Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment of Cow's Milk Protein Allergy

  • Vandenplas, Yvan (Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel) ;
  • De Greef, Elisabeth (Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel) ;
  • Devreker, Thierry (Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel)
  • Received : 2014.01.29
  • Accepted : 2014.02.23
  • Published : 2014.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

The diagnosis and treatment of cow's milk protein allergy (CMPA) is still a challenge. A systematic literature search was performed using Embase, Medline, The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials for the diagnosis and treatment of cow's milk allergy (CMA). Since none of the symptoms of CMPA is specific and since there is no sensitive diagnostic test (except a challenge test), the diagnosis of CMPA remains difficult. A "symptom-based score" is useful in children with symptoms involving different organ systems. The recommended dietary treatment is an extensive cow milk based hydrolysate. Amino acid based formula is recommended in the most severe cases. However, soy infant formula and hydrolysates from other protein sources (rice) are gaining popularity, as they taste better and are cheaper than the extensive cow's milk based hydrolysates. Recent meta-analyses confirmed the safety of soy and estimate that not more than 10-15% of CMPA-infants become allergic to soy. An accurate diagnosis of CMA is still difficult. The revival of soy and the development of rice hydrolysates challenge the extensive cow's milk based extensive hydrolysates as first option and amino acid formula.

Keywords

References

  1. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011;127:594-602. https://doi.org/10.1016/j.jaci.2010.11.044
  2. Sackesen C. Epidemiology of cow's milk allergy: has it changed? Clin Transl Allergy 2011;1(Suppl 1):S50. https://doi.org/10.1186/2045-7022-1-S1-S50
  3. Fiocchi A, Brozek J, Schunemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010;3:57-161. https://doi.org/10.1097/WOX.0b013e3181defeb9
  4. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000;106(2 Pt 1):346-9. https://doi.org/10.1542/peds.106.2.346
  5. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al; European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012;55:221-9. https://doi.org/10.1097/MPG.0b013e31825c9482
  6. Host A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy 1990;45:587-96. https://doi.org/10.1111/j.1398-9995.1990.tb00944.x
  7. Gordon BR. The allergic march: can we prevent allergies and asthma? Otolaryngol Clin North Am 2011;44:765-77. https://doi.org/10.1016/j.otc.2011.03.006
  8. Vandenplas Y, Bhatia J, Shamir R, Agostoni C, Turck D, Staiano A, et al. Hydrolysed formulas for allergy prevention. J Pediatr Gastroenterol Nutr 2014.
  9. Host A. Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89(6 Suppl 1):33-7. https://doi.org/10.1016/S1081-1206(10)62120-5
  10. Vandenplas Y, Steenhout P, Planoudis Y, Grathwohl D; Althera Study Group. Treating cow's milk protein allergy: a double-blind randomized trial comparing two extensively hydrolysed formulas with probiotics. Acta Paediatr 2013;102:990-8. https://doi.org/10.1111/apa.12349
  11. Vandenplas Y, Althera Study Group, Steenhout P, Grathwohl D. A pilot study on the application of a symp- tom-based score for the diagnosis of cow's milk protein allergy. SAGE Open Med 2014;2:205031211452 3423.
  12. Crittenden RG, Bennett LE. Cow's milk allergy: a complex disorder. J Am Coll Nutr 2005;24(6 Suppl): 582S-91S. https://doi.org/10.1080/07315724.2005.10719507
  13. Bahna SL. Hypoallergenic formulas: optimal choices for treatment versus prevention. Ann Allergy Asthma Immunol 2008;101:453-9. https://doi.org/10.1016/S1081-1206(10)60281-5
  14. Vandenplas Y, De Greef E, Hauser B, Paradice Study Group. Safety and tolerance of a new extensively hydrolyzed rice protein-based formula in the management of infants with cow's milk protein allergy. Eur J Pediatr 2014.
  15. Vandenplas Y, Castrellon PG, Rivas R, Jimenez Gutierrez C, Diaz Garcia L, Estevez Jimenez J, et al. Safety of soya-based infant formulas in children. Br J Nutr 2014;10:1-21.
  16. Katz Y, Gutierrez-Castrellon P, Gonzalez MG, Rivas R, Lee BW, Alarcon P. A comprehensive review of sensitization and allergy to soy-based products. Clin Rev Allergy Immunol 2014.
  17. Jarvinen KM, Chatchatee P. Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis. Curr Opin Allergy Clin Immunol 2009;9:251-8. https://doi.org/10.1097/ACI.0b013e32832b3f33

Cited by

  1. Cow’s Milk Protein Allergy vol.55, pp.11, 2014, https://doi.org/10.1177/0009922816664512
  2. Nutrition and Allergic Diseases vol.9, pp.7, 2014, https://doi.org/10.3390/nu9070762
  3. Expert panel on practice patterns in the management of cow’s milk protein allergy and associated economic burden of disease on health service in Turkey vol.20, pp.9, 2014, https://doi.org/10.1080/13696998.2017.1342171
  4. A descriptive pilot study of cytokine production following stimulation of ex-vivo whole blood with commercial therapeutic feline hydrolyzed diets in individual healthy immunotolerant cats vol.13, pp.None, 2014, https://doi.org/10.1186/s12917-017-1219-9
  5. Short article: The endoscopic and histologic findings of infants who have experienced brief resolved unexplained events vol.30, pp.2, 2014, https://doi.org/10.1097/meg.0000000000001012
  6. A synbiotic-containing amino-acid-based formula improves gut microbiota in non-IgE-mediated allergic infants vol.83, pp.3, 2014, https://doi.org/10.1038/pr.2017.270
  7. Differences in the immunoreactivity of milk from local farms and from points of purchase vol.246, pp.1, 2014, https://doi.org/10.1007/s00217-019-03400-2
  8. Use of Soy-Based Formulas and Cow's Milk Allergy: Lights and Shadows vol.8, pp.None, 2020, https://doi.org/10.3389/fped.2020.591988
  9. Alergia a la proteína de leche de vaca. Enfoque diagnóstico y terapéutico vol.35, pp.1, 2014, https://doi.org/10.22516/25007440.379
  10. Diarrhea in the pediatric solid organ transplantation recipient: A multidisciplinary approach to diagnosis and management vol.25, pp.2, 2014, https://doi.org/10.1111/petr.13886
  11. Milk Alternatives. What Advice should Dental Professionals be Giving? vol.48, pp.5, 2014, https://doi.org/10.12968/denu.2021.48.5.359