Cow’s Milk Allergy in Children, from Avoidance to Tolerance
Lorenzo Calligaris, Giorgio Longo, Laura Badina, Irene Berti and Egidio Barbi
Affiliation: Pediatric Emergency Department, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” – Trieste, Italy, Via dell’Istria 65/1, 34137 Trieste, Italy.
Keywords: Anaphylaxis, avoidance, cow’s milk, food allergy, SOTI, tolerance.
Food allergy is the primary cause of anaphylaxis in paediatric age affecting roughly 4% of children and their
families worldwide, and requiring changes in dietary habits. The prognosis for food allergy in children has traditionally
been regarded as good for the most frequent allergens, however the prognosis for cow’s milk allergy in the pediatric age is
currently considered to be worse than previously believed. There is now enough evidence that measures of avoidance for
children at risk did not have any preventive effect whatsoever, but they still came to be counterproductive by avoiding the
physiological interaction between food allergens and gastrointestinal mucosal immune system. Programs of specific oral
tolerance induction (SOTI) have obtained interesting results in the treatment of food allergy supporting the idea that
antigen exposure through gastrointestinal section is important to allow the development of tolerance. Nevertheless this
approach is not yet considered “ready” for community recommendations. In this paper we describe our experience in the
field of SOTI in children with cow’s milk allergy.
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