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Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow's milk allergy: 3‐year randomized controlled trial

  • 2017-06
  • Journal of Allergy and Clinical Immunology 139(6)
    • R. B. Canani
    • M. Di Costanzo
    • G. Bedogni
    • Antonio Amoroso
    • L. Cosenza
    • C. di Scala
    • V. Granata
    • R. Nocerino

Abstract

Background: Children with cow's milk allergy (CMA) have an increased risk of other allergic manifestations (AMs).

Objective: We performed a parallel-arm randomized controlled trial to test whether administration of an extensively hydrolyzed casein formula (EHCF) containing the probiotic Lactobacillus rhamnosus GG (LGG) can reduce the occurrence of other AMs in children with CMA.

Methods: Children with IgE-mediated CMA were randomly allocated to the EHCF or EHCF+LGG groups and followed for 36 months. The main outcome was occurrence of at least 1 AM (eczema, urticaria, asthma, and rhinoconjunctivitis). The secondary outcome was tolerance acquisition, which was defined as the negativization of a double-blind food challenge results at 12, 24, and 36 months. AMs were diagnosed according to standardized criteria. Tolerance acquisition was evaluated every 12 months.

Results: A total of 220 children (147 boys [67%]) with a median age of 5.0 months (interquartile range, 3.0-8.0 months) were randomized; 110 children were placed in the EHCF group, and 110 children were placed in the EHCF+LGG group. In the complete case analysis the absolute risk difference for the occurrence of at least 1 AM over 36 months was -0.23 (95% CI, -0.36 to -0.10; P < .001), and the absolute risk difference for the acquisition of cow's milk tolerance was 0.20 (95% CI, 0.05-0.35; P < .01) at 12 months, 0.24 (95% CI, 0.08-0.41; P < .01) at 24 months, and 0.27 (95% CI, 0.11-0.43; P < .001) at 36 months. In the sensitivity analysis the effect size of the main outcome was virtually unchanged when the occurrence of AMs was assigned to all 27 missing children.

Conclusions: EHCF+LGG reduces the incidence of other AMs and hastens the development of oral tolerance in children with IgE-mediated CMA.

Keywords: Eczema; asthma; atopic march; food allergy; gut microbiota; probiotics; rhinoconjunctivitis; urticaria.

Research Insights

SupplementHealth OutcomeEffect TypeEffect Size
Lacticaseibacillus rhamnosusImproved Cow's Milk ToleranceBeneficial
Moderate
Lacticaseibacillus rhamnosusReduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus DSM33560Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus DSM33560Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus DSM 6594Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus DSM 6594Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus GGReduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus GR-1Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus GR-1Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus HA-111Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus HA-111Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus HA-500Accelerated Oral Tolerance DevelopmentBeneficial
Large
Lactobacillus rhamnosus HA-500Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus LBV96Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus LBV96Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus LBV 96Accelerated Oral Tolerance DevelopmentBeneficial
Large
Lactobacillus rhamnosus LBV 96Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus LCS-742Accelerated Oral Tolerance DevelopmentBeneficial
Large
Lactobacillus rhamnosus LCS-742Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus Lr-32Improved ToleranceBeneficial
Large
Lactobacillus rhamnosus Lr-32Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus lysate powderAccelerated Oral Tolerance DevelopmentBeneficial
Large
Lactobacillus rhamnosus lysate powderReduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus MAK79L08RImproved Oral ToleranceBeneficial
Large
Lactobacillus rhamnosus MAK79L08RReduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus R0343NDReduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus SD-5217Improved Cow's Milk ToleranceBeneficial
Moderate
Lactobacillus rhamnosus SD-5217Reduced Incidence of Allergic ManifestationsBeneficial
Large
Lactobacillus rhamnosus VPro 11Improved Cow's Milk ToleranceBeneficial
Moderate
L. casei rhamnosusEnhanced Tolerance AcquisitionBeneficial
Large
L. casei rhamnosusReduced Incidence of Allergic ManifestationsBeneficial
Large

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