TY - JOUR
T1 - Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy
AU - Zepeda-Ortega, Benjamin
AU - Goh, Anne
AU - Xepapadaki, Paraskevi
AU - Sprikkelman, Aline
AU - Nicolaou, Nicolaos
AU - Hernandez, Rosa Elena Huerta
AU - Latiff, Amir Hamzah Abdul
AU - Yat, Miu Ting
AU - Diab, Mohamed
AU - Hussaini, Bakr Al
AU - Setiabudiawan, Budi
AU - Kudla, Urszula
AU - van Neerven, R.J.J.
AU - Muhardi, Leilani
AU - Warner, John O.
PY - 2021/6/10
Y1 - 2021/6/10
N2 - The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
AB - The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
KW - cow milk allergy
KW - early oral tolerance development milk ladder
KW - extensive hydrolysate
KW - hydrolysate step-wise approach
KW - intermediate extensive hydrolysate
KW - management
KW - partially hydrolysate
KW - prevention
U2 - 10.3389/fimmu.2021.608372
DO - 10.3389/fimmu.2021.608372
M3 - Article
C2 - 34177882
AN - SCOPUS:85109668349
SN - 1664-3224
VL - 12
SP - 608372
JO - Frontiers in Immunology
JF - Frontiers in Immunology
ER -