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 .
Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow's milk allergy: 3‐year randomized controlled trial
Background Children with cow 's milk allergy ( CMA ) have an increased risk of other allergic manifestations ( AMs ) . Objective We performed a parallel‐arm r and omized controlled trial to test whether administration of an extensively hydrolyzed casein formula ( EHCF ) containing the probiotic Lactobacillus rhamnosus GG ( LGG ) can reduce the occurrence of other AMs in children with CMA . Methods Children with IgE‐mediated CMA were r and omly allocated to the EHCF or EHCF+LGG groups and followed for 36 months . The main outcome was occurrence of at least 1 AM ( eczema , urticaria , asthma , and rhinoconjunctivitis ) . The secondary outcome was tolerance acquisition , which was defined as the negativization of a double‐blind food challenge results at 12 , 24 , and 36 months . AMs were diagnosed according to st and ardized criteria . Tolerance acquisition was evaluated every 12 months . Results A total of 220 children ( 147 boys [ 67 % ] ) with a median age of 5.0 months ( interquartile range , 3.0‐8.0 months ) were r and omized ; 110 children were placed in the EHCF group , and 110 children were placed in the EHCF+LGG group . In the complete case analysis the absolute risk difference for the occurrence of at least 1 AM over 36 months was −0.23 ( 95 % CI , −0.36 to −0.10 ; P < .001 ) , and the absolute risk difference for the acquisition of cow 's milk tolerance was 0.20 ( 95 % CI , 0.05‐0.35 ; P < .01 ) at 12 months , 0.24 ( 95 % CI , 0.08‐0.41 ; P < .01 ) at 24 months , and 0.27 ( 95 % CI , 0.11‐0.43 ; P < .001 ) at 36 months . In the sensitivity analysis the effect size of the main outcome was virtually unchanged when the occurrence of AMs was assigned to all 27 missing children . Conclusions EHCF+LGG reduces the incidence of other AMs and hastens the development of oral tolerance in children with IgE‐mediated CMA
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 .