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Treatment of Cow’s Milk Allergy: New Developments
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Treatment of Cow’s Milk Allergy: New Developments

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (20 December 2023) | Viewed by 13388

Special Issue Editor

Prof. Dr. Yvan Vandenplas

E-Mail Website
Guest Editor
KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
Interests: milk; milk proteins; breastfeeding; infant
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Allergic diseases, such as food allergies, are heterogeneous inflammatory immune-mediated disorders that have shown a significantly increased prevalence in Western countries in recent decades. Cow’s milk allergy (CMA) represents a model for evaluating the natural history of food allergies. The management of cow’s milk allergy is an area of debate. Which formula is the best as a diagnostic elimination diet? As a therapeutic elimination diet? Is there a role for a plant-based formula? What about the role of soy infant formula or rice hydrolysates? Is there an advantage to adding oligosaccharides or probiotics to the elimination diet to acquire a more rapid tolerance?

In this Special Issue, we focus on preventive measures of cow’s milk allergy, follow-up recommendations, and treatment with alternative formulas. Thus, the management of patients with CMA is of interest not only for the pediatrician but also for the adult allergist and will be discussed in this Special Issue.

I invite our readers to share the results of their research in this area.

Prof. Dr. Yvan Vandenplas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cow’s milk allergy
  • soy formula
  • rice hydrolyzed formula
  • extensive cow’s-milk-based hydrolysate
  • amino acid formula
  • plant-based formula
  • partial hydrolysate
  • breast feeding
  • donkey’s milk
  • non-cow’s milk animal milk
  • oligosaccharides
  • probiotics
  • postbiotics

Published Papers (5 papers)

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Review

11 pages, 539 KiB  
Review
To Diet or Not to Diet This Is the Question in Food-Protein-Induced Allergic Proctocolitis (FPIAP)—A Comprehensive Review of Current Recommendations
by Silvia Salvatore, Alice Folegatti, Cristina Ferrigno, Licia Pensabene, Massimo Agosti and Enza D’Auria
Nutrients 2024, 16(5), 589; https://doi.org/10.3390/nu16050589 - 21 Feb 2024
Viewed by 977
Abstract
Food-protein-induced allergic proctocolitis (FPIAP) is an increasingly reported transient and benign form of colitis that occurs commonly in the first weeks of life in healthy breastfed or formula-fed infants. Distal colon mucosal inflammation is caused by a non-IgE immune reaction to food allergens, [...] Read more.
Food-protein-induced allergic proctocolitis (FPIAP) is an increasingly reported transient and benign form of colitis that occurs commonly in the first weeks of life in healthy breastfed or formula-fed infants. Distal colon mucosal inflammation is caused by a non-IgE immune reaction to food allergens, more commonly to cow’s milk protein. Rectal bleeding possibly associated with mucus and loose stools is the clinical hallmark of FPIAP. To date, no specific biomarker is available, and investigations are reserved for severe cases. Disappearance of blood in the stool may occur within days or weeks from starting the maternal or infant elimination diet, and tolerance to the food allergen is typically acquired before one year of life in most patients. In some infants, no relapse of bleeding occurs when the presumed offending food is reassumed after a few weeks of the elimination diet. Many guidelines and expert consensus on cow’s milk allergy have recently been published. However, the role of diet is still debated, and recommendations on the appropriateness and duration of allergen elimination in FPIAP are heterogeneous. This review summarizes and compares the different proposed nutritional management of infants suffering from FPIAP, highlighting the pros and cons according to the most recent literature data. Full article
(This article belongs to the Special Issue Treatment of Cow’s Milk Allergy: New Developments)
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14 pages, 1414 KiB  
Review
The Remaining Challenge to Diagnose and Manage Cow’s Milk Allergy: An Opinion Paper to Daily Clinical Practice
by Yvan Vandenplas, Rosan Meyer, Anna Nowak-Wegrzyn, Silvia Salvatore, Carina Venter and Mario C. Vieira
Nutrients 2023, 15(22), 4762; https://doi.org/10.3390/nu15224762 - 13 Nov 2023
Viewed by 2040
Abstract
Guidelines and recommendations for the diagnosis and management of cow’s milk allergy (CMA) in childhood are based on scientific review of the available evidence. While this approach is the most rigorous, guidelines may not fully address all scenarios encountered by clinicians. Many symptoms [...] Read more.
Guidelines and recommendations for the diagnosis and management of cow’s milk allergy (CMA) in childhood are based on scientific review of the available evidence. While this approach is the most rigorous, guidelines may not fully address all scenarios encountered by clinicians. Many symptoms of CMA overlap with other common childhood illnesses and are subjectively reported by the caregivers of the infant, as is the interpretation of the dietary interventions. Additionally, many healthcare professionals and caregivers do not follow the recommendations to perform an oral food challenge or reintroduction of cow’s milk after a diagnostic elimination diet because (1) the infant is doing well and (2) the carer’s fear of symptoms relapsing with this procedure. As a result, CMA in infants may be either under-diagnosed leading to reduced quality of life for families or over-diagnosed, resulting in unnecessary long-term elimination diets and increasing the risk for nutritional deficiencies. This paper discusses some of these controversial topics, focusing on misdiagnosis and mismanagement in clinical practice. The lack of objective diagnostic criteria can hamper the diagnosis and management of CMA in daily practice. Full article
(This article belongs to the Special Issue Treatment of Cow’s Milk Allergy: New Developments)
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17 pages, 321 KiB  
Review
The Link between Different Types of Prebiotics in Infant Formula and Infection Rates: A Review
by Roxane Cool and Yvan Vandenplas
Nutrients 2023, 15(8), 1942; https://doi.org/10.3390/nu15081942 - 18 Apr 2023
Cited by 4 | Viewed by 1530
Abstract
Breastfeeding plays a protective role against infections, partially through the prebiotic effect of human milk oligosaccharides (HMOs). Aiming to mimic these beneficial capacities, there is an ongoing search to make infant formula closer to human milk, including by adding oligosaccharides. Over the past [...] Read more.
Breastfeeding plays a protective role against infections, partially through the prebiotic effect of human milk oligosaccharides (HMOs). Aiming to mimic these beneficial capacities, there is an ongoing search to make infant formula closer to human milk, including by adding oligosaccharides. Over the past two decades, multiple studies have been published on different types of prebiotics and their role in reducing infection rates in infants. This review aims to answer the question of whether there is evidence that the addition of oligosaccharides to infant formula decreases the prevalence of infection, and whether the effect is influenced by the kind of oligosaccharide added. The review of the literature reveals an important heterogeneity, including different types and dosages of prebiotics, different intervention periods and inclusion criteria, etc., making it impossible to formulate a consensus about the efficacy of adding prebiotics to infant formula. We would cautiously suggest that supplementation with galactooligosaccharides (GOSs)/fructooligosaccharides (FOSs) seems to have a beneficial effect on infection rates. For HMOs, more studies about the different types of HMOs are necessary to make any deductions. GOSs alone, inulin, and MOSs (bovine-milk-derived oligosaccharides) do not reduce the incidence of infections. The combination of GOSs and PDX (polydextrose) was found to play a protective role in one study. The evidence of the effect of prebiotics in reducing the use of antibiotics is low. The many lacunas in the direction of study uniformity offer many opportunities for further research. Full article
(This article belongs to the Special Issue Treatment of Cow’s Milk Allergy: New Developments)
26 pages, 2468 KiB  
Review
‘Early Introduction’ of Cow’s Milk for Children with IgE-Mediated Cow’s Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management
by Caoimhe Cronin, Yukta Ramesh, Carlo De Pieri, Roberto Velasco and Juan Trujillo
Nutrients 2023, 15(6), 1397; https://doi.org/10.3390/nu15061397 - 14 Mar 2023
Cited by 8 | Viewed by 5533
Abstract
IgE-mediated cow’s milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict avoidance of milk products while awaiting natural tolerance, research increasingly shows that the rates of resolution are slowing [...] Read more.
IgE-mediated cow’s milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict avoidance of milk products while awaiting natural tolerance, research increasingly shows that the rates of resolution are slowing down. Therefore, there is a need to explore alternative pathways to promote tolerance to cow’s milk in pediatric populations. This review aims to combine and appraise the scientific literature regarding the three CMPA management methods: avoidance, the milk ladder, and oral immunotherapy (OIT) and their outcomes in terms of efficacy, safety, and immunological effects. Cow’s milk (CM) avoidance virtually protects against allergic reaction until natural tolerance occurs, with hypoallergenic substitutes available in the market, but accidental ingestion represents the main issue for this strategy. Introduction to baked milk using the milk ladder was designed, with most CMPA patients successfully completing the ladder. Similar to baked milk treatment, many OIT protocols also demonstrated decreased IgE and increased IgG4 levels post protocol, as well as a reduction in wheal size diameter. Though these strategies are shown to be safe and effective in CMPA, future clinical trials should compare the safety and effectiveness of these three management strategies. Full article
(This article belongs to the Special Issue Treatment of Cow’s Milk Allergy: New Developments)
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Graphical abstract

10 pages, 268 KiB  
Review
Infantile Colic and Long-Term Outcomes in Childhood: A Narrative Synthesis of the Evidence
by Flavia Indrio, Vanessa Nadia Dargenio, Ruggiero Francavilla, Hania Szajewska and Yvan Vandenplas
Nutrients 2023, 15(3), 615; https://doi.org/10.3390/nu15030615 - 25 Jan 2023
Cited by 6 | Viewed by 2590
Abstract
About 1 in 4 infants comes forward with prolonged crying, agitation, or infant colic (IC) during the first three months of life and is referred for medical evaluation. The pathogenesis remains poorly understood, as do its implications for future health. The aim of [...] Read more.
About 1 in 4 infants comes forward with prolonged crying, agitation, or infant colic (IC) during the first three months of life and is referred for medical evaluation. The pathogenesis remains poorly understood, as do its implications for future health. The aim of this narrative review was to critically examine and discuss the available literature on long-term consequences of excessive crying and/or colic. Most studies display an association between IC and the onset of functional gastrointestinal disorders (FGIDs) years later, probably related to the presence of common etiopathogenetic factors (environmental, dietary, intestinal dysmotility, visceral hypersensitivity). Although allergic disease in first-degree relatives may be a risk factor for IC, the latter does not appear to be a risk factor for subsequent atopic disease in the individual. Overall, there seems to be a relationship between IC and subsequent headaches, of the migraine type. Similarly, behavioral problems in children with a history of IC appear to be associated with higher parental stress scores. However, the current evidence is based on associations, and currently, a causal relationship between excessive crying and IC and long-term consequences remains not documented. Full article
(This article belongs to the Special Issue Treatment of Cow’s Milk Allergy: New Developments)
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