Early, continuing exposure to cow's milk formula and cow's milk allergy

Lachover‐Roth, Idit; Cohen-Engler, Anat; Furman, Yael; Shachar, Ido; Rosman, Yossi; Meir-Shafrir, Keren; Mozer-Mandel, Michal; Farladansky-Gershnabel, Sivan; Biron‐Shental, Tal; Mandel, Micha; Confino-Cohen, Ronit

doi:10.1016/j.anai.2022.10.013

Cited by 32 publications

(14 citation statements)

References 34 publications

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“…A recent Israeli population-based prospective study showed that the prevalence of CMA was 1.58% in exclusively breastfed infants, compared to zero in those receiving mixed or CMF feeding. 16 However, protocol violations were frequent, and on perprotocol analysis only 4/567 (0.7%) exclusively breastfed infants developed CMA. While the WHO recommends exclusive breastfeeding for at least 6 months, this duration is not reached in most cases, and CMP is introduced during the period of highest risk to develop CMA.…”

Section: Igementioning

confidence: 98%

“…Importantly, milk allergy was rare among those with sustained milk introduction within the first 14 days of life 13 . Observational case‐control studies and large population‐based studies on the timing of CMP introduction and the development of CMA were subsequently conducted with contradicting results 14–20 . In addition, the known health benefits of breastfeeding and the recommendation of exclusive breastfeeding for the first 6 months of life further complicates this issue 21 …”

Section: Introductionmentioning

confidence: 99%

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Consumption of cow's milk formula in the nursery and the development of milk allergy

Elizur,

Rachel‐Jossefi,

Rachmiel

et al. 2024

Clinical & Translational All

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BackgroundThe effect of the amount of transient cow's milk formula (CMF) consumed during the first days of life on IgE‐cow's milk allergy (IgE‐CMA) is unknown.MethodsA cohort of 58 patients with IgE‐CMA was identified from a large scale population‐based study of 13,019 infants followed from birth. A group of 116 infants matched for sex and breastfeeding only duration (beyond the nursery period), and another random group of 259 healthy infants were used as controls. Parents were interviewed and the infants' medical records were searched to assess CMF consumption in the nursery.ResultsWhile 96% of the mothers of the 174 infants (58 with Cow's milk allergy and 116 controls) reported on exclusive breastfeeding during the stay in the nursery, CMF consumption was documented in 96 (55%) of the infants. Of those, most (57; 59%) received one to three feedings, 20 (21%) received four to nine feedings, and 19 (20%) received ≥10 feedings. Fewer formula feeds (1–3) were significantly more common in the allergic group than ≥4 feeds (p = 0.0003) and no feeds at all (p = 0.02) compared to controls (n = 116). Of those exclusively breastfed in the nursery, 13/23 allergic infants (57%) introduced CMF at age 105–194 days (the period with highest‐risk for IgE‐CMA) compared to 33/98 (34%) from the random control group (n = 259) (p = 0.04).ConclusionsMost infants end up receiving few CMF feeds in the nursery. Transient CMF in the nursery is associated with increased risk of IgE‐CMA.

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Section: Igementioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Consumption of cow's milk formula in the nursery and the development of milk allergy

Elizur,

Rachel‐Jossefi,

Rachmiel

et al. 2024

Clinical & Translational All

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“…In a later manuscript, the authors reported that the analysis from the same data suggested that regular soy formula intake between 1 and 2 months of age in infants avoiding CM formula was significantly associated with a reduced risk of food sensitization in infancy (282). Early, consistent CM exposure was reported to be protective against adverse reactions to CM (280,284). Occasional exposure to CM increases the risk for IgE‐mediated CMA and should be avoided (284).…”

Section: Nutritional Intervention As Primary Prevention Of Cmamentioning

confidence: 99%

“…Early, consistent CM exposure was reported to be protective against adverse reactions to CM (280,284). Occasional exposure to CM increases the risk for IgE-mediated CMA and should be avoided (284). Overall, the effects of brief early exposure (during the first week of life or between 1 and 2 months of age) are not consistent.…”

Section: Avoiding Early Introduction Of CM Formulamentioning

confidence: 99%

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Vandenplas

Broekaert

Domellöf

et al. 2024

J. pediatr. gastroenterol. nutr.

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A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 1 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost and quality of life.

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“…This concept is supported by an intervention study from Israel [24 ▪▪ ]. In the Cow's Milk Early Exposure Trial (COMEET) study, Lachover-Roth et al investigated the development of cow's milk allergy during the first year of life by assigning 1992 newborns from the general population to either continued cow's milk formula feeding for the first 2 months of life or exclusive breastfeeding, depending on the mothers’ wishes.…”

Section: Early Introduction Of Allergenic Foods: Cow's Milkmentioning

confidence: 99%

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children

Sakihara

2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Over the past two decades, food allergy prevention strategies have shifted from ‘delayed introduction’ to ‘no delayed introduction’ to ‘early introduction’ of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention. Recent findings Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing. Summary Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.

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Early, continuing exposure to cow's milk formula and cow's milk allergy

Cited by 32 publications

References 34 publications

Consumption of cow's milk formula in the nursery and the development of milk allergy

Consumption of cow's milk formula in the nursery and the development of milk allergy

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children

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