Food, drug, insect sting allergy, and anaphylaxis
Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy

Parts of these data were presented in abstract form at the 2009 American Academy of Allergy, Asthma & Clinical Immunology meeting in Washington, DC.
https://doi.org/10.1016/j.jaci.2010.04.020Get rights and content

Background

The diversity in the perceived prevalence, recovery, and risk factors for cow's milk allergy (CMA) necessitated a large-scale, population-based prospective study.

Objective

We sought to determine the prevalence, cross-reactivity with soy allergy, and risk factors for the development of CMA.

Methods

In a prospective study the feeding history of 13,019 infants was obtained by means of telephone interview (95.8%) or questionnaire (4.2%). Infants with probable adverse reactions to milk were examined, skin prick tested, and challenged orally.

Results

Ninety-eight percent of the cohort participated in the study. The cumulative incidence for IgE-mediated CMA was 0.5% (66/13,019 patients). The mean age of cow's milk protein (CMP) introduction was significantly different (P < .001) between the healthy infants (61.6 ± 92.5 days) and those with IgE-mediated CMA (116.1 ± 64.9 days). Only 0.05% of the infants who were started on regular CMP formula within the first 14 days versus 1.75% who were started on formula between the ages of 105 and 194 days had IgE-mediated CMA (P < .001). The odds ratio was 19.3 (95% CI, 6.0-62.1) for development of IgE-mediated CMA among infants with exposure to CMP at the age of 15 days or more (P < .001). Sixty-four patients with IgE-mediated CMA tolerated soy, and none had a proved allergy to soy.

Conclusions

IgE-mediated CMA is much less common than generally reported. Early exposure to CMP as a supplement to breast-feeding might promote tolerance. Finally, soy is a reasonable feeding alternative in patients with IgE-mediated CMA.

Section snippets

Study population

The research protocol was approved by the Helsinki Review Board of the Assaf Harofeh Medical Center. All newborns (13,234) born from June 10, 2004, to June 30, 2006, at the Assaf-Harofeh Hospital (Zerifin, Israel) were enrolled. Contact details were verified after the routine anticipatory guidance session in which breast-feeding was encouraged but other alternative CMP-based feeding regimens were also discussed. The purpose of the project was explained, and the mothers were asked to fill out a

Study population

Recruitment into the study reached 98.4% (13,019) of our cohort (Fig 1). Initial contact was made by means of telephone interview in 12,473 (95.8%) infants and by means of questionnaire for the remaining 546 (4.2%) infants. The initial information regarding CMP-related adverse effects was obtained within 1 week of the event in most of the cases (58%) and in only 25% of cases in 30 days or longer. In 381 (2.9% of the sample) cases the parents either complained about adverse effects that they

Discussion

This article presents a large, prospective noninterventional study in which several fundamental questions regarding milk allergy were evaluated. To minimize bias, we aimed to reach the highest possible percentage of the target population. We therefore used the least invasive methods for diagnosis, including SPT, rather than measuring specific IgE cow's milk antibodies, and a less demanding open OFC rather than a double-blind placebo-controlled challenge. Importantly, the SPT is considered a

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    Supported by the Israel Dairy Board.

    Disclosure of potential conflict of interest: Y. Katz has received research support from the Israel Dairy Board. The rest of the authors have declared that they have no conflict of interest.

    In partial fulfillment of a PhD thesis at the Sackler School of Medicine, Tel Aviv, Israel.

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