Background: Cow milk allergy (CMA) is the most common food allergy in breastfed infants. The aim of this study is to verify whether certain perinatal factors may influence the development of CMA immunoglobulin E (IgE)+. Methods: A retrospective, observational study of case and control groups was carried out. Information was collected of patients with CMA IgE+ from our department during the years 1990-2013. Patients of the same age and sex were recruited for the control group. Information on the following variables was collected: sex, age, pregnancy tolerance, duration of pregnancy, type of delivery, isolated doses of formula feeding in hospital (FFH), duration of breastfeeding, and family history of allergy (defined as ≥1 first-degree family member with allergic disease). Statistical analysis was performed using multivariate logistic regression techniques. Results: A total of 211 cases were included in this study. Multivariate analysis showed an influence of duration of breastfeeding, FFH to be a risk factor (OR 4.94; 95% CI 2.68-9.08), especially in caesarean delivery (OR 11.82; 95% CI 2.64-47.50), and prematurity (OR 0.29; 95% CI 0.09-0.92) to be a protective factor. Conclusions: Perinatal factors play a key role in the development of CMA IgE+, with an influence of breastfeeding duration, FFH and caesarean delivery as risk factors and prematurity as a protective factor. While family history had no important role, environmental factors were more decisive.

1.
Rona RJ, Keil T, Summers C, et al: The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 2007;120:638-646.
2.
Sicherer SH: Epidemiology of food allergy. J Allergy Clin Immunol 2011;127:594-602.
3.
Liu AH, Jaramillo R, Sicherer SH, et al: National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol 2010;126:798-806.
4.
Plaza Martín AM: Alergia a proteínas de leche de vaca. Protoc Diagn Ter Pediatr 2013;1:51-61.
5.
Host A, Halken S: Cow's milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets 2014;14:2-8.
6.
Martorell-Aragonésa L, Echeverría-Zudaireb E, Alonso-Lebreroc J, et al: Position document: IgE-mediated cow's milk allergy. Allergol Immunopathol (Madr) 2015;43:507-526.
7.
Sladkevicius E, Nagy E, Lack G, Guest JF: Resource implications and budget impact of managing cow milk allergy in the UK. J Med Econ 2010;13:119-128.
8.
Sladkevicius E, Guest JF: Budget impact of managing cow milk allergy in the Netherlands. J Med Econ 2010;13:273-283.
9.
Sladkevicius E, Guest JF: Modelling the health economic impact of managing cow milk allergy in South Africa. J Med Econ 2010;13:257-272.
10.
Guest JF, Nagy E: Modelling the resource implications and budget impact of managing cow milk allergy in Australia. Curr Med Res Opin 2009;25:339-349.
11.
Kramer MS, Kakuma R: Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2012;3:CD000133.
12.
Lovegrove JA, Hampton SM, Morgan JB: The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. Br J Nutr 1994;71:223-238.
13.
Fiocchi A, Burks W, Bahna SL, et al: Clinical use of probiotics in pediatric allergy (CUPPA): a world allergy organization position paper. World Allergy Org J 2012;5:148-167.
14.
Von Berg A: Dietary interventions for primary allergy prevention - what is the evidence? World Rev Nutr Diet 2013;108:71-78.
15.
Osborn DA, Sinn J: Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006, p CD003664.
16.
Osborn DA, Sinn J: Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006;4: CD003741.
17.
Osborn DA, Sinn JK: Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007, p CD006475.
18.
Osborn DA, Sinn JK: Prebiotics in infants for prevention of allergy. Cochrane Database Syst Rev 2013;3:CD006474.
19.
Eggesbø M, Botten G, Stigum H, Samuelsen SO, Brunekreef B, Magnus P: Cesarean delivery and cow milk allergy/intolerance. Allergy 2005;60:1172-1173.
20.
Metsälä J, Lundqvist A, Kaila M, Gissler M, Klaukka T, Virtanen SM: Maternal and perinatal characteristics and the risk of cow's milk allergy in infants up to 2 years of age: a case-control study nested in the Finnish population. Am J Epidemiol 2010;171:1310-1316.
21.
Toro Monjaraz EM, Ramírez Mayans JA, Cervantes Bustamante R, et al: Perinatal factors associated with the development of cow's milk protein allergy. Rev Gastroenterol Mex 2015;80:27-31.
22.
Sánchez-Valverde F, Gil F, Martinez D, et al: The impact of caesarean delivery and type of feeding on cow's milk allergy in infants and subsequent development of allergic march in childhood. Allergy 2009;64:884-889.
23.
Bager P, Wohlfahrt J, Westergaard T: Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 2008;38:634-642.
24.
Høst A, Husby S, Osterballe O: A prospective study of cow's milk allergy in exclusively breast-fed infants: incidence, pathogenetic role of early inadvertent exposure to cow's milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr Scand 1988;77:663-670.
25.
Cantani A, Micera M: Neonatal cow milk sensitization in 143 case-reports: role of early exposure to cow's milk formula. Eur Rev Med Pharmacol Sci 2005;9:227-230.
26.
De Jong MH, Scharp-van der Linden VT, Aalberse RC, Oosting J, Tijssen JG, de Groot CJ: Randomised controlled trial of brief neonatal exposure to cows' milk on the development of atopy. Arch Dis Child 1998;79:126-130.
27.
De Jong MH, Scharp-Van Der Linden VT, Aalberse R, Heymans HS, Brunekreef B: The effect of brief neonatal exposure to cows' milk on atopic symptoms up to age 5. Arch Dis Child 2002;86:365-369.
28.
Lodge CJ, Tan DJ, Lau M, et al: Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr 2015;104:38-53.
29.
Zachariassen G, Faerk J, Esberg BH, et al: Allergic diseases among very preterm infants according to nutrition after hospital discharge. Pediatr Allergy Immunol 2011;22:515-520.
30.
Byberg KK, Ogland B, Eide GE, Oymar K: Birth after preeclamptic pregnancies: association with allergic sensitization and allergic rhinoconjunctivitis in late childhood: a historically matched cohort study. BMC Pediatr 2014;14:101.
31.
Kumar R, Ouyang F, Story RE, et al: Gestational diabetes, atopic dermatitis, and allergen sensitization in early childhood. J Allergy Clin Immunol 2009;124:1031-1038.
32.
Instituto de Estadística de Navarra: Población y demografía. http://www.navarra.es/AppsExt/GN.InstitutoEstadistica.Web/informacionestadistica.aspx?R=1&E=1 (accessed September 16, 2015)
33.
World Health Organization: Global strategy for infant and young child feeding. 2003. http://www.who.int/maternal_child_adolescent/documents/9241562218/en/ (accessed February 28, 2017).
34.
Stintzing G, Zetterström R: Cow's milk allergy, incidence and pathogenetic role of early exposure to cow's milk formula. Acta Paediatr Scand 1979;68:383-387.
35.
Høst A: Importance of the first meal on the development of cow's milk allergy and intolerance. Allergy Proc 1991;12:227-232.
36.
Saarinen KM, Savilahti E: Infant feeding patterns affect the subsequent immunological features in cow's milk allergy. Clin Exp Allergy 2000;30:400-406.
37.
Katz Y, Rajuan N, Goldberg MR, et al: Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. J Allergy Clin Immunol 2010;126:77-82.
38.
Salminen S, Gibson GR, McCartney AL, Isolauri E: Influence of mode of delivery on gut microbiota composition in seven year old children. Gut 2004;53:1388-1389.
39.
Azad MB, Konya T, Persaud RR, et al: Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 2016;123:983-993.
40.
Liao SL, Lai SH, Yeh KW, et al: Exclusive breastfeeding is associated with reduced cow's milk sensitization in early childhood. Pediatr Allergy Immunol 2014;25:456-461.
41.
Van Odijk J, Kull I, Borres MP, et al: Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966--2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy 2003;58:833-843.
42.
Rieger CH, Rothberg RM: Development of the capacity to produce specific antibody to an ingested food antigen in the premature infant. J Pediatr 1975;87:515-518.
43.
Pawankar R, Canonica GW, Holgate ST, Lockey RF: World Health Organization White Book on Allergy: 2011-2012 Executive Summary. Milwaukee, WAO, 2011.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.