Synbiotics in Cow’s Milk Allergy Management

Cow’s milk is one of the most common food allergens in early life with 0.5-3% of infants affected by cow’s milk allergy1,2.  A recently published article in the EMJ journal describes how synbiotics can impact the management of cow’s milk allergy by supporting the gut microbiota, outgrowth and infection outcomes. Below is a topline summary of the EMJ article:

Synbiotics: inspiration from human milk and the effect on the gut microbiota

A healthy, balanced gut microbiota acts as a barrier against the infiltration and colonization of pathogens, thereby protecting infants against infections. Recent research has shown that infants with cow’s milk allergy (CMA) have an altered gut microbiota with lower levels of beneficial bacteria and higher levels of harmful bacteria in their gut compared to healthy breastfed infants. The addition of pre- and probiotic ingredients (together synbiotics) to formulas can help ensure a baby’s microbiome more closely resembles that of breastfed infants when breastfeeding is not possible. Three clinical studies repetitively showed that synbiotics added to hypoallergenic formula rebalanced the gut microbiota composition4,5,6,7. 

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Clinical benefits of synbiotic on the immune system

Simple infections can have a considerable impact on the lives of young children. During the first three years of life, children experience multiple infections, particularly of the upper respiratory tract8. This is caused by the immaturity of the immune system at birth. Some studies have shown that infants with CMA are more susceptible to ear and respiratory tract infections9. Three recent clinical studies suggest that an amino acid formula with synbiotics can reduce infections and the use of antibiotics in children with CMA10,11,12.

Effect of amino acid formula (AAF) with synbiotics on outgrowth of CMA

Natural outgrowth of CMA is common. The ongoing clinical trial called “PRESTO”  investigating the effect of an amino acid-based formula (AAF) with synbiotics has found that approximately one-half of children in the study with CMA who received an amino acid-based formula (AAF) outgrew their allergy within 12 months13. These results are in line with three other studies that previously reported on outgrowth of CMA in a comparable population after 12-18 months, which ranged from 38% to 57%14.

At Nutricia, we have been studying the effects of synbiotics on the microbiota for the last 10 years. The synbiotic blend included in this amino acid based formula with synbiotics studied in PRESTO has been studied in over 15000 infants over the last ten years. 

For more information on the use of synbiotics for the nutritional management of CMA , check out Nutricia EAACI FAAM symposium’s webinar focusing on the importance of the gut microbiota, the impact of synbiotics on CMA outgrowth and reported infection outcomes and the EMJ summary article.

Check out Nutricia EAACI FAAM symposium's webinar

  1. Flom and Sicherer 2019; Schoemaker et al. 2015
  2. Savage 2015
  3. Knol et al. 2005; Scholtens et al. 2012; Zhang et al. 2017
  4. Burks AW et al. Pediatr Allergy Immunol. 2015;26(4):316–322
  5. Fox AT et al. Clin Transl Allergy. 2019;9(1):5
  6. Candy DCA et al. Pediatr Res. 2018;83(3):677-686
  7. Wopereis et al. EAACI FAAM abstract 2020
  8. Wald 1991; Gruber 2008
  9. Lubianca 2006; Arroyave 2001; Woicka-Kolejwa 2016
  10.  Burks AW et al. Pediatr Allergy Immunol. 2015;26(4):316–322
  11.  Candy DCA et al. Pediatric research. 2018;83(3):677–686.
  12.  Fox AT et al. Clin Transl Allergy. 2019;9(1):5.
  13.  Chatchatee P et al. Abstract. EAACI PAAM Meeting, 17-19 October, 2019
  14.  Høst and Halken 1990; Saarinen et al. 2005; Schoemaker et al. 2015

Cow’s Milk Allergy

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