Elissa M Abrams1, Scott H Sicherer2. 1. Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada. Electronic address: elissa.abrams@gmail.com. 2. Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Mount Sinai Kravis Children's Hospital, New York, New York; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
OBJECTIVE: Scoping review on IgE-mediated cow's milk allergy prevention. DATA SOURCES: Literature search of PubMed database and gray literature. STUDY SELECTIONS: Peer-reviewed relevant observational and randomized controlled studies in the pediatric population in the English language were selected and reviewed. 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. It is possible that gut colonization and the diversity and intensity of microbial exposure may play a role in inducing cow's milk tolerance. It is also possible that vitamin D may have a role in modulating those immune functions. 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. Studies in higher risk populations are required. However, there is an intriguing and increasingly more pervasive association between early ongoing cow's milk ingestion and cow's milk allergy prevention.
OBJECTIVE: Scoping review on IgE-mediated cow's milk allergy prevention. DATA SOURCES: Literature search of PubMed database and gray literature. STUDY SELECTIONS: Peer-reviewed relevant observational and randomized controlled studies in the pediatric population in the English language were selected and reviewed. 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. It is possible that gut colonization and the diversity and intensity of microbial exposure may play a role in inducing cow's milk tolerance. It is also possible that vitamin D may have a role in modulating those immune functions. 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. Studies in higher risk populations are required. However, there is an intriguing and increasingly more pervasive association between early ongoing cow's milk ingestion and cow's milk allergy prevention.