Materiały źródłowe

• #1 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10421120/

  Cows milk allergy (CMA) is one of the most common pediatric food allergies. […] Among the environmental factors, diet represents one of the main modifiable ones. Since dietary habits have a role in eliciting potentially negative or positive effects in CMA occurrence, nutritional modulation could be considered an effective target for the prevention and management of CMA. […] The CMAs primary prevention should start from the prenatal period, focusing on a maternal healthy lifestyle and food diversity during pregnancy. […] High adherence to the Mediterranean diet has been reported to increase GM diversity. Thus, a maternal diet rich in Mediterranean diet-based foods, including vegetables and yogurt, was associated with protective effects for offspring allergies. […] Through a positive modulation of the GM and the proper development of the immune system during infancy, breastfeeding is the first nutritional postnatal factor able to protect against allergy occurrence.

• #2 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://www.mdpi.com/2072-6643/15/15/3328

  Cow’s milk allergy (CMA) is one of the most common pediatric food allergies. The prevalence and severity of CMA have increased dramatically in the last decades, under the pressure of environmental factors in genetically predisposed individuals. Among the environmental influences, nutritional factors play a crucial role. Diet is the most modifiable factor, representing a potential target for the prevention and treatment of CMA. In this review, we report the most scientific-based nutritional strategies for preventing and managing pediatric CMA. […] The CMA’s primary prevention should start from the prenatal period, focusing on a maternal healthy lifestyle and food diversity during pregnancy. Maternal diet during pregnancy has been considered a potential target for allergy prevention. Maternal diet may affect, through direct or indirect mechanisms, infant GM, which is associated with a range of allergy outcomes. High adherence to the Mediterranean diet has been reported to increase GM diversity. Thus, a maternal diet rich in Mediterranean diet-based foods, including vegetables and yogurt, was associated with protective effects for offspring allergies.

• #3 Nurturing Resilience: Strategies for Milk Allergy Prevention in I

  https://www.longdom.org/open-access/nurturing-resilience-strategies-for-milk-allergy-prevention-in-infants-105765.html

  Milk allergies can pose significant challenges for infants and their families, necessitating a proactive approach to prevention. […] Early intervention and awareness are crucial in mitigating the risk of developing milk allergies. […] This article explores strategies for milk allergy prevention, emphasizing the importance of informed choices, breastfeeding, and introducing solid foods in a manner that minimizes the risk of allergic reactions. […] Prevention strategies aim to reduce the likelihood of infants developing sensitivities to milk proteins, fostering a foundation of resilience against potential allergic responses. […] The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods until at least one year of age.

• #4 Dietary exposures and allergy prevention in high-risk infants | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-021-00638-y

  Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. […] When cows milk protein formula has been introduced in an infants diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. […] For high-risk infants, there is compelling evidence that introducing allergenic foods early at around 6 months, but not before 4 months of age can prevent common food allergies, and allergies to peanut and egg in particular. […] Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. […] If cows milk formula is introduced, regular ingestion (as little as 10 mL daily) should be maintained to prevent loss of tolerance.

• #5 Dietary exposures and allergy prevention in high-risk infants | Canadian Paediatric Society

  https://cps.ca/documents/position/dietary-exposures-and-allergy-prevention

  Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. […] Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. […] When cows milk protein formula has been introduced in an infants diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. […] For high-risk infants, there is compelling evidence that introducing allergenic foods early at around 6 months, but not before 4 months of age can prevent common food allergies, and allergies to peanut and egg in particular.

• #6 Food Allergy Prevention – Allergies Québec

  https://allergies-alimentaires.org/en/prevention/

  The prevalence of allergies in children is around 6%. Combinations of genetic and environmental factors contribute to the risk of developing an allergic condition. The term atopy describes this predisposition. Infants who have severe eczema have a high risk of developing a food allergy. Infants with mild to moderate eczema, those with a family history of atopy in one or both parents (food allergies, allergic rhinitis, eczema, asthma), or those who already have a known food allergy are also more at risk of developing a food allergy (or an additional one). […] Conclusion: Maternal avoidance of priority allergens, for the sake of allergy prevention, is not recommended during pregnancy. […] Conclusion: With respect to the most common food allergens, no dietary restrictions are recommended during breastfeeding. However, if a reaction to the proteins in breastmilk is suspected, it is important to assess the situation with a health professional and modify the mother’s diet if necessary.

• #7 AAIR :: Allergy, Asthma & Immunology Research

  https://e-aair.org/DOIx.php?id=10.4168/aair.2023.15.4.419

  The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. […] The rationale of preventive strategies can be broadly classified into: 1) those modulating the immune system to reduce proinflammatory responses, and 2) those improving the epithelial barrier function of the skin, respiratory tract and gastrointestinal mucosa. […] Recommendation: Pregnant women should have a healthy and balanced diet, rich in fish. There is no need for pregnant women to avoid allergenic foods (GRADE: very low). […] Recommendation: Avoid the use of CMF in the first week of life. However, if required, continuing a daily ingestion of at least 10 mL of CMF until 2 months of age may reduce the risk of CMA associated with short term supplementation (GRADE: low). […] Recommendation: Introduce allergenic foods, particularly egg and peanut, around age 6 months but not earlier than 4 months (GRADE: moderate).

• #8 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://www.mdpi.com/2072-6643/15/15/3328

  Cow’s milk allergy (CMA) is one of the most common pediatric food allergies. The prevalence and severity of CMA have increased dramatically in the last decades, under the pressure of environmental factors in genetically predisposed individuals. Among the environmental influences, nutritional factors play a crucial role. Diet is the most modifiable factor, representing a potential target for the prevention and treatment of CMA. In this review, we report the most scientific-based nutritional strategies for preventing and managing pediatric CMA. […] The CMA’s primary prevention should start from the prenatal period, focusing on a maternal healthy lifestyle and food diversity during pregnancy. Maternal diet during pregnancy has been considered a potential target for allergy prevention. Maternal diet may affect, through direct or indirect mechanisms, infant GM, which is associated with a range of allergy outcomes. High adherence to the Mediterranean diet has been reported to increase GM diversity. Thus, a maternal diet rich in Mediterranean diet-based foods, including vegetables and yogurt, was associated with protective effects for offspring allergies.

• #9 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10421120/

  Cows milk allergy (CMA) is one of the most common pediatric food allergies. […] Among the environmental factors, diet represents one of the main modifiable ones. Since dietary habits have a role in eliciting potentially negative or positive effects in CMA occurrence, nutritional modulation could be considered an effective target for the prevention and management of CMA. […] The CMAs primary prevention should start from the prenatal period, focusing on a maternal healthy lifestyle and food diversity during pregnancy. […] High adherence to the Mediterranean diet has been reported to increase GM diversity. Thus, a maternal diet rich in Mediterranean diet-based foods, including vegetables and yogurt, was associated with protective effects for offspring allergies. […] Through a positive modulation of the GM and the proper development of the immune system during infancy, breastfeeding is the first nutritional postnatal factor able to protect against allergy occurrence.

• #10 Food Allergy Prevention – Allergies Québec

  https://allergies-alimentaires.org/en/prevention/

  The prevalence of allergies in children is around 6%. Combinations of genetic and environmental factors contribute to the risk of developing an allergic condition. The term atopy describes this predisposition. Infants who have severe eczema have a high risk of developing a food allergy. Infants with mild to moderate eczema, those with a family history of atopy in one or both parents (food allergies, allergic rhinitis, eczema, asthma), or those who already have a known food allergy are also more at risk of developing a food allergy (or an additional one). […] Conclusion: Maternal avoidance of priority allergens, for the sake of allergy prevention, is not recommended during pregnancy. […] Conclusion: With respect to the most common food allergens, no dietary restrictions are recommended during breastfeeding. However, if a reaction to the proteins in breastmilk is suspected, it is important to assess the situation with a health professional and modify the mother’s diet if necessary.

• #11

  https://journals.lww.com/apallergy/fulltext/2023/03000/food_allergy_prevention__where_are_we_in_2023_.4.aspx

  Food allergy prevention involves recommendations to the maternal diet during pregnancy and breast feeding, early life feeding and introduction of solid foods. Pregnant and breastfeeding women are not recommended to exclude any food allergens from their diet, but data are lacking to support active consumption of food allergens for prevention of food allergy. Breastfeeding is recommended for the many health benefits to the mother and child but has not shown any association with reduction in childhood food allergies. There is currently no recommendation regarding the use of any infant formula for allergy prevention, including the use of partially or extensively hydrolyzed formulas. Once the introduction of solid food commences, based on randomized controlled trials, it is advised to actively introduce peanuts and egg early into the infant diet and continue with consumption of these.

• #12 Maternal Diet | Allergy – Asthma Care and Prevention Center

  https://www.allergydenver.com/project/617/

  No maternal dietary restriction. […] A 2011 study in Finland found that mothers who drank cows milk during pregnancy were less likely to have an infant with a cows milk allergy. […] The current guidelines from the Academy of Allergy, Asthma and Immunology do NOT recommend that the mother avoid allergenic foods (such as milk, egg, wheat, tree nuts, fish or shellfish) during pregnancy or breastfeeding. […] Do not avoid any foods during pregnancy or breastfeeding in an attempt to prevent allergic disease in the baby.

• #13 Maternal Diet | Allergy – Asthma Care and Prevention Center

  https://www.allergydenver.com/project/617/

  No maternal dietary restriction. […] A 2011 study in Finland found that mothers who drank cows milk during pregnancy were less likely to have an infant with a cows milk allergy. […] The current guidelines from the Academy of Allergy, Asthma and Immunology do NOT recommend that the mother avoid allergenic foods (such as milk, egg, wheat, tree nuts, fish or shellfish) during pregnancy or breastfeeding. […] Do not avoid any foods during pregnancy or breastfeeding in an attempt to prevent allergic disease in the baby.

• #14 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6683055/

  Exclusive breastfeeding up to 6 months of age is the preferred feeding for all infants. […] When breastfeeding is not possible or not sufficient, certain pHF-W have shown benefits in prevention of allergy, especially atopic eczema in at-risk infants. […] The participants agreed that a clinically proven pHF-W formula can play an important role in allergy prevention. […] When breastfeeding is not possible or when breast milk is not available, partially hydrolyzed whey formula (pHF-W) with documented safety and efficacy should be recommended for infants at risk of allergy. […] Not all pHFs are the same, as different formulations have different peptide compositions and production methods and have demonstrated different outcomes. […] In non-breastfed infants, cow-milk-based formula and supplementary foods containing CMP or other unmodified animal milk proteins such as goat milk and sheep milk should be strictly avoided. […] A step-down approach can be considered while managing children with CMPA, using pHF-W as a bridge between eHF or AAF and the intact CMP. […] pHF-W can be used in the transition from eHF or AAF to intact CMP, if the initial pHF-W challenge is tolerated by the child.

• #15 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://www.mdpi.com/2072-6643/11/7/1444

  Allergy prevention and CMPA treatment in the Middle-East […] Exclusive breastfeeding up to 6 months of age is the preferred feeding for all infants. The World Health Organization recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. […] When breastfeeding is not possible or not sufficient, certain pHF-W have shown benefits in prevention of allergy, especially atopic eczema in at-risk infants. […] The participants agreed that a clinically proven pHF-W formula can play an important role in allergy prevention. […] When breastfeeding is not possible or when breast milk is not available, partially hydrolyzed whey formula (pHF-W) with documented safety and efficacy should be recommended for infants at risk of allergy.

• #16 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://www.mdpi.com/2072-6643/15/15/3328

  Through a positive modulation of the GM and the proper development of the immune system during infancy, breastfeeding is the first nutritional postnatal factor able to protect against allergy occurrence. Several protective mechanisms of breastfeeding have been proposed. Breast milk has anti-allergic immune properties and contains a large amount of biologically active compounds, including lysozyme, lactoferrin, immunoglobulins (Ig)A, IgM, cytokines, nucleotides, microRNAs and hormones that provide passive immunity and could induce oral tolerance to food antigens. […] The European guidelines recommend the importance of not avoiding the intake of potentially allergenic foods during weaning, emphasizing that there is no reason for delaying their introduction after 12 months nor for an early introduction <4 months. Evidence supports the role of early exposure to potential allergens in the development of immune tolerance; indeed, the regular ingestion of food allergens between 4 and 6 months of life can lead to immune tolerance and alter the immunological responses to food antigens.

• #17

  https://amaraorganicfoods.com/blogs/blog/allergy-prevention-breastfeeding-and-starting-solids?srsltid=AfmBOooigBwZ53bobUN8PKMA7q7ydSgLy60Vv2T00ScsGupdWYulgK1A

  Yes, breastfeeding is clearly the preferred method of infant nutrition in most cases because of its nutritional, immunological, and psychological benefits. […] Exclusive breastfeeding for at least 4 months and up to 6 months of age seems to reduce the incidence of atopic dermatitis and eczema for children in the first 2 years of life, to reduce early onset wheezing before the age of 4 years, to reduce the risk of asthma in the first 5 years and to reduce the incidence of cow’s milk allergy, but not food allergy in general, in the first 2 years. […] Recommendation: Exclusive breastfeeding for at least 4 and up to 6 months is endorsed. If high risk infants cannot be breastfed, hydrolyzed formula appears to offer advantages to prevent allergic disease and cows milk allergy. […] It’s important that mothers exclusively breastfeed their infant for at least the first 4 months of life whenever at all possible.

• #18 Allergy treatment and prevention | Arla Foods Ingredients

  https://www.arlafoodsingredients.com/early-life-nutrition/explore-industry/science–insights/allergy-management-and-prevention/

  Breastmilk provides the best nutrition for the newborn infant and is recommended for allergic infants and infants at risk of allergy. […] Exposure to allergens is critical to build oral tolerance towards food components that infants will consume later in life. For high-risk infants, it has been found in clinical studies that hydrolysed proteins can potentially stimulate oral tolerance and reduce allergenicity. Feeding formula containing Peptigen IF-3080 and Peptigen IF-3085 was found to reduce allergy prevalence when compared to feeding standard formula in several infant clinical studies. […] If breastfeeding is not possible, the recommended diet for an infant with CMA is an extensively hydrolysed infant formula with proven efficacy, which means it is tolerated by more than 90% of allergic infants. Peptigen IF-3032 from Arla Foods Ingredients was found to be efficient in several studies. […] Arla Foods Ingredients supports the WHO recommendation for exclusive breastfeeding for the first six months of an infants life and continued breastfeeding up to the age of two or beyond in combination with nutritionally appropriate complementary foods.

• #19

  https://amaraorganicfoods.com/blogs/blog/allergy-prevention-breastfeeding-and-starting-solids?srsltid=AfmBOooigBwZ53bobUN8PKMA7q7ydSgLy60Vv2T00ScsGupdWYulgK1A

  Yes, breastfeeding is clearly the preferred method of infant nutrition in most cases because of its nutritional, immunological, and psychological benefits. […] Exclusive breastfeeding for at least 4 months and up to 6 months of age seems to reduce the incidence of atopic dermatitis and eczema for children in the first 2 years of life, to reduce early onset wheezing before the age of 4 years, to reduce the risk of asthma in the first 5 years and to reduce the incidence of cow’s milk allergy, but not food allergy in general, in the first 2 years. […] Recommendation: Exclusive breastfeeding for at least 4 and up to 6 months is endorsed. If high risk infants cannot be breastfed, hydrolyzed formula appears to offer advantages to prevent allergic disease and cows milk allergy. […] It’s important that mothers exclusively breastfeed their infant for at least the first 4 months of life whenever at all possible.

• #20 Milk allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/milk-allergy/symptoms-causes/syc-20375101

  Milk allergy is an atypical immune system response to milk and products containing milk. […] Avoiding milk and milk products is the primary treatment for milk allergy. […] There’s no sure way to prevent a food allergy, but you can prevent reactions by avoiding the food that causes them. If you know you or your child is allergic to milk, avoid milk and milk products. […] In children who are allergic to milk, breastfeeding and the use of hypoallergenic formula can prevent allergic reactions. […] If you’re breastfeeding and your child is allergic to milk, cow’s milk proteins passed through your breast milk may cause an allergic reaction. You may need to exclude from your diet all products that contain milk. […] If you or your child is on a milk-free diet, your health care provider or dietitian can help you plan nutritionally balanced meals.

• #21 Food Allergy Prevention – Allergies Québec

  https://allergies-alimentaires.org/en/prevention/

  The prevalence of allergies in children is around 6%. Combinations of genetic and environmental factors contribute to the risk of developing an allergic condition. The term atopy describes this predisposition. Infants who have severe eczema have a high risk of developing a food allergy. Infants with mild to moderate eczema, those with a family history of atopy in one or both parents (food allergies, allergic rhinitis, eczema, asthma), or those who already have a known food allergy are also more at risk of developing a food allergy (or an additional one). […] Conclusion: Maternal avoidance of priority allergens, for the sake of allergy prevention, is not recommended during pregnancy. […] Conclusion: With respect to the most common food allergens, no dietary restrictions are recommended during breastfeeding. However, if a reaction to the proteins in breastmilk is suspected, it is important to assess the situation with a health professional and modify the mother’s diet if necessary.

• #22 The Role of the Maternal Diet and Supplements in the Prevention of Infant Food Allergies – IABLE

  https://lacted.org/questions/the-role-of-the-maternal-diet-and-supplements-in-the-prevention-of-infant-food-allergies/

  There is increased focus on the role of maternal interventions in the prevention of food allergy in infancy. […] There is no role for maternal dietary modifications during pregnancy or lactation, such as allergen avoidance, as a means of infant allergy prevention. […] Although exclusive breastfeeding is the recommended infant nutrition source globally, the effect of breastfeeding on infant allergy prevention remains unclear. […] There is also emerging evidence that maternal peanut ingestion during breastfeeding along with early peanut introduction in infancy might have a preventive role. […] Maternal avoidance of food allergens during pregnancy and lactation clearly does not prevent infant food allergy, so it is advised that pregnant and lactating parents not restrict their diets for this purpose.

• #23

  https://amaraorganicfoods.com/blogs/blog/allergy-prevention-breastfeeding-and-starting-solids?srsltid=AfmBOooigBwZ53bobUN8PKMA7q7ydSgLy60Vv2T00ScsGupdWYulgK1A

  Recommendation: Breastfeed exclusively for at least up to 4 months. Keep a close eye on baby and watch for allergic reactions. Consult with your pediatrician to see if an elimination diet during breastfeeding might help determine the cause. […] Current high-quality evidence suggests that avoidance of a certain allergen during breastfeeding will not prevent allergies in baby. […] Recommendation: Similar to pregnancy, avoidance of allergens has not shown to have any protective effect against developing allergies in baby. Again, a wide varied maternal diet during lactation and exclusively breastfeeding for up to the first 6 months are shown to give the greatest benefits to baby. […] There is no current data to suggest that cows milk protein (except for whole cows milk), egg, soy, wheat, peanut, tree nuts, fish and shellfish introduction into the diet need to be delayed beyond 4-6 months of age.

• #24 The Role of the Maternal Diet and Supplements in the Prevention of Infant Food Allergies – IABLE

  https://lacted.org/questions/the-role-of-the-maternal-diet-and-supplements-in-the-prevention-of-infant-food-allergies/

  There is increased focus on the role of maternal interventions in the prevention of food allergy in infancy. […] There is no role for maternal dietary modifications during pregnancy or lactation, such as allergen avoidance, as a means of infant allergy prevention. […] Although exclusive breastfeeding is the recommended infant nutrition source globally, the effect of breastfeeding on infant allergy prevention remains unclear. […] There is also emerging evidence that maternal peanut ingestion during breastfeeding along with early peanut introduction in infancy might have a preventive role. […] Maternal avoidance of food allergens during pregnancy and lactation clearly does not prevent infant food allergy, so it is advised that pregnant and lactating parents not restrict their diets for this purpose.

• #25 Frontiers | Prevention of Allergy to a Major Cow’s Milk Allergen by Breastfeeding in Mice Depends on Maternal Immune Status and Oral Exposure During Lactation

  https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2020.01545/full

  Discussion: New epidemiological and interventional studies demonstrate the food allergy preventive effect of early introduction of some allergens in infant diet such as egg and peanut. In contrast, the interventional introduction of cow’s milk in the diet of breast-fed infant after 3 months is not associated with protection. This is in line with the non-interventional large study from Katz and coworkers that evidenced the highest cow’s milk prevalence in infants for who regular exposure to cow’s milk protein was withheld until the age of 4–6 months. In parallel, studies evidenced that regular introduction of cow’s milk formula in the first 2 weeks or first 3 months while pursuing breastfeeding might allow protection. In these studies, no or few information is available on the mother immune status and cow’s milk consumption while breastfeeding. Yet, oral exposure in the mother during lactation might already have a significant impact on the breastfed progeny; it has been evidenced recently that early peanut introduction is associated with protection only if the mother consumed peanut while breastfeeding. This highlights the need to better understand the way to maximize the chance of food allergy prevention. Here, we then aimed to determine how both the immune status of the mother and her ingestion of a clinically-relevant cow’s milk allergen during breastfeeding will impact the allergic outcome in the progeny. Using a mother-child mouse model, we found that these factors do have a major impact on sensitization susceptibility in offspring. Effect on sensitization ranged between nihil for naïve mothers exposed to BLG to a very potent protection for i.p. sensitized mothers (highly sensitized) ingesting or not BLG during lactation. Tolerant mothers and orally immunized (moderate sensitization) mothers induced some protection from sensitization but only when exposed to BLG during lactation. No additional in utero effect was evidenced in our experimental set up.

• #26 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6683055/

  Exclusive breastfeeding up to 6 months of age is the preferred feeding for all infants. […] When breastfeeding is not possible or not sufficient, certain pHF-W have shown benefits in prevention of allergy, especially atopic eczema in at-risk infants. […] The participants agreed that a clinically proven pHF-W formula can play an important role in allergy prevention. […] When breastfeeding is not possible or when breast milk is not available, partially hydrolyzed whey formula (pHF-W) with documented safety and efficacy should be recommended for infants at risk of allergy. […] Not all pHFs are the same, as different formulations have different peptide compositions and production methods and have demonstrated different outcomes. […] In non-breastfed infants, cow-milk-based formula and supplementary foods containing CMP or other unmodified animal milk proteins such as goat milk and sheep milk should be strictly avoided. […] A step-down approach can be considered while managing children with CMPA, using pHF-W as a bridge between eHF or AAF and the intact CMP. […] pHF-W can be used in the transition from eHF or AAF to intact CMP, if the initial pHF-W challenge is tolerated by the child.

• #27 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://www.mdpi.com/2072-6643/11/7/1444

  Allergy prevention and CMPA treatment in the Middle-East […] Exclusive breastfeeding up to 6 months of age is the preferred feeding for all infants. The World Health Organization recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. […] When breastfeeding is not possible or not sufficient, certain pHF-W have shown benefits in prevention of allergy, especially atopic eczema in at-risk infants. […] The participants agreed that a clinically proven pHF-W formula can play an important role in allergy prevention. […] When breastfeeding is not possible or when breast milk is not available, partially hydrolyzed whey formula (pHF-W) with documented safety and efficacy should be recommended for infants at risk of allergy.

• #28 Dietary exposures and allergy prevention in high-risk infants | Canadian Paediatric Society

  https://cps.ca/documents/position/dietary-exposures-and-allergy-prevention

  Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. […] Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. […] No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy. […] There is insufficient evidence at this time to advise on the use of specific formulas, such as hydrolyzed formulas, for allergy prevention. […] However, a recent Cochrane review found no evidence to support short-term or prolonged hydrolyzed formula feeding (compared with exclusive breastfeeding) to prevent atopic disease.

• #29 Allergy: from avoidance to exposure through nutrition | Danone Research & Innovation

  https://www.danoneresearch.com/allergy/allergy-from-avoidance-to-exposure-through-nutrition/

  Breastfeeding is always the primary recommendation for infants to reduce their risk of developing allergy. […] For example, infants with cows milk allergy are given a hydrolysed formula that is free of intact milk proteins until symptoms resolve and an infant or childs immune system can tolerate milk protein. […] In line with the emerging scientific evidence, Danone Research Innovation supports the hypothesis that controlled exposure to allergens is better than complete avoidance for a majority of infants, except for those with severe allergies for whom any exposure poses a safety risk. […] Educating the immune system by exposing it to different allergens is an important part of an infants growth and development. […] European Academy of Allergy and Clinical Immunology guidelines recommend the use of a hypoallergenic hydrolysed formula for high-risk infants.

• #30 Dietary exposures and allergy prevention in high-risk infants | Canadian Paediatric Society

  https://cps.ca/documents/position/dietary-exposures-and-allergy-prevention

  Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. […] Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. […] No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy. […] There is insufficient evidence at this time to advise on the use of specific formulas, such as hydrolyzed formulas, for allergy prevention. […] However, a recent Cochrane review found no evidence to support short-term or prolonged hydrolyzed formula feeding (compared with exclusive breastfeeding) to prevent atopic disease.

• #31 Consensus document on the primary prevention of cow’s milk protein allergy in infants aged less than 7 days | Anales de Pediatría

  https://www.analesdepediatria.org/en-consensus-document-on-primary-prevention-articulo-S2341287922001399

  Cows milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. […] Based on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population. […] In the case some form of supplementation to breastfeeding is needed in the first week of life, it should not be provided routinely with extensively hydrolysed formulas or CMP-free formulas with the aim of preventing CMPA (100% agreement).

• #32 Early introduction of infant formula to prevent cow’s milk allergy

  https://www.aaaai.org/tools-for-the-public/latest-research-summaries/the-journal-of-allergy-and-clinical-immunology/2020/formula

  Published: September 2, 2020 Previous research has produced conflicting evidence on the preventative effects of early cows milk protein introduction on cows milk allergy (CMA). […] In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Sakihara et al investigated whether the early introduction of cows milk formula (CMF) could serve as an effective strategy in the primary prevention of cows milk allergy in a general population. […] This study demonstrates that daily ingestion of 10 mL of cows milk formula between 1 and 2 months of age prevents the development of cows milk allergy and does not compete with breastfeeding. […] This multicenter randomized controlled trial in infants from the general population demonstrates a safe and practical strategy for preventing cows milk allergy.

• #33 Early and ongoing infant cow’s milk exposure may prevent allergy

  https://www.aaaai.org/tools-for-the-public/latest-research-summaries/the-journal-of-allergy-and-clinical-immunology-in/2022/cow-milk

  Early and ongoing infant cows milk exposure may prevent allergy. Cows milk allergy is among the most common food allergies in young children, and cows milk protein is often introduced before any other allergens or foods, in the form of milk-based infant formulas. […] Recent research on peanut allergy has led to new allergy prevention paradigms supporting the early introduction of peanuts, along with other complementary foods, at 4-6 months of age. […] Overall, infants who were first introduced to cows milk at or after 6 months of age had the highest risk for later adverse reactions to cows milk. […] The findings support not delaying introduction of cows milk protein beyond 6 months and suggest that earlier introduction may be even better.

• #34 Cow’s milk allergy prevention. | GreenMedInfo

  https://cdn.greenmedinfo.com/article/cows-milk-allergy-prevention

  OBJECTIVE: Scoping review on IgE-mediated cow’s milk allergy prevention. […] RESULTS: There is increasing literature supporting the role of early and ongoing cow’s milk ingestion in the prevention of cow’s milk allergy. The studies supporting a preventive role with early cow’s milk ingestion suggest cow’s milk introduction at a very early age (most within the first month of life), suggesting the possibility of a different mechanism of sensitization than other common allergens. […] CONCLUSION: Further research regarding the role that early cow’s milk ingestion plays in the prevention of cow’s milk allergy is required, and questions remain. The absolute amount required for tolerance is unclear. […] However, there is an intriguing and increasingly more pervasive association between early ongoing cow’s milk ingestion and cow’s milk allergy prevention.

• #35 Should I introduce cow’s milk to my baby? — Prevent Food Allergies

  https://www.preventallergies.org/blog/introducing-cows-milk-to-baby

  Introducing your baby to milk before their first birthday will help reduce their risk of developing a milk allergy later in life. […] For the best chance at preventing a milk allergy, babies should be introduced to cow’s milk before their first birthday. […] As long as you continue to use breastmilk or formula as your baby’s primary food source, it’s perfectly fine to introduce cow’s milk as a supplement (not a beverage) before your baby is 12 months old. […] Introducing cow’s milk products in a baby’s first year of life is vital to help prevent your baby from developing a milk allergy. […] The USDA DGA report recommends introducing cow’s milk products in baby’s first year because cow’s milk is such a common allergy-causing food. […] Cow’s milk allergy is the most common childhood food allergy, making it even more important to introduce cow’s milk products early.

• #36

  https://journals.lww.com/co-allergy/fulltext/2024/06000/regular_consumption_following_early_introduction.10.aspx

  Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children. […] 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. […] Both the SPADE study subgroup analysis and COMEET study found that despite early exposure to cow’s milk protein, irregular consumption and discontinuation increases the risk of cow’s milk allergy. […] Therefore, the continued ingestion of cow’s milk formula, even in low doses, appears to reduce the risk of cow’s milk allergy. […] Recent studies have shown that protecting the skin surface with emollients alone is insufficient to prevent the development of food allergies, and that anti-inflammatory topical treatments for eczema (including nonlesional skin) are also necessary.

• #37

  https://journals.lww.com/co-allergy/fulltext/2024/06000/regular_consumption_following_early_introduction.10.aspx

  Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children. […] 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. […] Both the SPADE study subgroup analysis and COMEET study found that despite early exposure to cow’s milk protein, irregular consumption and discontinuation increases the risk of cow’s milk allergy. […] Therefore, the continued ingestion of cow’s milk formula, even in low doses, appears to reduce the risk of cow’s milk allergy. […] Recent studies have shown that protecting the skin surface with emollients alone is insufficient to prevent the development of food allergies, and that anti-inflammatory topical treatments for eczema (including nonlesional skin) are also necessary.

• #38 Should I introduce cow’s milk to my baby? — Prevent Food Allergies

  https://www.preventallergies.org/blog/introducing-cows-milk-to-baby

  Based on the results of landmark studies, clinical guidelines recommend introducing your baby to common allergy-causing foods, like milk, early and often, to reduce their food allergy risk. […] Introduce cow’s milk before your baby turns one. Start as early as 4-6 months (the earlier the better). […] Feed your baby milk products 2-7 times per week for at least several months.

• #39 Primary prevention of food allergy: beyond early introduction | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00924-5

  Food allergy typically begins early in life and persists as a lifelong condition. […] However, regular, ongoing ingestion of allergenic foods is also critical for the primary prevention of food allergy. […] Infants who have failed primary prevention should be referred to an allergist for consideration of early infant oral immunotherapy (OIT). […] To reduce the risk of cows milk allergy (CMA), intermittent supplementation of breastfeeding with cows milk formula (CMF) in the first few months of life should be avoided. If introduced, ongoing regular supplementation (e.g., one bottle per day to supplement breastfeeding) is recommended to maintain tolerance. […] Once introduced and tolerated, it is essential that allergenic foods be eaten regularly (multiple times per month and at least once per week) in amounts representative of age-appropriate servings.

• #40 Dietary exposures and allergy prevention in high-risk infants | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-021-00638-y

  Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. […] When cows milk protein formula has been introduced in an infants diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. […] For high-risk infants, there is compelling evidence that introducing allergenic foods early at around 6 months, but not before 4 months of age can prevent common food allergies, and allergies to peanut and egg in particular. […] Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. […] If cows milk formula is introduced, regular ingestion (as little as 10 mL daily) should be maintained to prevent loss of tolerance.

• #41 Dietary exposures and allergy prevention in high-risk infants | Canadian Paediatric Society

  https://cps.ca/documents/position/dietary-exposures-and-allergy-prevention

  Current evidence does not favour using hydrolyzed formulas rather than intact cows milk formula to prevent atopic conditions. […] Therefore, practitioners and families should be aware that irregularly supplementing breastfeeding with cow’s milk formula may increase risk for cow’s milk allergy. […] If cows milk formula is introduced, regular ingestion (as little as 10 mL daily) should be maintained to prevent loss of tolerance. […] Several observational studies have found an association between early ingestion (at less than 6 months of age) of a specific food allergen (in particular cows milk, egg, and peanut) and lower rates of allergy to that food in childhood. […] Following the LEAP study, the NIAID released addendum guidelines which recommended that infants with severe eczema, egg allergy, or both have peanut introduced into their diet at 4 to 6 months of age.

• #42 ASCIA Information on how to introduce solid foods to babies for allergy prevention – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

  Unless your baby has an allergic reaction to the food, continue to give the food to your baby regularly (twice weekly), as part of a varied diet. Trying a food and then not giving it regularly may result in a food allergy developing. […] It is important to note that some babies may still develop a food allergy even if this advice is followed. […] All babies should be given common allergy causing foods by 12 months of age, including egg and peanut, in an age appropriate form such as well cooked egg and smooth peanut butter/paste (not whole nuts or pieces). This includes babies who have eczema (very dry skin), another food allergy, or a family member with food allergy, even though they may have a higher chance of developing food allergy. […] However, it is best to offer your baby well cooked egg and smooth peanut butter/paste regularly (twice weekly), starting before 12 months of age. Delayed introduction of these foods has been shown to increase the chance of developing food allergy.

• #43 Primary prevention of food allergy: beyond early introduction | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00924-5

  A single exposure or occasional/intermittent exposures to allergenic foods should be avoided as this could be detrimental and result in food allergy. […] The latest CPS/CSACI position statement advised that intermittent supplementation with intact CMF (e.g., a few bottles in the hospital followed by exclusive breastfeeding) should be avoided due to an increased risk of CMA, and when CMF has been introduced in an infant’s diet, it is important to ensure that regular ingestion of as little as 10 mL daily is maintained to prevent loss of tolerance. […] The most cost-effective, practical and reliable way to introduce allergenic foods is to do so at home. […] Families who are hesitant to introduce allergenic foods at home, despite proper education about the benefits of home introduction, should be offered introduction in a primary care clinic.

• #44 Primary prevention of food allergy: beyond early introduction | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00924-5

  A single exposure or occasional/intermittent exposures to allergenic foods should be avoided as this could be detrimental and result in food allergy. […] The latest CPS/CSACI position statement advised that intermittent supplementation with intact CMF (e.g., a few bottles in the hospital followed by exclusive breastfeeding) should be avoided due to an increased risk of CMA, and when CMF has been introduced in an infant’s diet, it is important to ensure that regular ingestion of as little as 10 mL daily is maintained to prevent loss of tolerance. […] The most cost-effective, practical and reliable way to introduce allergenic foods is to do so at home. […] Families who are hesitant to introduce allergenic foods at home, despite proper education about the benefits of home introduction, should be offered introduction in a primary care clinic.

• #45 Dietary exposures and allergy prevention in high-risk infants | Canadian Paediatric Society

  https://cps.ca/documents/position/dietary-exposures-and-allergy-prevention

  Current evidence does not favour using hydrolyzed formulas rather than intact cows milk formula to prevent atopic conditions. […] Therefore, practitioners and families should be aware that irregularly supplementing breastfeeding with cow’s milk formula may increase risk for cow’s milk allergy. […] If cows milk formula is introduced, regular ingestion (as little as 10 mL daily) should be maintained to prevent loss of tolerance. […] Several observational studies have found an association between early ingestion (at less than 6 months of age) of a specific food allergen (in particular cows milk, egg, and peanut) and lower rates of allergy to that food in childhood. […] Following the LEAP study, the NIAID released addendum guidelines which recommended that infants with severe eczema, egg allergy, or both have peanut introduced into their diet at 4 to 6 months of age.

• #46 AAIR :: Allergy, Asthma & Immunology Research

  https://e-aair.org/DOIx.php?id=10.4168/aair.2023.15.4.419

  The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. […] The rationale of preventive strategies can be broadly classified into: 1) those modulating the immune system to reduce proinflammatory responses, and 2) those improving the epithelial barrier function of the skin, respiratory tract and gastrointestinal mucosa. […] Recommendation: Pregnant women should have a healthy and balanced diet, rich in fish. There is no need for pregnant women to avoid allergenic foods (GRADE: very low). […] Recommendation: Avoid the use of CMF in the first week of life. However, if required, continuing a daily ingestion of at least 10 mL of CMF until 2 months of age may reduce the risk of CMA associated with short term supplementation (GRADE: low). […] Recommendation: Introduce allergenic foods, particularly egg and peanut, around age 6 months but not earlier than 4 months (GRADE: moderate).

• #47

  https://journals.lww.com/co-allergy/fulltext/2024/06000/regular_consumption_following_early_introduction.10.aspx

  Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children. […] 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. […] Both the SPADE study subgroup analysis and COMEET study found that despite early exposure to cow’s milk protein, irregular consumption and discontinuation increases the risk of cow’s milk allergy. […] Therefore, the continued ingestion of cow’s milk formula, even in low doses, appears to reduce the risk of cow’s milk allergy. […] Recent studies have shown that protecting the skin surface with emollients alone is insufficient to prevent the development of food allergies, and that anti-inflammatory topical treatments for eczema (including nonlesional skin) are also necessary.

• #48

  https://journals.lww.com/co-allergy/fulltext/2024/06000/regular_consumption_following_early_introduction.10.aspx

  The suppression of percutaneous sensitization through early and aggressive eczema treatment could help to reduce symptoms induced by allergen ingestion, which in turn may contribute to the well tolerated prevention of food allergies. […] Recent evidence indicates that the following are integral to preventing food allergies in childhood: eczema should be treated promptly and aggressively with anti-inflammatory therapy to achieve remission; foods associated with high allergy prevalence in a region should be introduced to all infants at an early stage; and once an allergenic food is introduced, children should continue its regular consumption.

• #49 ASCIA Information on how to introduce solid foods to babies for allergy prevention – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

  Unless your baby has an allergic reaction to the food, continue to give the food to your baby regularly (twice weekly), as part of a varied diet. Trying a food and then not giving it regularly may result in a food allergy developing. […] It is important to note that some babies may still develop a food allergy even if this advice is followed. […] All babies should be given common allergy causing foods by 12 months of age, including egg and peanut, in an age appropriate form such as well cooked egg and smooth peanut butter/paste (not whole nuts or pieces). This includes babies who have eczema (very dry skin), another food allergy, or a family member with food allergy, even though they may have a higher chance of developing food allergy. […] However, it is best to offer your baby well cooked egg and smooth peanut butter/paste regularly (twice weekly), starting before 12 months of age. Delayed introduction of these foods has been shown to increase the chance of developing food allergy.

• #50 Food Allergy Prevention – Allergies Québec

  https://allergies-alimentaires.org/en/prevention/

  According to the most recent studies on the subject, delaying the consumption of allergenic foods after six months of age would not prevent the development of a food allergy in young children. In addition, according to a Canadian Paediatric Society guideline published on January 24, 2019, it is now recommended that solid foods, including priority allergens, be introduced to high-risk children between the ages of four and six months (but not before the age of four months), or as soon as the child is ready. […] Other recommendations related to the introduction of peanuts to at risk children include: When the child has mild to moderate eczema, it is recommended to introduce peanut-containing foods at about six months of age in a form appropriate for an infant in order to prevent choking. For a child with severe eczema or a diagnosed milk allergy, the introduction of peanuts is recommended between the ages of 4 and 6 months (again in a baby appropriate form). If the child tolerates peanuts, they should continue to consume them regularly to maintain tolerance. […] If your child tolerates an allergenic food, continue to offer it regularly, a few times a week, to allow your child to maintain tolerance.

• #51 ASCIA Information on how to introduce solid foods to babies for allergy prevention – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

  Only introduce one common allergy causing food at each meal. If only one new common allergy causing food is introduced at each meal and an allergic reaction occurs, the problem food can be easily identified. If your baby has an allergic reaction, stop giving that food and seek medical advice. […] Unless your baby has an allergic reaction to the food, continue to give the food to your baby regularly (twice weekly), as part of a varied diet. Trying a food and then not giving it regularly may result in a food allergy developing.

• #52 Primary prevention of food allergy: beyond early introduction | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00924-5

  Infants who have failed primary prevention should be referred to an allergist as soon as possible for consideration of early infant OIT. […] The CSACI recommends both early introduction and, once introduced, regular ingestion of age-appropriate amounts and textures of all common allergens multiple times per month (with a goal of at least once each week based on expert opinion) to establish and maintain tolerance.

• #53 ASCIA Information on how to introduce solid foods to babies for allergy prevention – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

  Only introduce one common allergy causing food at each meal. If only one new common allergy causing food is introduced at each meal and an allergic reaction occurs, the problem food can be easily identified. If your baby has an allergic reaction, stop giving that food and seek medical advice. […] Unless your baby has an allergic reaction to the food, continue to give the food to your baby regularly (twice weekly), as part of a varied diet. Trying a food and then not giving it regularly may result in a food allergy developing.

• #54 Cow’s milk allergy | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cows-milk-allergy

  Milk is a common cause of allergies in babies and children. Most outgrow cows milk allergy by the age of 3 to 5 years. However, in some people it may not be outgrown. […] The best way to manage a milk allergy is to avoid all products containing milk (under strict medical supervision) and substitute with other products to ensure adequate nutrition and growth. […] To manage a cows milk allergy, all food containing milk must be avoided (under strict medical supervision). […] Exclusion and reintroduction of cow’s milk and other dairy foods should only be undertaken with advice from a medical specialist (and in many cases, a dietitian), particularly in cases of anaphylaxis. […] Do not change your child’s diet without consulting a doctor or your child could suffer from nutritional deficiencies.

• #55 ASCIA Information on how to introduce solid foods to babies for allergy prevention – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies

  Unless your baby has an allergic reaction to the food, continue to give the food to your baby regularly (twice weekly), as part of a varied diet. Trying a food and then not giving it regularly may result in a food allergy developing. […] It is important to note that some babies may still develop a food allergy even if this advice is followed. […] All babies should be given common allergy causing foods by 12 months of age, including egg and peanut, in an age appropriate form such as well cooked egg and smooth peanut butter/paste (not whole nuts or pieces). This includes babies who have eczema (very dry skin), another food allergy, or a family member with food allergy, even though they may have a higher chance of developing food allergy. […] However, it is best to offer your baby well cooked egg and smooth peanut butter/paste regularly (twice weekly), starting before 12 months of age. Delayed introduction of these foods has been shown to increase the chance of developing food allergy.

• #56 Milk allergy: Management – UpToDate

  https://www.uptodate.com/contents/milk-allergy-management

  The management of cow’s milk allergy (CMA) does not differ from that of other food allergies. It requires instructions on avoidance and education about treatment of reactions in the event of accidental exposure. It also includes monitoring for the resolution of the allergy. […] The most straightforward approach in managing any food allergy is complete avoidance of the culprit food. Eliminating CM from the diet can be difficult and can pose nutritional as well as quality-of-life concerns since CM is a ubiquitous food in many cultures and diets and is an important source of fat and protein in early childhood. […] Accidental exposures are common. In one prospective series of 500 infants aged 3 to 15 months with suspected or confirmed hen’s egg allergy and/or CMA, 72 percent had an allergic reaction, most commonly to CM, egg, or peanut, during a three-year period, with an annualized reaction rate of 0.81 per year. Eighty-seven percent of these reactions were due to accidental exposures.

• #57 Milk allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/milk-allergy/symptoms-causes/syc-20375101

  Milk allergy is an atypical immune system response to milk and products containing milk. […] Avoiding milk and milk products is the primary treatment for milk allergy. […] There’s no sure way to prevent a food allergy, but you can prevent reactions by avoiding the food that causes them. If you know you or your child is allergic to milk, avoid milk and milk products. […] In children who are allergic to milk, breastfeeding and the use of hypoallergenic formula can prevent allergic reactions. […] If you’re breastfeeding and your child is allergic to milk, cow’s milk proteins passed through your breast milk may cause an allergic reaction. You may need to exclude from your diet all products that contain milk. […] If you or your child is on a milk-free diet, your health care provider or dietitian can help you plan nutritionally balanced meals.

• #58 Cow’s milk allergy | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cows-milk-allergy

  If you or your child have been diagnosed with milk allergy, treatment involves total avoidance of milk or products containing milk. This can be difficult to achieve. […] To avoid milk and milk products, read food labels and avoid foods that contain milk or milk products such as: butter, buttermilk, casein and caseinate, cheese, chocolate, cow’s or goat’s milk including A2 milk, cream, crme fraiche, ghee, ice cream, margarines that contain milk products, milk powder, nougat, whey, yoghurt. […] Eliminate milk and milk products from your baby or young child’s diet only under strict medical supervision. Your doctor will need to advise on replacement sources of calcium and protein, which are especially important nutrients for children.

• #59 Milk Allergy | Causes, Symptoms & Treatment | ACAAI Public Website

  https://acaai.org/allergies/allergic-conditions/food/milk-dairy/

  Milk: It’s good for your health and good for bone strength. It’s also one of the most common food allergens, particularly in children. […] Avoidance of milk or items containing milk products is the only way to manage a milk allergy. People who are allergic to milk and the parents of children who have this allergy must read ingredient labels very carefully. […] Milk is one of eight allergens with specific labeling requirements under the Food Allergen Labeling and Consumer Protection Act of 2004. That law requires manufacturers of packaged food products sold in the U.S. and containing milk as an ingredient to include the presence of milk or milk products, in clear language, on the ingredient label. […] Allergies to food (including milk) are the most common causes of anaphylaxis, a potentially life-threatening allergic reaction. Symptoms include swelling of the airways, impairing the ability to breathe, and a sudden drop in blood pressure, causing dizziness and fainting. An allergist will advise patients with a food allergy to carry an auto-injector containing epinephrine (adrenaline), which is the only treatment for anaphylactic shock, and will teach the patient how to use it.

• #60 Milk allergy: Management – UpToDate

  https://www.uptodate.com/contents/milk-allergy-management

  The management of cow’s milk allergy (CMA) does not differ from that of other food allergies. It requires instructions on avoidance and education about treatment of reactions in the event of accidental exposure. It also includes monitoring for the resolution of the allergy. […] The most straightforward approach in managing any food allergy is complete avoidance of the culprit food. Eliminating CM from the diet can be difficult and can pose nutritional as well as quality-of-life concerns since CM is a ubiquitous food in many cultures and diets and is an important source of fat and protein in early childhood. […] Accidental exposures are common. In one prospective series of 500 infants aged 3 to 15 months with suspected or confirmed hen’s egg allergy and/or CMA, 72 percent had an allergic reaction, most commonly to CM, egg, or peanut, during a three-year period, with an annualized reaction rate of 0.81 per year. Eighty-seven percent of these reactions were due to accidental exposures.

• #61 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6683055/

  Exclusive breastfeeding up to 6 months of age is the preferred feeding for all infants. […] When breastfeeding is not possible or not sufficient, certain pHF-W have shown benefits in prevention of allergy, especially atopic eczema in at-risk infants. […] The participants agreed that a clinically proven pHF-W formula can play an important role in allergy prevention. […] When breastfeeding is not possible or when breast milk is not available, partially hydrolyzed whey formula (pHF-W) with documented safety and efficacy should be recommended for infants at risk of allergy. […] Not all pHFs are the same, as different formulations have different peptide compositions and production methods and have demonstrated different outcomes. […] In non-breastfed infants, cow-milk-based formula and supplementary foods containing CMP or other unmodified animal milk proteins such as goat milk and sheep milk should be strictly avoided. […] A step-down approach can be considered while managing children with CMPA, using pHF-W as a bridge between eHF or AAF and the intact CMP. […] pHF-W can be used in the transition from eHF or AAF to intact CMP, if the initial pHF-W challenge is tolerated by the child.

• #62 Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus

  https://www.mdpi.com/2072-6643/11/7/1444

  Not all pHFs are the same, as different formulations have different peptide compositions and production methods and have demonstrated different outcomes. […] The recommended management of CMPA involves strict avoidance of intact CMP, by replacing it with extensively hydrolyzed formula (eHF) or amino acid formula (AAF) in case of severe symptoms such as anaphylaxis. […] pHF-W can be used in the transition from eHF or AAF to intact CMP, if the initial pHF-W challenge is tolerated by the child.

• #63 Navigating the Cow’s Milk Allergy Journey: From Diagnosis to Nutritional Optimisation – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/symposium/navigating-the-cows-milk-allergy-journey-from-diagnosis-to-nutritional-optimisation-s010324/

  Meyer described publications on the role of baked milk as a bingo moment. […] Importantly, subjects who incorporated dietary baked milk were 16 times more likely than the comparison group to become tolerant to unheated milk. […] The World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cows Milk Allergy (DRACMA) guidelines published in 2022 considered oral immunotherapies for CMA and concluded that this approach is a balance and not a zero-risk procedure, Meyer noted. […] Recommendations are therefore conditional due to the low certainty of the health effects based on evidence. However, in those infants where the benefit of having milk outweighs the side effects, milk oral immunotherapy can be considered. […] For IgE-mediated CMA, earlier intervention with baked milk and the use of the milk ladder approach has yielded promising results.

• #64

  https://all-imm.com/index.php/aei/article/view/1023

  Tertiary allergy prevention focuses on reducing the risk of a patient having anaphylaxis, with oral immunotherapy being the most common method of promoting tolerance in allergic children. Several studies have demonstrated successful reintroduction for milk, egg and peanut; however, no such guidelines are recommended for other foods. Finally, dietary advancement therapy in the form of milk and egg ladders has been employed as a method of primary, secondary and tertiary prevention of allergies, particularly in Ireland, the UK and Canada.

• #65 Navigating the Cow’s Milk Allergy Journey: From Diagnosis to Nutritional Optimisation – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/symposium/navigating-the-cows-milk-allergy-journey-from-diagnosis-to-nutritional-optimisation-s010324/

  Meyer described publications on the role of baked milk as a bingo moment. […] Importantly, subjects who incorporated dietary baked milk were 16 times more likely than the comparison group to become tolerant to unheated milk. […] The World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cows Milk Allergy (DRACMA) guidelines published in 2022 considered oral immunotherapies for CMA and concluded that this approach is a balance and not a zero-risk procedure, Meyer noted. […] Recommendations are therefore conditional due to the low certainty of the health effects based on evidence. However, in those infants where the benefit of having milk outweighs the side effects, milk oral immunotherapy can be considered. […] For IgE-mediated CMA, earlier intervention with baked milk and the use of the milk ladder approach has yielded promising results.

• #66 Cow’s milk protein allergy in infants and children | Canadian Paediatric Society

  https://cps.ca/en/documents/position/cows-milk-protein-allergy

  Cows milk protein allergy (CMPA) is an immune-mediated reaction to cows milk proteins, which can involve multiple organ systems including the gastrointestinal tract. […] This statement focuses on delayed non-IgE/cell-mediated CMPA and assists health care providers to distinguish between and identify varied reactions to cows milk, discusses the role of diagnostic testing, and provides management recommendations based on best evidence. […] Strict avoidance of CMP is the safest strategy. […] Most infants and children with CMPA tolerate an extensively hydrolyzed formula (eHF), with 10% of infants requiring an amino acid formula (AAF). […] The natural history of non-IgE-mediated gastrointestinal food allergies is generally favourable, with most affected infants achieving tolerance in the first years of life and most cases resolving before school age.

• #67 Milk Allergy: Causes, Symptoms, Diagnosis & Treatment | Allergy & Asthma Network

  https://allergyasthmanetwork.org/food-allergies/milk-allergy/

  Most of us grew up hearing how good drinking milk is for the body. We heard how it would make us strong and healthy. But for some people, milk is a food allergen that can cause serious symptoms. In fact, it is one of the most common food allergies in children. […] The good news is that 80 percent of children will outgrow their milk allergy by age 16, according to the American College of Allergy, Asthma Immunology (ACAAI). […] For most people with milk allergy, the best treatment option is actually prevention. If you’re allergic to cows milk, do not consume milk or milk products, dairy products, or any other foods containing milk protein. […] Avoidance of milk and milk products is the best way to prevent a non-IgE-mediated milk reaction. You will need to work together with a doctor or nutritionist to develop a diet plan that is not only milk-free but also nutritionally balanced. Many children outgrow a non-IgE-mediated milk allergy. However, the condition could indicate the child may develop an IgE-mediated milk or food allergy later in life.

• #68 Cow’s milk protein allergy in infants and children | Canadian Paediatric Society

  https://cps.ca/en/documents/position/cows-milk-protein-allergy

  For FPIAP in breastfed infants, empiric elimination of dairy and soy, the most common allergens from the maternal diet, should be considered for 2 weeks. […] If an infant’s symptoms persist, an eHF is recommended first, with AAF being reserved for the less than 10% of infants who do not respond to eHF. […] For formula-fed infants with CMPA, eHF must be considered. […] FPIAP symptoms typically improve within 72 hours of food elimination, although stools may take up to 2 weeks to normalize. […] Re-challenge at home with fresh pasteurized cows milk may be used to assess for tolerance to CMP after 1 year of age, with most children developing tolerance by 1 to 2 years of age. […] For FPE in breastfed infants with failure to thrive, consider empiric elimination of cows milk and soy from the maternal diet for 2 to 4 weeks.

• #69 Navigating the Cow’s Milk Allergy Journey: From Diagnosis to Nutritional Optimisation – European Medical Journal

  https://www.emjreviews.com/allergy-immunology/symposium/navigating-the-cows-milk-allergy-journey-from-diagnosis-to-nutritional-optimisation-s010324/

  For non-IgE mediated allergies, there is currently consensus about reintroduction at around 6-12 months of age (at least 6 months after elimination) but waiting until 1 year of age will not be required. […] When using the milk ladder, Meyer reiterated the need to repeat steps as required and not just assume failure.

• #70 Cow’s milk protein allergy in infants and children | Canadian Paediatric Society

  https://cps.ca/en/documents/position/cows-milk-protein-allergy

  If symptoms do not improve OR if the infant is formula-fed, an AAF is recommended. […] For FPIES, there are recent international consensus guidelines for diagnosis and management. […] Acute FPIES is a medical emergency that requires treatment with aggressive fluid resuscitation, steroids, and ondansetron in infants with hypovolemic shock. […] Avoid recurrence of acute relapse by strictly avoiding offending food protein(s). […] An OFC should be performed under close physician supervision 12 to 18 months after the last reaction to assess for resolution of FPIES.

• #71 Cow’s milk protein allergy in infants and children | Canadian Paediatric Society

  https://cps.ca/en/documents/position/cows-milk-protein-allergy

  If symptoms do not improve OR if the infant is formula-fed, an AAF is recommended. […] For FPIES, there are recent international consensus guidelines for diagnosis and management. […] Acute FPIES is a medical emergency that requires treatment with aggressive fluid resuscitation, steroids, and ondansetron in infants with hypovolemic shock. […] Avoid recurrence of acute relapse by strictly avoiding offending food protein(s). […] An OFC should be performed under close physician supervision 12 to 18 months after the last reaction to assess for resolution of FPIES.

• #72 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10421120/

  Starting from this evidence, in Table 2 are listed the compounds that could be necessary for the prevention of nutritional status alterations/deficiencies in CMA pediatric patients and improve the disease course of milk allergies. […] The anthropometric parameters assessment represents the most important step of nutritional follow-up since body growth is a sensitive indicator of an adequate nutritional status and optimal intake of energy and nutrients. […] The prevalence and severity of pediatric CMA have increased dramatically in the last decades under the pressure of environmental factors in genetically predisposed individuals. Among environmental factors, nutrition plays a pivotal role. Diet is one of the most relevant modifiable factors, representing a potential target for the prevention and treatment of CMA.

• #73 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://www.mdpi.com/2072-6643/15/15/3328

  In pediatric patients with a confirmed CMA diagnosis, international guidelines recommend a strict cow’s milk protein elimination diet as the only therapeutic strategy to treat CMA. […] Another cornerstone of nutritional counseling is educating patients and their parents/tutors to prevent accidental ingestion of the allergen. […] The CMA treatment is based on the exclusion from the diet of cow’s milk and milk derivatives (dairy products). […] An elimination diet does not necessarily affect the growth of children if their diet is adequately supplemented. This underscores the importance of an adequate supplementation of deficient nutrients during the dietary management in CMA children, and in general of FA children. […] Interventions are required to avoid the harmful consequences of nutritional deficiencies, including nutrition education, fortification and supplementation.

• #74 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10421120/

  The European guidelines recommend the importance of not avoiding the intake of potentially allergenic foods during weaning, emphasizing that there is no reason for delaying their introduction after 12 months nor for an early introduction 4 months. […] Evidence supports the role of early exposure to potential allergens in the development of immune tolerance. […] The CMA treatment is based on the exclusion from the diet of cows milk and milk derivatives (dairy products). […] To avoid the high risk of nutritional deficits for CMA patients following an elimination diet, any nutrient supplementation should be considered during nutritional counseling. […] Interventions are required to avoid the harmful consequences of nutritional deficiencies, including nutrition education, fortification and supplementation.

• #75 Nutritional Strategies for the Prevention and Management of Cow’s Milk Allergy in the Pediatric Age

  https://www.mdpi.com/2072-6643/15/15/3328

  In pediatric patients with a confirmed CMA diagnosis, international guidelines recommend a strict cow’s milk protein elimination diet as the only therapeutic strategy to treat CMA. […] Another cornerstone of nutritional counseling is educating patients and their parents/tutors to prevent accidental ingestion of the allergen. […] The CMA treatment is based on the exclusion from the diet of cow’s milk and milk derivatives (dairy products). […] An elimination diet does not necessarily affect the growth of children if their diet is adequately supplemented. This underscores the importance of an adequate supplementation of deficient nutrients during the dietary management in CMA children, and in general of FA children. […] Interventions are required to avoid the harmful consequences of nutritional deficiencies, including nutrition education, fortification and supplementation.

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