Development of cow's milk allergy in breast-fed infants

• Published in: Clinical and experimental allergy Vol. 31; no. 7; pp. 978 - 987
• Main Authors: Järvinen, K.-M., Suomalainen, H.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford, UK Blackwell Science, Ltd 01-07-2001; Blackwell; Wiley Subscription Services, Inc
• Subjects: Allergic diseases; Animals; Biological and medical sciences; Breast Feeding; Humans; Immunopathology; Medical sciences; Milk - adverse effects; Milk Hypersensitivity - diagnosis; Milk Hypersensitivity - etiology; Other localizations; Human; Immunopathology; Allergy; Pathogenesis; Human milk; Cow milk; Infant; Breast feeding; Food; Allergen; Breast milk
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1046/j.1365-2222.2001.01151.x

Cow's milk allergy (CMA) is defined as an immunologically mediated adverse reaction against cow's milk antigens. CMA is the first phenomenon of atopic symptomatology and the `allergic march' because cow's milk proteins are the first foreign proteins consumed in large quantities by an infant. The overall incidence of CMA ranges from 1.9% to 7.5% in population-based studies. Symptoms of CMA commonly appear during the first year of life and in 75-90% of patients within the first month of their life. They occur within days or weeks after commencing feeding with a cow's milk-based formula, or already at their first exposure. Several studies have reported appearance of CMA during exclusive breastfeeding, which occurs in 2-23% of infants with CMA. The incidence of CMA during exclusive breastfeeding (with cow's milk never given to the infants) has been reported as 0.4-0.5%. In the light of epidemiological studies, the effect of breastfeeding on the development of allergic diseases and CMA in the breast-fed infant remains controversial. The protective effect of breastfeeding in the prevention of atopic diseases has especially been defined in allergic families. However, Wright et al. recently reported that in mothers with low IgE, breastfeeding was associated with low IgE levels in the breast-fed, whereas in atopic mothers, breastfeeding for more than 4 months was related to development of atopy in the child. This controversy may in part be due to individual variations in the levels of immunological constituents in the mother's milk. Therefore, evidence is accumulating in favour of the protective effect of breastfeeding against allergies in non-atopic families.