A significant position paper was published today (Sunday) by the Israeli Association of Allergy and Clinical Immunology - warning that temporary feeding with cow's milk-based infant formula (IMF) in the first few days of life may increase the risk of developing a milk allergy.
The position paper is based on several medical studies published in recent years, and the recommendations of the European Academy of Allergy and Clinical Immunology (EAACI). the paper is directed at medical teams in neonatal units, new mothers, expectant parents, the medical community, and the general public, focusing on the feeding of newborns in the first days after birth.
Cow's milk protein allergy (CMPA) is one of the most common food allergies in infancy. Over the past few decades, the incidence of food allergies in general, and CMPA specifically, has increased. The data is clear: the prevalence of CMPA among young children in Israel at the beginning of the 2000s was between 0.3% to 0.5%, but it is now estimated to be between 0.85% and 1% - more than a twofold increase, in just two decades.
While CMPA often resolves in early childhood (in 60%-70% of cases), its health implications are significant, even in cases that resolve early, and especially for those who remain allergic into adolescence and adulthood. CMPA can lead to nutritional deficiencies during growth and development, which may impact height potential in adulthood and reduce bone density. Additionally, CMPA is responsible for the majority of life-threatening allergic reactions in Israel. Given these health implications, the risk of severe allergic reactions, and the impact on quality of life, primary prevention of CMPA is critically important.
The World Health Organization (WHO) recommends that infants be exclusively breastfed from the first hour of life and continue breastfeeding exclusively (without additional foods or fluids, including water) for at least six months. However, a recent study conducted in Israel found that while the majority of new mothers (96%) believed their infants were exclusively breastfed from birth, the majority of infants (55%) actually received additional cow's milk-based formula during this period - while in the hospital.
Furthermore, several studies published in recent years have demonstrated that infants who were fed cow's milk-based formula in the first days of life, even in small amounts, and were then exclusively breastfed, developed milk allergies at a higher rate than infants who were exclusively breastfed from birth or who were consistently fed a combination of breastfeeding and formula.
The 2021 guidelines from the European Academy of Allergy and Clinical Immunology, along with accompanying clarifications, suggest avoiding the temporary addition of cow's milk-based formula in the first week after birth to prevent the development of milk allergies. Recent studies in Israel have confirmed these findings and support the recommendations of the European Academy. The accumulated conclusions indicate that temporary feeding of infants with cow's milk-based formula in the first days of life, even in small amounts, followed by exclusive breastfeeding, may increase the risk of developing a milk allergy.
In light of this, to reduce the risk of infants developing CMPA, the Israeli Association of Allergy and Clinical Immunology recommends:
- Mothers who intend to exclusively breastfeed should avoid giving their infants cow's milk-based formula in the first days of life.
- If the infant received small amounts of cow's milk-based formula in the first days of life, regular supplementation with the formula a few times a week, in parallel with breastfeeding, may reduce the risk of developing a milk allergy.
The position paper is endorsed by members of the Israeli Association of Allergy and Clinical Immunology: Chairman, Prof. Arnon Elitzur (Shamir Medical Center - Assaf Harofeh), former Chairman Prof. Alon Hershko (Hadassah Medical Center), Secretary of the Association Prof. Yuval Tal (Hadassah Medical Center), Prof. Ilan Dalal (Wolfson Medical Center), Prof. Avraham Beigelman (Schneider Children's Medical Center), Dr. Idit Lahover Roth (Meir Medical Center), Dr. Ramit Maoz-Segal (Sheba Medical Center), and Prof. Aharon Kesel (Bnei Zion Medical Center).
