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 .
Lack of Effect of Lactobacillus GG in Breast-fed Infants With Rectal Bleeding: A Pilot Double-blind Randomized Controlled Trial
Objectives : For breast-fed infants with rectal bleeding , maternal restriction of dietary protein such as cow 's milk proteins is often recommended ; however , poor response to dietary protein restriction is of concern . This pilot study was design ed to assess the effectiveness of Lactobacillus GG ( LGG ) in breast-fed infants with rectal bleeding . Patients and Methods : Breast-fed infants < 6 months of age with rectal bleeding ( defined as the presence of visible specks or streaks of blood mixed with mucus in the stool in otherwise healthy infants ) were enrolled in a double-blind r and omized controlled trial in which they received LGG 3 × 109 colony-forming units ( n = 14 ) or placebo ( n = 15 ) twice daily for 4 weeks as an adjunct to cow 's milk restriction in the mother 's diet . Analyses were based on allocated treatment and included data from 26 infants . Results : Mean duration of rectal bleeding was similar in the LGG and control groups ( 17.3 ± 10.6 vs 15.4 ± 11 days ; mean difference −1.9 ( 95 % confidence interval [ CI ] −4 to 7 ) . No difference was found in the number of infants with clinical resolution of rectal bleeding within 72 hours and no relapse afterward ( 2/11 vs 3/15 , relative risk [ RR ] 0.9 , 95 % CI 0.2–3.9 ) and the number of infants with clinical resolution of rectal bleeding within 72 hours followed by relapse of symptoms ( 5/11 vs 5/15 , RR 1.4 , 95 % CI 0.5–3.5 ) . Breast-feeding cessation was not needed in any infant . Conclusions : These results do not support the use of LGG as an adjunct to maternal cow 's milk restriction in breast-fed infants with rectal bleeding
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 .