, Milk and Wheat Allergy.

Reintroduction of excluded food triggers as a crucial step in managing patients with food allergies

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.