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Importance of the first meal on the development of cow's milk allergy and intolerance
1Department of Pediatrics, Odense University Hospital, Denmark.
Insights
Early cow's milk formula feeding in newborns is linked to a higher risk of developing cow's milk allergy (CMA) or intolerance (CMI). Neonatal cow's milk protein intake may be a key factor in sensitization and subsequent adverse reactions.
Area of Science:
- Pediatrics
- Immunology
- Allergy
Background:
- Cow's milk allergy (CMA) and cow's milk protein intolerance (CMI) are common concerns in infancy.
- Understanding the early-life factors contributing to these conditions is crucial for prevention and management.
Purpose of the Study:
- To investigate the association between early infant feeding practices and the development of CMA/CMI.
- To determine if neonatal cow's milk formula intake influences the risk of adverse reactions to cow's milk protein.
Main Methods:
- Prospective cohort study of 1749 newborns over their first year.
- Diagnosis of CMA/CMI based on elimination/open milk challenge procedures.
- Analysis of feeding history, including cow's milk formula supplementation and exclusive breastfeeding.
Main Results:
- 39 infants (2.2%) developed CMA/CMI.
- Infants with CMA/CMI were significantly more likely to have received cow's milk formula daily in the first month (p < .001).
- All infants diagnosed with CMA/CMI had received neonatal cow's milk formula, while none of the exclusively breastfed neonates without formula supplementation developed CMA/CMI (p < .05).
Conclusions:
- Early cow's milk formula feeding is associated with an increased risk of developing CMA/CMI.
- Neonatal exposure to cow's milk protein may play a role in sensitization and the subsequent development of adverse reactions.
- These findings suggest that timing and introduction of cow's milk protein may be critical factors in infant allergy development.
Abstract:
A cohort of 1749 newborns from the municipality of Odense born during 1985 in the University Hospital of Odense were followed prospectively for the development of cow's milk allergy (CMA)/cow's milk protein intolerance (CMI) during their first year. The diagnosis of CMA/CMI was based on elimination/open milk challenge procedures according to generally accepted criteria. Thirty nine infants (2.2%) developed CMA/CMI. Infants with CMA/CMI were fed cow's milk formula daily during the first month of life significantly more often than infants in the study population (p less than .001). All 39 infants with CMA/CMI had ingested cow's milk formula (40-830 mL) neonatally, whereas none of the 210 neonates without supplements of cow's milk formula developed CMA/CMI (p less than .05). Based on a positive skin-prick test (2+ or more) and/or specific serum IgE antibody to cow's milk (AL-RAST class 2 or more) 16 infants were classified as having CMA. In infants solely breast-fed for greater than 1 month CMA was as frequent (1% [14/1414] as in cow's milk formula fed infant (0.6% [2/335]). In infants with CMI, a significant majority (3.9% [13/335] versus 0.7% [10/1414], p less than .001) had been cow's milk formula fed during the first month. These data indicate an association between early cow's milk formula feeding and development of reproducible adverse reactions to cow's milk protein. Early neonatal intake of cow's milk protein is probably a condition of sensitization and later adverse reactions to cow's milk protein.