To the Editor The Special Communication by Munblit et al, “Assessment of Evidence About Common Infant Symptoms and Cow’s Milk Allergy,”1 concluded that recommendations to manage common infant symptoms as cow’s milk allergy (CMA) are not evidence based, especially in breastfed infants who are not directly consuming cow’s milk. Analysis of the authors suggested that for more than 99% of the infants with proven CMA, breast milk from a cow’s milk–consuming mother contains insufficient β-lactoglobulin levels to trigger an allergic reaction. Although the authors admitted limitations in their analysis, it should be furthermore noted that the analysis was based on indirect evidence; it compares thresholds of proteins needed to induce allergic reaction in older children than breast-fed infants with the concentration of a single cow’s milk component in breast milk. In fact, this is not evidence based, and one should look at more direct evidence.
Hilvo M. Maternal Elimination Diet and Symptoms of Cow’s Milk Allergy in Breastfed Infants. JAMA Pediatr. 2021;175(4):425–426. doi:10.1001/jamapediatrics.2020.5311
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