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December 11, 1996

Association of Exposure to Cow's Milk Protein and β-Cell Autoimmunity-Reply

Author Affiliations

University of Florida Gainesville

JAMA. 1996;276(22):1801. doi:10.1001/jama.1996.03540220025016

In Reply.  —As we had concluded in our Editorial, nothing short of a prospective clinical trial will definitively confirm or reject the hypothesis that the early introduction of cow's milk to infants positively influences the subsequent appearance of IDDM. The letters of Dr Dosch and Dr Johnston and Ms Spear agree with our position that the conclusions of the study of Norris et al1 are limited by the relatively small cohort studied. They also question the use of autoantibodies as a surrogate endpoint marker of the autoimmune disease process leading to IDDM.It is generally accepted that the triggering event that leads to the autoimmune process that culminates in IDDM occurs early in early childhood and can be detected by the subsequent presence of islet-reactive autoantibodies comprising ICA, insulin autoantibody (IAA), GAD65A, and IA-2 and IA2βA. The information on the natural history of the temporal appearance of these autoantibodies