Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies.
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Date
2019-09
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Abstract
This review addresses the current strategies of inducing tolerance development in infant
and childhood cow’s milk protein allergy (CMPA). The change in prevention strategies
for CMPA has been emphasized based on the lack of evidence to support the efficacy
of food allergen avoidance in infancy and the concept of the dual-allergen-exposure
hypothesis, which suggests that allergen exposure through the skin leads to sensitization,
whereas early oral consumption of allergenic food protein induces oral tolerance. The
new approach is based on the likelihood of early introduction of allergenic foods to the
infant’s diet to reduce the development of food allergies through oral tolerance induction.
The latest treatment guidelines recommend the continuation of breast feeding and the
elimination of cow’s milk and products from the maternal diet in exclusively breast-fed
infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven
efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use
of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy,
eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as
well as cases of multiple system involvement, multiple food allergies, and intolerance
to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current
knowledge on tolerance development in infants and children with CMPA to increase
the awareness of the clinicians concerning the new approaches in CMPA treatment
Tolerance development is considered a relatively new concept in CMPA, inducing a shift
in interventions in CMPA from a passive (avoidance of responsible allergen) toward a
proactive (tolerance induction) strategy.
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Keywords
cow’s milk protein allergy, prevention, tolerance, formula, allergenic foods
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