Primary prevention of cow’s milk sensitization and food allergy by avoiding supplementation

A new study by Urashima et al. shows that sensitization to cow’s milk and food allergy, including CMA and anaphylaxis, is preventable by avoiding CMF (cow milk formula) supplementation for at least the first few days of life. Although examined only indirectly in this study, vitamin D supplementation seems to be involved in the sensitization process.

Note to self – this is now study no 5 of vitamin D related clinical trials on allergy
1. De Montis G, Gendrel D, Chemillier-Truong M, Dupont C. Sensitisation to peanut and vitamin D oily preparations. The Lancet 1993;341(8857):1411.6.
2. Norizoe C, Akiyama N, Segawa T, Tachimoto H, Mezawa H, Ida H, Urashima M. Increased food allergy with vitamin D: A randomized, double-blind, placebo-controlled trial. Pediatr Int 2014; 56:6-12.7.
3. Rueter K, Jones AP, Siafarikas A, Lim EM, Bear N, Noakes PS, et al. Direct infant UV light exposure is associated with eczema and immune development. J Allergy Clin Immunol 2018; in press, doi: 10.1016/j.jaci.2018.08.037.
4. Rosendahl J, Pelkonen AS, Helve O, et al. . High-Dose Vitamin D Supplementation Does Not Prevent Allergic Sensitization of Infants. J Pediatr. 2019 Jun;209:139-145.e1. doi: 10.1016/j.jpeds.2019.02.021
5. Urashima M, Mezawa H, Okuyama M, et al. Primary Prevention of Cow’s Milk Sensitization and Food Allergy by Avoiding Supplementation With Cow’s Milk Formula at Birth. JAMA Pediatr. 2019;173(12):1137-1145. doi:10.1001/jamapediatrics.2019.3544

The Urashima study is accompanied by a valuable editorial of George du Toit and Kari Nadeau

There is currently a lack of consensus among national allergy societies .. Although the EAACI3 and American Academy of Allergy, Asthma and Immunology (AAAI) currently recommend the use of hypoallergenic formulas in infants at high risk of allergy, the Australian Society of Clinical Immunology and Allergy does not. The EAACI and the AAAI are likely to reconsider their guidelines because results of more re- cent studies have been contradictory. …
Guidelines in the United States and United Kingdom recommend routine vitamin D supplementation in all breastfed infants, whereas guidelines in Australia recommend supplementation only in breastfed infants at high risk of vitamin D insufficiency.