Early, sustained introduction to cow’s milk formula inhibits IgE-mediated allergy
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Early and continuing exposure to cow’s milk formula during infancy was associated with reduced development of IgE-mediated cow’s milk allergy, according to a study published in Annals of Allergy, Asthma & Immunology.
However, occasional exposure increased the risk for IgE-mediated cow’s milk allergy, Idit Lachover-Roth, MD, pediatrician in the allergy and clinical immunology unit at Meir Medical Center in Kfar Saba, Israel, and colleagues wrote.
The single-center, prospective interventional study followed 1,992 infants from birth to age 12 months between May 2018 and May 2021. Parents completed monthly questionnaires about exposure to cow’s milk formula or other dairy products as well as about suspected allergic reactions and accompanying atopy.
Study population
According to the questionnaires, 1,073 infants (53.86%) were exclusively breastfed, 47% of whom deviated from the protocol and were exposed to small amounts of cow’s milk formula.
Of the 919 infants (46.14%) in the cow’s milk exposure group, 32.8% only consumed formula. The other 67.14% were breastfed and also consumed at least one bottle of cow’s milk formula each day, 2.5% of whom switched to exclusive breastfeeding before age 2 months.
The researchers also reported that 772 infants (38.7%) had one family member or more with an atopic comorbidity, including 272 family members (13.6%) with atopic dermatitis.
Study findings
Overall, 97.5% of the infants had been exposed to cow’s milk formula or dairy products routinely without any suspected allergic reaction by age 12 months.
In the intention-to-treat analysis, 124 infants had a suspected allergic reaction to cow’s milk protein, with 47 (2.36%) cow’s milk allergies confirmed. These cases included 17 (0.85%) with IgE-mediated cow’s milk allergy, seven (0.35%) with food protein-induced enterocolitis (FPIES) and 23 (1.15%) with food protein-induced allergic proctocolitis (FPIAP).
The infants with cow’s milk allergies included 35 (3.26%) from the breastfeeding group compared with 12 (1.31%) from the group with regular exposure to cow’s milk formula (RR = 2.3; 95% CI, 1.22-4.33).
The 17 infants with IgE-mediated cow’s milk allergy all came from the breastfeeding group (RR using Haldane’s correction = 29.98; P < .001), with first allergic reactions at a mean of age of 6.1 months (range, 2-10 months).
Specifically, compared with none of the 825 infants in the cow’s milk formula group, IgE-mediated cow’s milk allergy occurred in four of the 567 infants (0.7%) in the breastfeeding group who followed protocol (RR using Haldane’s correction = 13.08) and 13 (3.27%) who did not (RR using Haldane’s correction = 62.41; P = .01). The difference in incidence of cow’s milk allergy between those who did not vs. did follow protocol in the breastfeeding group did not reach significance (RR = 4.64; 95% CI, 1.52-14.15).
The researchers did not find any significant differences between the infants with and without IgE-mediated cow’s milk allergy in sex, family atopic background or atopic comorbidities, with no significant differences in the prevalence of FPIES or FPIAP between the breastfeeding or cow’s milk formula groups either.
Implications
The researchers concluded that early continuing exposure to cow’s milk formula between birth and age 2 months was associated with prevention of IgE-mediated cow’s milk allergy, as none of the infants with this exposure developed the disease.
Also, the researchers called random exposure to cow’s milk formula before age 2 months the greatest risk factor for developing IgE-mediated cow’s milk allergy and said that occasional and infrequent exposure should be discouraged.
Although it would contradict current WHO and American Academy of Pediatrics guidelines for exclusive breastfeeding for the first 6 months, the researchers suggested that regular exposure to at least one meal of cow’s milk formula per day from birth could be considered to prevent cow’s milk allergy.
Perspective
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These findings are significant. They demonstrate that early and continuing consumption of cow’s milk formula decreased the risk for IgE-mediated cow’s milk allergy development among a general population of infants.
In fact, the COMEET study showed a beneficial effect in preventing the development of IgE-mediated cow’s milk allergy similar to our findings in the SPADE study and subgroup analysis of the SPADE study.
We suggest that continuous cow’s milk formula consumption in early infancy might be recommended to prevent IgE-mediated cow’s milk allergy development. Systematic review and meta-analysis that evaluate these findings are needed to elevate the quality of evidence.
References:
Sakihara T, et al. J Allergy Clin Immunol. 2021;doi:10.1016/j.jaci.2020.08.021.
Sakihara T, et al. J Allergy Clin Immunol Pract. 2021;doi:10.1016/j.jaip.2021.07.053.
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