Volume: 4, 2025
4th International PhD Student’s Conference at the University of Life Sciences in Lublin, Poland:
ENVIRONMENT – PLANT – ANIMAL – PRODUCT
Abstract number: H009
DOI: https://doi.org/10.24326/ICDSUPL4.H009
Published online: 9 April 2025
ICDSUPL, 4, H009 (2025)
From allergy to tolerance: immunological mechanisms and therapeutic approaches in cow’s milk allergy treatment
Karol Ludwinek1*, Kacper Bluczak1, Wiktoria Kudła1, Monika Cendrowska-Pinkosz2
1 Student Scientific Association of Anatomy at the Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Chodźki 4, 20-093 Lublin, Poland
2 Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Chodźki 4, 20-093 Lublin, Poland
* Corresponding author: karolludwinek19@gmail.com
Abstract
Cow’s milk allergy (CMA) is a common pediatric food allergy, occurring in IgE-mediated and non-IgE-mediated forms. IgE-mediated CMA involves Th2-driven production of IL-4 and IL-13, which stimulate B cells to generate IgE. This IgE binds to FcεRI receptors on mast cells, leading to histamine release and allergic reactions. Non-IgE-mediated CMA is characterized by Th17 and CD8⁺ responses, causing enterocyte damage via IL-17 and TNF-α. Tolerance acquisition depends on regulatory immune cells. Treg cells (CD4⁺CD25⁺) secrete IL-10, essential for immune tolerance, particularly in children who outgrow CMA. Regulatory innate lymphoid cells (ILCregs) produce IL-10 and TGF-β, modulating gut immunity. Although regulatory B cells (Bregs) remain under study, their involvement in tolerance development is promising. Gut microbiota influence immune responses to cows milk proteins. Commensal bacteria, including Clostridium spp. and Faecalibacterium prausnitzii, promote Treg differentiation by generating short-chain fatty acids (SCFA) like butyrate, which enhances Foxp3 and IL-10 expression. Bifidobacterium species support tolerance by stimulating TGF- β and reducing inflammation. Dysbiosis, marked by increased Enterobacteriaceae and reduced Bacteroides, weakens gut barrier integrity and exacerbates allergic sensitization. Selected articles include “review” and “systematic review” from the years 2015–2025, retrieved using the keywords: cow milk allergy, regulatory T cells, milk substitute, microbiota. Therapeutic strategies focus on tolerance induction. Hydrolyzed milk formulas remain the primary dietary intervention. Gradual exposure approaches, such as the milk ladder, introduce baked milk in controlled amounts to accelerate tolerance. Emerging evidence suggests raw cows milk may offer protective benefits, though its safety requires further study. Probiotics and prebiotics, particularly when combined with hydrolyzed formulas, show promise in immune modulation. Advancing CMA research is critical for developing novel immunomodulatory treatments. Pediatricians and allergologists play key roles in guiding effective therapies while ensuring patient safety. Understanding the mechanisms of tolerance acquisition can improve CMA management and support better long-term outcomes.
Keywords: cow milk allergy, regulatory T cells, allergologist, milk substitute, microbiota
How to cite
K. Ludwinek, K. Bluczak, W. Kudła, M. Cendrowska-Pinkosz, 2025. From allergy to tolerance: immunological mechanisms and therapeutic approaches in cow’s milk allergy treatment. In: 4th International PhD Student’s Conference at the University of Life Sciences in Lublin, Poland: Environment – Plant – Animal – Product. https://doi.org/10.24326/ICDSUPL4.H009