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Early introduction of infant formula to prevent cow’s milk allergy

Published: September 2, 2020

Previous research has produced conflicting evidence on the preventative effects of early cow’s milk protein introduction on cow’s milk allergy (CMA).

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Sakihara et al investigated whether the early introduction of cow’s milk formula (CMF) could serve as an effective strategy in the primary prevention of cow’s milk allergy in a general population. Authors recruited newborns from 4 hospitals in Okinawa, Japan. Participants were randomly allocated to ingest ≥10 mL of cow’s milk formula daily (ingestion group) or avoid cow’s milk formula (avoidance group) between 1 and 2 months of age. The avoidance group supplemented breastfeeding with soy formula as needed. An oral food challenge was performed at 6 months of age to assess cow’s milk allergy development. Continuous breastfeeding was recommended for both groups until 6 months of age.

Five-hundred and four infants were randomized. Twelve participants declined to receive the intervention, and the study sample comprised 491 participants (ingestion group: 242; avoidance group: 249) for the modified intention-to-treat analysis. The number of cow’s milk allergy cases was 2 (0.8%) of 242 in the ingestion group and 17 (6.8%) of 249 in the avoidance group (risk ratio: 0.12; 95% confidence interval: 0.01–0.50; P<.001). The risk difference was 6.0% (95% confidence interval: 2.7–9.3). Approximately 70% of participants continued to breastfeed at 6 months of age in both groups.

This study demonstrates that daily ingestion of ≥10 mL of cow’s milk formula between 1 and 2 months of age prevents the development of cow’s milk allergy and does not compete with breastfeeding. This multicenter randomized controlled trial in infants from the general population demonstrates a safe and practical strategy for preventing cow’s milk allergy.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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