Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies

Abstract

This review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.

An Expert Panel Statement on the Beneficial Effects of Human Milk Oligosaccharides (HMOs) in Early Life and Potential Utility of HMO-Supplemented Infant Formula in Cow’s Milk Protein Allergy

“…Overall, the management of CMPA is based on three intervention strategies including primary prevention of initial IgE sensitization, secondary prevention of the triggering of allergic reactions in IgE-sensitized children and tertiary prevention to reduce the expression of end-organ allergic disease in case of known food allergy via avoidance of allergic food and induction of tolerance. 110 , 113–116 …”

The Role and Place of Partially Hydrolysed Protein Infant Formulas in the Nutrition of Full-term Children: Digestive Comfort and Allergy Prevention

“…Продемонстрировано, что в целом более половины детей с аллергией к БКМ к 5-летнему возрасту приобретают к нему толерантность [59,60]. При этом оказалось, что изолированная гастроинтестинальная (не-IgE-зависимая) форма аллергии к БКМ характеризуется лучшим прогнозом и более ранним формированием толерантности к БКМ, а высокие / 2020 / ТОМ 19 / № 4 CURRENT PEDIATRICS / 2020 / V. 19 / № 4 титры специфических IgE к БКМ, ранний дебют, наличие системных реакций на БКМ, меньшая доза, вызывающая развитие клинических симптомов, а также сочетание с другими атопическими болезнями и поливалентная сенсибилизация предопределяют персистирующее течение пищевой аллергии [61].…”

Production of Liquid Milk Protein Concentrate with Antioxidant Capacity, Angiotensin Converting Enzyme Inhibitory Activity, Antibacterial Activity, and Hypoallergenic Property by Membrane Filtration and Enzymatic Modification of Proteins

“…Due to the presence of Immunoglobulin E-and Immunoglobulin G-binding epitopes, milk proteins are listed among the "big 8" allergens [23,24]. Milk allergens provoke mild symptoms to life-threatening biochemical outcomes, including severe enterocolitis atopic eczema and immediate immunoglobulin-mediated systematic multisystem reactions [25]. Milk is not recommended in the diet chart due to the presence of saturated fatty acids-those contribute heart disease [26,27], type 2 diabetes, and Alzheimer's disease [28,29].…”