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 .
Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status.
BACKGROUND Large , prospect i ve population -based studies on clinical course , development of tolerance , and risk for other atopy in children with cow 's milk allergy ( CMA ) are lacking . OBJECTIVE We investigated the development of tolerance and the risk for asthma , rhinoconjunctivitis , atopic dermatitis , and sensitization in children with CMA followed to school age . METHODS We followed 118 children with CMA until recovery and repeatedly measured their sensitization to cow 's milk ( CM ) . At age 8.6 years , 94 allergic subjects and 80 control subjects from the same cohort were studied for atopic diseases and sensitization . In addition , the parents of 12 allergic subjects and 26 control children returned a question naire on atopy , respectively . RESULTS IgE-mediated CMA was detected in 86 ( 73 % ) children ; at age 8.6 years , 13 ( 15 % ) had persistent CMA . All children with IgE-negative CMA were tolerant by age 5.0 years ( P < .0001 ) . Risk factors for persistent CMA at age 2.0 years were sensitization to CM at age 1.6 years ( odds ratio , 6.3 ; 95 % CI , 2.6 - 15.2 ) , urticaria at diagnostic challenge ( odds ratio , 3.3 ; 95 % CI , 1.4 - 7.8 ) , CM exposure at the maternity hospital ( odds ratio , 3.2 ; 95 % CI , 1.4 - 7.8 ) , and early sensitization to egg ( odds ratio , 2.8 ; 95 % CI , 1.2 - 6.6 ) . By age 8.6 years , children with IgE-positive CMA more frequently had asthma ( 31 % vs 13 % , P < or = .01 ) , rhinoconjunctivitis ( 66 % vs 21 % , P < or = .001 ) , atopic eczema ( 81 % vs 26 % , P < or = .001 ) , and sensitization to any allergen ( 88 % vs 39 % , P < or = .001 ) than control subjects . CMA and family history of atopy were independent risk factors for atopic diseases , and CMA was also a risk factor for sensitization to inhalant allergens . CONCLUSION IgE-mediated CMA often persists to school age and is a risk factor for other atopy ; non-IgE-mediated CMA , by contrast , is a benign infantile condition
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 .