ESPEYB17 15. Editors’ choice (1) (18 abstracts)
15.6. Primary prevention of cow’s milk sensitization and food allergy by avoiding supplementation with cow’s milk formula at birth: A randomized clinical trial
Urashima M , Mezawa H , Okuyama M , Urashima T , Hirano D , Gocho N & Tachimoto H
To read the full abstract: JAMA Pediatr. 2019 Oct 21;173(12):1137–45. doi: 10.1001/jamapediatrics.2019.3544.
The authors describe a randomised controlled trial to decrease risks of sensitization to cow’s milk protein by avoiding supplementation with cow’s milk formula at birth. The trial included 330 newborns in Japan, where the practice of supplementing breastfeeding with infant formula at birth is common. Instead, the intervention group received breastmilk plus or minus an amino acid-based elemental formula for at least the first 3 days of life.
At age 2 years (with an impressive 96.8% follow-up), the intervention group had reduced risk of sensitization to cow’s milk (based on IgE levels; 16.8% vs. 32.2%; relative risk (RR), 0.52), and substantially lower prevalence of immediate (2.6% vs. 13.2%; RR, 0.20) and anaphylactic (0.7% vs. 8.6%; RR, 0.08) types of food allergy.
It is well established that breastfeeding is protective against the development of food allergies (among its many benefits). This study demonstrates that, conversely, exposure to cow’s milk protein at birth causes a lasting sensitisation, which is detectable biochemically and clinically, in terms of acute food allergy. As well as having immediate lessons for routine practice, these important findings suggest potential for similar approaches to avoid autoimmune diseases, such as type 1 diabetes.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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