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Investigating the impact of cow’s milk allergy interventions on infants’ gut microbiomes

  • Publications
  • Children special needs

Given that cow’s milk allergy (CMA) is one of the most prevalent allergies in early childhood, it is vital that we develop a deeper scientific understanding of the effects of dietary interventions on the gut microbiome – so that we can support infants with CMA and help them (and their gut flora) to thrive.

Therefore, we set up a study that examined the impact of giving synbiotic supplements to infants with CMA. Synbiotics are mixtures of probiotics and prebiotics designed to support digestion, containing both ‘good’ bacteria and fibers to help those bacteria grow. The research, which was partly funded by Danone Research & Innovation via the EARLYFIT project, revealed that six months of synbiotic supplementation did successfully – and significantly – alter the infants’ fecal metabolome (the complete set of small-molecule chemicals within the infants’ poo).

Finding answers in feces

CMA affects approximately 0.5–3% of children in developed countries. 1 This study focused on infants with immunoglobin E (IgE)-mediated CMA, the most common form of food allergy. The study’s authors analyzed a subset of stool samples collected during PRESTO – a multicenter, randomized, double-blind, controlled clinical study – as part of EARLYFIT, a collaborative project between NWO Domain Applied Engineering Sciences and Danone to identify molecular markers that underlie the interaction between nutrition, the intestinal microbiome, and immune fitness in early life.​ In the clinical trial, CMA-allergic infants all received amino acid-based formula, but some also received synbiotic supplementation containing inulin, oligofructose, and Bifidobacterium breve M-16V. Their feces were sampled at the start of the trial, and then after six and 12 months.

Digesting the results

The analysis revealed that synbiotic intake altered the infants’ levels of purine, bile acid, and unsaturated fatty acids. There were also indications of successful colonization by ‘good’ bacteria: while children with IgE-mediated CMA may have less bifidobacteria than their healthy counterparts,3 these results suggest induced bifidobacteria activity among those taking synbiotic supplements. At the six-month mark, the study revealed increased metabolites produced by infant-type Bifidobacterium species enhanced by the synbiotic formula: indolelactic acid and 4-hydroxyphenyllactic acid. The increase subsequently declined after 12 months of intervention, but this is a significant finding. Bifidobacteria and its metabolites play a pivotal role in gut microbiome development in early life.

The study also looked at the impact of cow’s milk tolerance acquisition – i.e., when infants outgrow their allergy – on the fecal metabolome. The results were inconclusive, but the analysis did suggest that amino acids, bile acids, and branched short-chain fatty acids were more present in infants who outgrew CMA, compared to those with more persistent CMA​.