Nutritional Management of Cow's Milk Allergy in Infants: A Comparison of DRACMA, ESPGHAN, and AAP Guidelines

Cow’s Milk Allergy (CMA) is one of the most common food allergies presented during infancy and childhood. The diagnosis and management of CMA is a complex task. First and foremost, CMA is manifested by a variety of symptoms classified by their type of mediation (either IgE and/or non-IgE responses), organ systems involved, and the onset of the reaction. Second, although several guidelines for the management of CMA have been published worldwide, they differ in their recommendations. To our knowledge, no global consensus exists for the management of the different symptoms associated with CMA. This review provides a table to compare three widely accepted published guidelines to enable the reader to easily navigate and compare the nutritional recommendations to be followed depending on the symptomatology. This review is intended to represent a practical tool to assess the nutritional recommendations for the management of CMA.

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Development of Food Allergies with Special Reference to Cow's Milk Allergy

PEDIATRICS ◽

10.1542/peds.75.1.177 ◽

1985 ◽

Vol 75 (1) ◽

pp. 177-181

Author(s):

Tony Foucard

Keyword(s):

Wide Spectrum ◽

Gastrointestinal Symptoms ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Gradual Change ◽

Milk Allergy ◽

Early Introduction ◽

Cow's Milk ◽

Cow's Milk Allergy

Using strict criteria, the incidence of cow's milk sensitivity is probably 1% to 2% during the first 2 years of life. Although there is a wide spectrum of sensitivity symptoms caused by cow's milk, two major groups of infants are discernible. One group consists of infants who react to small amounts of cow's milk within a few minutes up to one hour, usually with gastrointestinal symptoms or urticaria. These infants are often atopic and have positive findings on skin prick tests and radioallergosorbent test (RAST) reactions to cow's milk allergens. The other group consists of children whose reaction to cow's milk occurs one hour or longer after intake of cow's milk or cow's milk-based formula. These reactions are usually not immunoglobulin (Ig)E-mediated and different immune and nonimmune mechanisms probably cause the symptoms. The risk of developing cow's milk sensitivity seems to be influenced by the atopic constitution of the infant and the age at which cow's milk is introduced. Early exposure to cow's milk increases the risk, not only of adverse reactions to this milk but also of developing allergies to other foods. It is suggested that early introduction of cow's milk may enhance the risk of future respiratory allergies. Allergists are still not in agreement as to whether the weaning process should be rapid or should consist of a gradual change from breast milk to cow's milk in order to minimize the risk of cow's milk allergy.

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Oral Immunotherapy for Children with Cow’s Milk Allergy

Pathogens ◽

10.3390/pathogens10101328 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1328

Author(s):

Mika Ogata ◽

Jun Kido ◽

Kimitoshi Nakamura

Keyword(s):

Oral Immunotherapy ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Long Time

Cow’s milk allergy (CMA) is one of the most common IgE-dependent food allergies in children. Some children develop severe and persistent CMA, with near-fatal reactions after exposure to trace amounts of cow’s milk (CM). Because milk and dairy products are included in various processed food products, it is difficult to completely remove milk, which negatively affects the quality of life of children with CMA. Oral immunotherapy (OIT) can alleviate food allergen-induced anaphylaxis under continuous ingestion of a little of the causative food. Children with severe CMA may benefit from OIT, but the treatment requires a long time and poses a risk of anaphylaxis. Moreover, in recent years, new therapies, including omalizumab, sublingual immunotherapy, and epicutaneous immunotherapy, have played the role of optional OIT. In this review, we present the current methods of and other attempts at OIT, and discuss OIT for safely treating CMA.

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Role of Cellular Immunity in Cow’s Milk Allergy: Pathogenesis, Tolerance Induction, and Beyond

Mediators of Inflammation ◽

10.1155/2014/249784 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 14

Author(s):

Juandy Jo ◽

Johan Garssen ◽

Leon Knippels ◽

Elena Sandalova

Keyword(s):

Cellular Immunity ◽

Tolerance Induction ◽

Milk Proteins ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Cow’S Milk Proteins

Food allergy is an aberrant immune-mediated reaction against harmless food substances, such as cow’s milk proteins. Due to its very early introduction, cow’s milk allergy is one of the earliest and most common food allergies. For this reason cow’s milk allergy can be recognized as one of the first indications of an aberrant inflammatory response in early life. Classically, cow’s milk allergy, as is true for most other allergies as well, is primarily associated with abnormal humoral immune responses, that is, elevation of specific immunoglobulin E levels. There is growing evidence indicating that cellular components of both innate and adaptive immunity play significant roles during the pathogenesis of cow’s milk allergy. This is true for the initiation of the allergic phenotype (stimulation and skewing towards sensitization), development and outgrowth of the allergic disease. This review discusses findings pertaining to roles of cellular immunity in allergic inflammation, and tolerance induction against cow’s milk proteins. In addition, a possible interaction between immune mechanisms underlying cow’s milk allergy and other types of inflammation (infections and noncommunicable diseases) is discussed.

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Epidemiology of Cow’s Milk Allergy

Nutrients ◽

10.3390/nu11051051 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1051 ◽

Cited By ~ 21

Author(s):

Julie D. Flom ◽

Scott H. Sicherer

Keyword(s):

Natural History ◽

Immunoglobulin E ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Immune Mediated

Immunoglobulin E (IgE)-mediated cow’s milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing the epidemiology of CMA. However, assessment is complicated by the presence of other immune-mediated reactions to cow’s milk. These include non-IgE and mixed (IgE and non-IgE) reactions and common non-immune mediated reactions, such as lactose intolerance. Estimates of prevalence and population-level patterns are further complicated by the natural history of CMA (given its relatively high rate of resolution) and variation in phenotype (with a large proportion of patients able to tolerate baked cow’s milk). Prevalence, natural history, demographic patterns, and long-term outcomes of CMA have been explored in several disparate populations over the past 30 to 40 years, with differences seen based on the method of outcome assessment, study population, time period, and geographic region. The primary aim of this review is to describe the epidemiology of CMA. The review also briefly discusses topics related to prevalence studies and specific implications of CMA, including severity, natural course, nutritional impact, and risk factors.

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Immunonutrition for Pediatric Patients With Cow's Milk Allergy: How Early Interventions Could Impact Long-Term Outcomes

Frontiers in Allergy ◽

10.3389/falgy.2021.676200 ◽

2021 ◽

Vol 2 ◽

Author(s):

Laura Carucci ◽

Serena Coppola ◽

Anna Luzzetti ◽

Luana Voto ◽

Veronica Giglio ◽

...

Keyword(s):

System Development ◽

Dietary Factors ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Immune System Development

Cow's milk allergy (CMA) is one of the most common food allergies and one of the main causes of food-induced anaphylaxis in the pediatric age. Moreover, up to 45% of CMA children develop other atopic manifestations later in life, a phenomenon commonly named atopic march. Thus, CMA imposes a significant cost to health care systems as well as to families, and has emerged as one of the most expensive allergic diseases. The immunonutrition strategy builds its foundation on the ability of selected dietary factors to modulate immune system development and function. Recent studies highlighted the potential of immunonutrition in the management of CMA. This review is focused on the mechanisms and long-term clinical outcomes of the immunonutrition approach in children with CMA.

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