European Academy of Allergy & Clinical Immunology

Food allergies are a growing health epidemic, with population-based surveys in the USA estimating that up to 8% of children and 11% of adults are now living with a food allergy. During the 1990s and early 2000s, international guidelines recommended the avoidance of commonly problematic food during infancy due to the belief that early introduction of these foods may increase the risk of allergies. However, beginning with the publication of the LEAP trial in 2015,3 a paradigm shift in the understanding of food allergy prevention has occurred. Clinical guidelines now generally recommend the introduction of potentially allergenic food after 4–6 months of exclusive breastfeeding. This symposium occurred during the European Academy of Allergy and Clinical Immunology (EAACI) Congress, 2022 and discussed early allergen introduction and food allergy prevention.

Advancing the Management of Cow's Milk Protein Allergy with Human Milk Oligosaccharides: Priming the Immune System

During NNI Symposium at the European Academy of Allergy and Clinical Immunology (EAACI) hybrid congress 2021, leading experts in paediatric allergy and immunology discussed the importance of the early-life microbiome in driving immune maturation and preventing allergy. They explored key evidence supporting the benefits of human milk oligosaccharides (HMOs) in priming the immune system and promoting infant health, particularly in cow’s milk protein allergy (CMPA).

Vandenplas summarised clinical trials of HMOs in CMPA to date, highlighting data on growth, tolerance, and reduction in infection risk achieved with HMO-supplemented specialty formula. The major role that HMOs play in shaping the gut microbiome in early infancy was discussed by Heine. He presented recent data showing how supplementation of standard or extensively hydrolysed infant formula with two HMOs, 2’-fucosyllactose (2’FL) and lacto-N-neotetraose (LNnT), can shift the gut microbiome in CMPA closer to the profile of breastfed infants. Nutten outlined how 2’FL and LNnT can beneficially modulate Type 2 immune responses, which may have important implications for both allergy prevention and treatment strategies.

Human Milk Oligosaccharides: New Developments in the Management of Cow’s Milk Protein Allergy
 

Human milk oligosaccharides (HMO) are the third largest component in breastmilk. They resemble mucosal glycans at the host–microbe interface, supporting HMO to play important roles in orchestrating the host–microbial interactions via multiple mechanisms. These include preventing pathogen growth and adhesion, reducing inflammatory responses and aiding the mucosal barrier function, as well as promoting an early life microbiome. Observational studies with breastfed infants suggest that HMO  support the immune system with protection from infections and possibly allergies. It has been shown that feeding a formula with the two HMO, 2’FL and LNnT, reduces the risk for infections in both healthy and infants with cow’s milk protein allergy. Furthermore, feeding a formula with these two HMO supports a gut microbiota closer to breastfed infants. In this symposium we will learn more about the effect of HMO supplementation on the gut microbiome in children with cow’s milk protein allergy

Human Milk Oligosaccharides: New Ways to Shape the Gut Microbiome in Cow’s Milk Protein Allergy

The human gut is colonised by a wide diversity of microbes and they exhibit highly evolved synergistic relationships to provide essential biological functions to the host and how the gut microbiome is influenced by many factors in early life. It is important to establish a stable gut microbial community, which closely tracks host growth and immune development. The mechanisms whereby delays or alterations in the establishment of these communities can lead to microbiome immaturity, raise the risk of allergy development including cow’s milk protein allergy (CMPA).

Human milk oligosaccharides (HMO) are multifunctional breast milk components that shape the developing gut microbiota and influence the developing immune system. Supplementing specialty formulas for the management of CMPA with HMO offers a new way to shape the gut microbiome in infants with CMPA that for any reason cannot be breastfed.

The Scientific Programme Committee carefully developed an outstanding programme under the theme: Challenging Dogmas. It covered the whole field of allergy, as well as lots of new topics and formats.