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Tolerance to cow’s milk

What is oral tolerance?

When a patient who is sensitive to food proteins can ingest those proteins and not experience a local or systemic immune response, they have developed oral tolerance.1

It is a state where immune homeostasis is maintained as the regulatory T-cells prevent potentially dangerous hypersensitivity reactions to harmless antigens.1

Symptoms, including gastrointestinal and respiratory, can result if patients are exposed to a food protein they are allergic to. However, strict avoidance does not seem to aid the development of tolerance to the protein.2-3 Studies have shown that exposure to baked milk and egg increases the development of tolerance to those proteins compared with strict avoidance. 2-3

The importance of tolerance in CMA

Cow’s milk allergy (CMA) doesn’t just affect the child, it affects the whole family, and recent studies suggest a later acquisition of tolerance to cow's milk than in previous years.4 On average, most infants with CMA will reach oral tolerance by outgrowing CMA naturally, but not usually until 3-5 years of age.4-6

The ultimate goal of allergy management after symptom resolution is to achieve oral tolerance7-9

The quicker the time to oral tolerance the quicker the time to a life free from the burden of CMA10

The only eHf with clinical evidence of oral tolerance

Clinical data has demonstrated that 54% of Nutramigen LIPIL-fed infants are tolerant to cow’s milk after 12 months’ intake.11

Nutramigen LIPIL is the only eHF with clinical evidence of oral tolerance.7,11 Nutramigen LIPIL has been extensively hydrolysed, with 95.4% of the cow's milk protein fragments 8

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Oral tolerance means an infant can consume cow’s milk again without allergic reactions. The quicker the time to oral tolerance, the quicker the time to a life free from the burden of CMA.10

Shortened CMA management could lead to potential cost savings by potentially reducing the costs of formula prescriptions and symptom-related medication6

Nutramigen LIPIL gives effective symptom relief12 and could help you achieve your goal of faster tolerance acquisition in CMA.

Show references
  1. Pabst O and Mowatt. AM. Oral tolerance to food protein. Mucosal Immunol 2012;5(3):232–239.

  2. Kim JS et al. Dietary baked-milk accelerates resolution of cow's milk allergy in children. J Allergy Clin Immunol 2011;128(1):125–131.

  3. Leonard SA et al. Dietary baked egg accelerates resolution of egg allergy in children.J Allergy Clin Immunol 2012;130:473–80.

  4. Santos A, Dias A, Pinheiro JA. Predictive factors for the persistence of cow’s milk allergy. Pediatr Allergy Immunol 2010;21(8):1127–1134.

  5. Host A. Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89(Suppl):33–37.

  6. Canani R et al. Formula selection for management of children with cow's milk allergy influences the rate of acquisition of tolerance: a prospective multicenter study. J Pediatr 2013;163:771–777.

  7. Koletzko S et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012;55(2):221–229.

  8. du Toit G et al. Identifying and managing cow's milk protein allergy. J Arch Dis Child Educ Pract Ed 2010;95:134-144.

  9. Canani RB et al. The potential therapeutic efficacy of Lactobacillus GG in children with food allergies. Pharmaceuticals 2012;5:655–664.

  10. Cummings AJ et al. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010;65:933−945.

  11. Canani R et al. Effect of Lactobacillus GG on tolerance acquisition in infants with cow's milk allergy: A randomized trial. J Allergy Clin Immunol 2012;129:580–582.

  12. Dupont C et al. Dietary treatment of cows’ milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics. British J Nutr 2011:1-14.