Cow's milk protein allergy: A risk factor for infections in infants?

Background

Cow's milk protein allergy (CMPA) imposes a significant burden on the lives of infants and families and can cause various complications, but there are limited data on the clinical burden associated with infection.

Objective

This study aimed to compare infection frequency, antibiotic use, and hospitalization rates between children with CMPA and healthy controls.

Methods

Patients diagnosed with CMPA (IgE-mediated or non-IgE-mediated) in the pediatric allergy-immunology outpatient clinic and healthy infants admitted to the social pediatrics outpatient clinic were evaluated prospectively at initial visit, 6 months, and 12 months. Clinical characteristics, history of respiratory, skin, gastrointestinal, and urinary tract infections, antibiotic use, and hospitalization rates were analyzed.

Results

Compared to controls, the CMPA group had significantly lower prevalence and duration of exclusive breastfeeding (p < 0.001 for both) and significantly higher income (p = 0.035), presence of siblings (p < 0.001), household size (p < 0.001), rate of suburban dwelling (p = 0.008), and rate of atopic dermatitis (p = 0.003). Rates of infection (all systems), antibiotic use, and hospitalization were higher in the CMPA group compared to controls (p < 0.001 for all) and among patients with IgE-mediated CMPA compared to those with non-IgE-mediated CMPA (p < 0.05 for all). Respiratory and skin infections were more common and gastrointestinal infections were less common in IgE-mediated CMPA compared to non-IgE-mediated CMPA (p < 0.001 for all).

Conclusion

CMPA (especially the IgE phenotype) was associated with increased infection frequency and severity in infants. These findings suggest the need for a more careful approach to infection risk in patients with CMPA and the importance of disease control.