Effect of feeding regimen on the acquisition of immunological tolerance in mexican infants with IgE-mediated cow's milk protein allergy.

OBJECTIVE

To compare the rate of tolerance acquisition in Mexican infants with IgE-mediated cow's milk protein allergy, fed according to three dietary regimens.

METHODS

A retrospective, observational cohort study was conducted on infants diagnosed with cow's milk protein allergy between 1 and 3 months of age, divided into three groups according to their feeding regimen: 1) exclusive breastfeeding with an elimination diet, 2) amino acid-based formula, and 3) hydrolyzed rice formula. Clinical characteristics, wheal size in skin prick tests against casein, alpha-lactalbumin, and beta-lactoglobulin, adherence to treatment, and coexisting allergic comorbidities were evaluated. Tolerance acquisition was determined by an open oral challenge test with whole milk after 12 months on an elimination diet. Comparative analyses and multivariate logistic regression were performed to identify associated factors.

RESULTS

285 infants were selected and assigned to one of three study groups (n = 95 per group). 62.1% achieved clinical tolerance at the end of the follow-up period. The highest proportion was observed in the exclusive breastfeeding group (78.9%), followed by the amino acid-based formula group (68.4%) and the hydrolyzed rice formula group (65.3%), with no statistically significant differences between the regimens (p = 0.094). Adherence to the dietary treatment was significantly associated with the acquisition of tolerance in the multivariate model, while allergic comorbidities were associated with a lower probability of clinical cure.

CONCLUSIONS

The elimination diet is associated with the acquisition of tolerance in a considerable proportion of infants with IgE-mediated cow's milk protein allergy. Although no superiority was identified among the dietary regimens, the findings suggest that adherence to treatment plays a determining role in clinical outcomes and should be considered a central component in the management of the disease.