Educating the immune system to build oral tolerance

  • The ultimate goal in CMA management is building oral tolerance1


    • Commonly, infants who have CMA build tolerance to cow’s milk protein by 3-5 years of age2-4
    • Infants low exposure to cow’s milk protein (CMP) sooner may help build oral tolerance to CMP5
    • Amino acid formulas lack cow’s milk peptides that can help educate the immune system

    The ultimate goal in CMA management is building oral tolerance

    Combination of eHP and LGG results in a comprehensive management of CMA

    Combination of eHP and LGG results in a more comprehensive management of CMA

    LGG is a registered trademark of Valio, LTD. CMP=cow's milk protein; LGG=Lactobacillus rhamnosus GG.

    Expert recommendations call for eHF as first-line choice for CMA


    eHF should be first choice for CMA management.

    Expert recommendations call for eHF

    • Consider AAF for severe CMA or if eHF is not tolerated
    • Partially hydrolyzed formulas are not indicated14-18
    • Soy formulas should not be recommended as first line choice

    AAF= amino acid formulac CMA=cow’s milk allergy eHF= extensively hydrolyzed formula ESPGHAN= European Society for Pediatric Gastroenterology, Hepatology, and Nutrition NASPGHAN= North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

  • References: 1. Koletzko S et al. J Pediatr Gastroenterol Nutr. 2012;55:221-229. 2. Wood RA. Pediatrics 2003; 111:1631-1637. 3. Host A et al. Allergy. 1990;45:587-596. 4. Bishop JM et al. J Pediatr. 1990; 116:862-867. 5. Allen CW et al. Pediatr Allergy Immunol. 2009;20:415-422. 6. Isolauri E et al. J Clin Gastroenterol. 2008; 42(suppl 2):S91-S96. 7. Baldassarre ME et al. J Pediatr. 2010; 156:397-401. 8. Baldassarre ME, Laforgia N, Fanelli M et al. Lactobacillus GG improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone. J Pediatr. 2010;156:397-401. 9. Isolauri E, Salminen S; Nutrition, Allergy, Mucosal Immunology, and Intestinal Microbiota (NAMI) Research Group Report. Probiotics: use in allergic disorders. J Clin Gastroenterol. 2008;42(suppl 2):S91-S96. 10. Isolauri E. Probiotics in human disease. Am J Clin Nutr. 2001;73(suppl):1142S-1146S. 11. Isolauri E, Majamaa H, Arvola T et al. Lactobacillus casei strain GG reverses increased intestinal permeability induced by cow milk in suckling rats. Gastroenterology. 1993;105:1643-1650. 12. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. 1997;99:179-185. 13. Petschow BW, Figueroa R, Harris CL et al. Effects of feeding an infant formula containing Lactobacillus GG on the colonization of the intestine: a dose-response study in healthy infants. J. Clin. Gastroenterol. 2005;39:786-790. 14. Koletzko S et al. J Pediatr Gastroenterol Nutr. 2012;55:221-229. 15. Dupont C et al. Br J Nutr. 2012;107:325-338. 16. Bhatia J et al. Pediatrics. 2008; 121:1062-1068. 17. Kemp AS et al. Med J Aust. 2008; 188:109-112. 18. Vandenplas Y et al. Arch Dis Child. 2007;92:902-908.