Maternal Elimination Diet and Symptoms of Cow’s Milk Allergy in Breastfed Infants—Reply

Abstract

In Reply In our article published in May 2020, we highlighted the need for innovative ways of delivering education, health, and social services owing to the disruptions caused by the coronavirus disease 2019 COVID-19 pandemic. 1 As the the pandemic progresses, many school districts have implemented virtual learning during the fall semester. 2 We appreciate Wong's identification of a novel way to deliver preschool and early intervention services to children and directly engage parents through employment. Training parents to deliver services could help overcome the challenges that young children face with the virtual learning environment, including attention span, curricular content, and the need for parent supervision even if content is available online. One factor to consider with respect to this approach would be that students would miss the in-person interaction and socialization with their peers that occurs in a classroom setting that can also be beneficial for development. 3

Cow’s Milk Antigens Content in Human Milk: A Scoping Review

“…However, it has not been well-documented yet whether they can trigger allergic sensitization in infants. The latest systematic reviews on this topic [ 10 , 11 , 12 , 13 , 14 ] as well as the 2019 American Academy of Pediatrics report [ 6 ] concluded that there is a lack of evidence to support maternal dietary restrictions during pregnancy and lactation. After many years of allergen avoidance, new guidelines recommend early exposure of the infants to oral allergens with the goal of inducing regulatory immune responses and generating tolerance to allergens [ 6 ].…”

The future of food allergy: Challenging existing paradigms of clinical practice

“…However, parental‐ and self‐report significantly overestimate the rate of food allergy. For example, a recent review concluded that confirmed milk allergy is 15‐ to 20‐fold less frequent than parentally reported symptoms 4 . Similarly, a European systematic review suggested a self‐reported prevalence between 13.1% and 19.9%, with serum IgE sensitization of 16.6% and skin testing of 5.7%, with only 0.8% based on oral food challenge (OFC).…”

“…For example, a recent review concluded that confirmed milk allergy is 15-to 20-fold less frequent than parentally reported symptoms. 4 Similarly, a European systematic review suggested a self-reported prevalence between 13.1% and 19.9%, with serum IgE sensitization of 16.6% and skin testing of 5.7%, with only 0.8% based on oral food challenge (OFC). Lipid transfer protein allergy has emerged as the most common cause of primary food allergy and food-induced anaphylaxis in older children and adults residing in Southern European countries (Mediterranean and Atlantic areas).…”