Conclusion : Limited low- quality evidence indicates that probiotic supplementation may be associated with earlier acquisition of tolerance to CMP in children with CMPA .
CMPA is associated with significant socioeconomic burden.• Elimination diet and extensively hydrolyzed formula is the mainstay of the management of CMPA.What is New:• This first systematic review of r and omized controlled trials shows that probiotics as an adjuvant can lead to earlier acquisition of tolerance to CMP  in children at 36 months of age .
However , the evidence is low quality and influenced by data from one large study .• Probiotic supplementation was not associated with earlier resolution of hematochezia
Cow ’s milk protein allergy ( CMPA ) is the commonest food allergy in infancy and is associated with significant health burden .
Given their immune modulatory properties , probiotics have been proposed as a strategy for management of CMPA .
We aim ed to systematic ally review efficacy and safety of probiotics in the management of CMPA .
Large well- design ed trials are essential to confirm these findings .What is Known:• Cow ’s milk protein allergy ( CMPA ) is one of the commonest food allergies in children .
Natural course and risk factors for persistence of IgE-mediated cow's milk allergy.
OBJECTIVE To describe the natural course of IgE-mediated cow 's milk allergy ( IgE-CMA ) and to determine risk factors for its persistence in a population -based cohort . STUDY DESIGN In a prospect i ve cohort study , 54 infants with IgE-CMA were identified from a population of 13 019 children followed from birth . Diagnosis of IgE-CMA was based on history , skin prick test ( SPT ) , and an oral food challenge ( OFC ) when indicated . Allergic infants were followed for 48 - 60 months . Families were contacted by telephone every 6 months and asked about recent exposures to milk . OFC was repeated to evaluate for recovery . Clinical characteristics , SPT , and OFC outcomes were compared between infants with persistent IgE-CMA and infants who recovered . RESULTS Thirty-one infants ( 57.4 % ) recovered from IgE-CMA during the study period . Most infants ( 70.9 % ) recovered within the first 2 years . Risk factors for persistence on multivariate analysis included a reaction to < 10 mL of milk on OFC ( or on first exposure as estimated by the guardian , if OFC was not performed ) ( P = .01 ) , a larger wheal size on SPT ( P = .014 ) , and age of ≤30 days at time of first reaction ( P = .05 ) . CONCLUSIONS Resolution occurs in most infants with IgE-CMA . Infants reacting to < 10 mL of milk or in the first month of life , and those with a larger wheal size on SPT , are at increased risk for persistence
Conclusion : Limited low- quality evidence indicates that probiotic supplementation may be associated with earlier acquisition of tolerance to CMP in children with CMPA .
CMPA is associated with significant socioeconomic burden.• Elimination diet and extensively hydrolyzed formula is the mainstay of the management of CMPA.What is New:• This first systematic review of r and omized controlled trials shows that probiotics as an adjuvant can lead to earlier acquisition of tolerance to CMP  in children at 36 months of age .
However , the evidence is low quality and influenced by data from one large study .• Probiotic supplementation was not associated with earlier resolution of hematochezia
Cow ’s milk protein allergy ( CMPA ) is the commonest food allergy in infancy and is associated with significant health burden .
Given their immune modulatory properties , probiotics have been proposed as a strategy for management of CMPA .
We aim ed to systematic ally review efficacy and safety of probiotics in the management of CMPA .
Large well- design ed trials are essential to confirm these findings .What is Known:• Cow ’s milk protein allergy ( CMPA ) is one of the commonest food allergies in children .