New Dietary Management of CMA; Engineering the Microbiome

Nathalie Newman attends, speaks at and reports on a recent conference hosted by Mead Johnson in Rotterdam.

BBQMuch has been made in the media in recent months of the seeming increase in CMA (cow’s milk allergy) in young children. According to Allergy UK, the prevalence of CMA in children living in the developed world is now believed to be 2-3%, making it the most common cause of food allergy in the paediatric population.

I had the privilege of working alongside some of the worlds leading paediatric consultants, Dr Adam Fox, Professor Neil Shah, Dr Helen Brough, Dr Rosan Meyer – and last week saw us all come together at an allergy conference hosted by Mead Johnson, one of the leading specialist baby formula manufacturers.

The purpose of the conference was to bring consultants, dieticians and GPs working in paediatrics up to speed with the latest findings, results from ongoing studies and best practice in terms of treatment of CMA and multiple allergies. Crucially for me, to broaden understanding of the impact allergies have on every day life.

Place of CMA in the allergy spectrum

In terms of severe allergic reactions, studies by Allergy UK suggest that cows milk is implicated in 10-19% of food-induced anaphylaxis cases seen in both field and in emergency departments in paediatric populations. It is the third most common food product to cause anaphylaxis.

To take it further, cows milk allergy is shown to affect between 1.8-7.5% of infants in the first year of life.

CMA is not going away. More and more children are being diagnosed each year, and it is easy to see why CMA is now becoming a hot topic of discussion and one that needs to be addressed in terms of improving diagnosis and treatment.

Aside from the medical discussions involving case studies, and advances in understanding of how the microbiome and gut flora may be involved in the allergic process, the take home message from the conference was
‘what do parents need to do to achieve a diagnosis for their child? And how can they be better supported?’

The battle for diagnosis

Certainly in the UK, there is a real struggle for CMA to be recognised and diagnosed properly. Too often it is passed off as colic, reflux, baby eczema, ‘just what a baby does’, when in reality, CMA is preventable and can be treated to relieve symptoms effectively.

The allergic march

The one message that came through each and every presentation was the confirmation that allergy is increasing dramatically in western countries. Dr Neil Shah described the allergic march as a ‘shifting’ of allergies – where they move from one area of the body to another. Initially presenting with eczema, then moving to asthma, before moving on to IBS, then returning to the original site.

Allergy is essentially an aberrant response to threat. The body feels threatened, and responds. Each time you are exposed to an allergen and you are affected by, the response becomes amplified. The allergic march is a shifting of this amplification.

Dr Shah even went so far as to question whether challenging food allergies to see whether tolerance has ‘built up’ really only shifts the allergy in question elsewhere. Only time will tell as more data is collated.

It is certainly something I will be watching closely as we are currently attempting to get my multi-allergic son, Callum through the baked egg challenge. He had a cautious pass in hospital despite symptoms which included lip swelling, hives and tummy pain. Having continued to challenge him with baked egg at home, he is now continuing to suffer with these symptoms and now has tightening of the throat as well. We are at the point of stopping as it is not conducive to better quality of life and is causing some discomfort.

See here for more on the conference and a very brief outline of some other presentations.

See also this review considering the importance of appropriate dietary management in children avoiding dairy products due to cow’s milk allergy.

April 2018

Click here for more articles on the management of cow's milk allergy

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