The natural course of cow’s milk allergy and the development of atopic diseases into adulthood

Hansen, None Michaela M.; Nissen, Susanne P; Halken, Susanne; Høst, Arne

doi:10.1111/pai.13440

Cited by 16 publications

(20 citation statements)

References 28 publications

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“…Whilst a proportion of eczema cases may be non‐atopic, 30 there is a greater prevalence of CMA among children with infantile eczema 31 . Similarly, atopic dermatitis may present in 11%–20% of children in the United Kingdom, 32 and has been found to be more common in children with CMA than those without 33 . The presentation of these symptoms in children with and without CMA may lead to challenges with differential diagnosis in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

Sorensen

Grimshaw

Cawood

et al. 2021

Immunity Inflam & Disease

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Introduction Cow's milk allergy (CMA) is common in infants and children. Clinical presentations may vary, with a range of symptoms affecting the gastrointestinal (GI), skin and respiratory systems. Whilst the primary focus of research to date has been on the management of these symptoms, studies investigating the broader clinical burden of CMA are limited. Methods We performed a retrospective matched cohort study examining clinical data, including allergic symptoms and infections, extracted from case records within The Health Improvement Network database. A total of 6998 children (54% male) were included in the study, including 3499 with CMA (mean age at diagnosis 4.04 months) and 3499 matched controls without CMA, observed for a mean period of 4.2 years. Results GI, skin and respiratory symptoms affected significantly more children with CMA (p < .001), which recurred more often (p < .001), compared with children without CMA. More children with CMA had symptoms affecting multiple systems (p < .001). CMA was associated with a greater probability of these symptoms requiring hypoallergenic formula (HAF) prescription persisting over time (log‐rank test p < .0001, unadjusted hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.76–0.85, p < .001), with a longer median duration of symptoms and HAF prescription compared with the duration of symptoms in those without CMA (3.48 vs. 2.96 years). GI, skin, respiratory and ear infections affected significantly more children with CMA than those without, increasing by 74% (p < .001), 20% (p < .001), 9% (p < .001), and 30% (p < .001) respectively. These infections also recurred more often among children with CMA, increasing by 62% for GI infections, 37% for skin and respiratory infections, and 44% for ear infections (p < .001). Conclusions This real‐world study provides evidence to suggest that CMA presents a significant clinical burden to children, which has implications for the healthcare system. Further research is warranted to understand the health economic impact of this, and the phenotypes, factors and management approaches which may affect clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

Sorensen

Grimshaw

Cawood

et al. 2021

Immunity Inflam & Disease

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show abstract

“…2,3 In addition, studies were mostly focusing on the development of respiratory diseases in risk populations and cross-sectional studies were largely lacking. 4 We highlight here as editor's choice the recent study by Strachan and colleagues, which aimed to update trends in prevalence of symptoms of childhood allergic respiratory diseases and compare them with data from 15 to 23 years ago. 5 Data of symptoms suggesting allergic rhinitis and conjunctivitis by standardized questionnaires were collected from over 100,000 participants.…”

mentioning

confidence: 99%

Editorial comments on: “Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I”

Genuneit

Eigenmann

2022

Pediatric Allergy Immunology

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“…By conducting a DBPCFC test, the study found that dermatological symptoms of urticaria, erythematous rash, and angioedema were noted primarily in the immediate hypersensitivity reaction group (62.5% of participants with CMA), whereas gastrointestinal symptoms were noted in the delayed-type hypersensitivity group (28.8% of participants with CMA) [23]. However, more recent studies have shown dermatological manifestations occurring within both mechanisms [24]. Interestingly, type I-mediated reactions were found to occur more frequently within infant and children populations.…”

Section: Review Type I Hypersensitivity Reactions and Atopic Dermatitismentioning

confidence: 99%

Underlying Immune Mechanisms Involved in Cow’s Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis

Weimer¹,

Beckler²

2022

Cureus

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Of the many symptoms associated with cow's milk allergy (CMA), many populations face the burden of the appearance or worsening of atopic dermatitis (AD) when consuming milk products. Due to the prevalence and possible severity of symptoms, it is important to understand the underlying immune mechanisms involved in such reactions. Hypersensitivity reactions are exaggerated immune responses to often benign antigens, many times resulting in a cascade of pro-inflammatory processes. Of the four major types, type I and IV are of most relevance when considering atopic dermatitis worsened by cow's milk. Considered a "true allergy," type I (immediate) hypersensitivity reactions occur within hours after secondary exposure to an allergen and are primarily driven by antibodies and humoral immune responses. On the contrary, type IV (delayed) hypersensitivity reactions are driven by cell-mediated responses involving T-cell activation. Due to the array of symptoms induced by these complex reactions, it is imperative to diagnose early and treat appropriately. In this literature review, we aim to highlight the primary underlying immune contributors to hypersensitivity reactions, discuss AD as a manifestation of hypersensitivity reactions to cow's milk, and consider current and future treatment options for combatting hypersensitivities manifesting as AD.

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The natural course of cow’s milk allergy and the development of atopic diseases into adulthood

Cited by 16 publications

References 28 publications

The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

Editorial comments on: “Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I”

Underlying Immune Mechanisms Involved in Cow’s Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis

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