NHD CPD eArticle NETWORK HEALTH DIGEST
Volume 7.20 - 30th November 2017
COWS’ MILK PROTEIN ALLERGY IN INFANTS Maeve Hanan Registered Dietitian, City Hospitals Sunderland Maeve works as a Paediatric Dietitian in City Hospitals Sunderland. She also runs a blog called Dietetically Speaking.com which promotes evidencebased nutrition and dispels misleading nutrition claims and fad diets.
Allergy has been called ‘the number one environmental epidemic disease facing children of the developed world’.1,2 Cows’ milk protein allergy (CMPA) is the most common food allergy found in children; with a worldwide prevalence of 1.9-4.9%3 and a UK prevalence of 2-3%.2,4 As milk is a key part of an infant’s diet, the nutritional management of this condition is crucial.
CMPA is a reproducible adverse immune response to one or more of the proteins found in cows’ milk, which usually presents before the age of one and is often outgrown by the age of five.4 The risk of CMPA increases when an infant This article has a history, or family history, of atopy; has been Peer for example, eczema or asthma in the Reviewed by infant, or a family history of eczema, Dr Rosan Meyer, asthma, hay fever or food allergies.5 Paediatric There is evidence that breastfed Research Dietitian, infants have a lower prevalence of Honorary Senior CMPA, with about 7% of formula or Lecturer, Imperial mixed-fed infants developing CMPA College, London compared to about 0.5% of exclusively and Chair of the breastfed infants. Furthermore, breastBDA Food Allergy fed infants are reported to have less and Intolerance severe reactions if they do develop Specialist Group. CMPA.3,6 The primary factor involved in the development of food allergy in infancy is genetic, with a parental atopic
history (asthma, eczema and hayfever) significantly increasing the risk.8 Research has also identified contributing environmental factors, which include smoking during pregnancy, the infant’s gut microbiome which may be affected by route of birth (C-section versus vaginal birth), early antibiotic use and dietary diversity.8,20,21 CMPA is classified as either immunoglobulin E- (IgE) or non-IgEmediated, depending on the type of immune response which occurs. IgEmediated reactions occur when IgE antibodies form in response to cows’ milk protein, which causes the release of histamine from basophils and mast cells;
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1. De Boissieu D, Matarazzo P, Dupont C. J Pediatr 1997; 131(5):744-747. 2. Vanderhoof JA, Murray MD, Kaufman S et al. J Pediatr 1997; 131 (5):741-744.
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