Prevalence, Risk Factors, Clinical Manifestation, Diagnosis Aspects and Nutrition Therapy in Relation to both IgE and IgG Cow’s Milk Protein Allergies among a Population of Saudi Arabia: A Literature Review

Cow milk protein allergy (CMPA) becoming a major public health issue that has attracted the attention of health professionals and researchers. This paper aimed to review the important aspects of both IgE and IgG types of cow’s milk protein allergy in terms of prevalence, clinical manifestation, risk factors, other health-related issues and nutritional therapy proposed for such allergies in the adult and pediatric population in Saudi Arabia. A search on “cow’s milk allergy” was done using PubMed, Google Scholar and Scopus Engine for published papers between 1993 and 2020 to find studies yielding knowledge on that context. The prevalence of cow’s milk protein allergy (CMPA) among infants is now in the range of 2–3%. This type of allergy is also detected in adulthood but less frequently. CMPA is defined as an immunological reaction to specific proteins in milk. CMPA is classified based on its type as an immunoglobulin E (IgE)-mediated form and an immunoglobulin G (IgG)-mediated form, each type representing different immunological pathways. The presence of Genetic aspects, family history and short duration of breastfeeding in the infant are among the risk factors contributing to this form of allergy. Its manifestations mainly present as skin presentation, followed by the gastrointestinal and respiratory presentation in most cases in addition to a life-threatening anaphylactic reaction that may occur in 12% of cases. food allergy committees have developed strict diagnosis criteria, including blood testing for food-specific immunoglobulin E (sIgE), a skin prick test and double-blind placebo-controlled food challenges (DBPCFC) as the gold standard. A diet free of cow’s milk protein (CMP) allergen and including the appropriate alternative milk formula is the first line of prevention recommended by many organizations and food allergy experts. As for Saudi Arabia, more research and clinical trials are required to discuss the various aspects of adult and pediatric CMPA and to provide a better understanding along with good control strategies implementation.

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Assessment of IgE-Mediated and Non-IgE-Mediated Cow’s Milk Protein Allergy in Children

ARS Medica Tomitana ◽

10.2478/arsm-2019-0026 ◽

2019 ◽

Vol 25 (3) ◽

pp. 129-131

Author(s):

Balasa Adriana ◽

Mihai Cristina ◽

Pruna Irina ◽

Chisnoiu Tatiana ◽

Daineanu Diana ◽

...

Keyword(s):

Primary Care Physicians ◽

Milk Protein ◽

Immunoglobulin E ◽

Clinical Manifestations ◽

Specific Ige ◽

Cow Milk ◽

Cow’S Milk ◽

Cow's Milk ◽

Ige Mediated ◽

Cow’S Milk Protein

Abstract Cow’s milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth. In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta. The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow’s Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed. We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), the remaining (17,5%) being represented by exclusively breastfed infants. The most frequent clinical manifestations were rashes (87,5%), failure to thrive (82,5%), regurgitation (50%) and diarrhea (35%). Further data should be collected to prove if the association between a CoMiSS score higher than 12 and specific IgE-mediated CMPA is clinically relevant, and can predict, based on clinical examination and anamnesis, high serum levels of specific immunoglobulin E. The prognosis can depend on the titre of specific IgE at the time of diagnosis, as they are more likely to develop several crossed allergies and less prone to become tolerant to cow milk proteins than those with non-IgE-mediated CMPA.

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Differential Cytokine Expression in the Duodenum and Rectum of Children with Non-Immunoglobulin E-Mediated Cow’s Milk Protein Allergy

Digestive Diseases and Sciences ◽

10.1007/s10620-020-06743-z ◽

2021 ◽

Author(s):

Erick M. Toro-Monjaraz ◽

Gabriela Fonseca-Camarillo ◽

Flora Zárate-Mondragón ◽

Ericka Montijo-Barrios ◽

José Cadena-León ◽

...

Keyword(s):

Milk Protein ◽

Immunoglobulin E ◽

Cytokine Expression ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein

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Immunological biomarkers changes during diet therapy in children with food allergy

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja510 ◽

2015 ◽

Vol 12 (1) ◽

pp. 73-78

Author(s):

I V Vorozhko ◽

T B Sentsova ◽

V A Revyakina ◽

O O Chernyak ◽

S N Denisova

Keyword(s):

Food Allergy ◽

Milk Protein ◽

Goat Milk ◽

Specific Ige ◽

Diet Therapy ◽

Cow’S Milk ◽

Igg Antibodies ◽

Cow's Milk ◽

Cow’S Milk Protein ◽

Different Sources

Immunological estimating of different diet therapy types became currently very important. The aim of this work was to study the changes of immunological biomarkers during usage of formulas based on different sources of protein in children with food allergy and to assess and predict the effectiveness of diet therapy. The study included 66 children with food allergy in age from 1,5 months to 1,5 years. Observed children were divided into three groups depending on the type of formulas used. The dynamics of immunoregulatory substances (IL-5, TGF β 1, IL-10, IL-4, IL-2, IL-13, Eotaxin3), and allergenspecific IgE and IgG antibodies to cow’s milk protein, α-lactoglobulin, β-laktoglobulin, casein, soy and goat’s milk during diet therapy were evaluated. Observation duration was 28-30 days. The differences in the dynamics of the investigated parameters depending on the type of formula were revealed. Thus, the use of formula based on cow’s milk hydrolysates revealed their primarily effect on cytokines IL-2, IL-5 and growth factor TGF β ; the use of formula based on soy protein revealed combined effect on humoral immunity (allergen specific IgE and IgG antibodies) and IL-5; the use of formula based on goat milk characterized decreased levels of allergenspecific IgG antibodies to the cow’s milk protein and its fractions, reduced allergen specific IgE antibody concentrations to cow’s milk protein and α-lactoglobulin, decreased levels of IL-5, and, exclusive for this formula - reduction of IL-4 level. Accordingly, the assessment of immunological biomarkers can be used to personalize diet therapy in children with food allergy.

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Screening for Cow Milk Allergy Among Young Egyptian Children

QJM ◽

10.1093/qjmed/hcab113.004 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Zeinab A El-Sayed ◽

Rasha H El-Owaidy ◽

Hanan M Abd El-Lateef ◽

Ahmed SA Hammouda

Keyword(s):

Milk Protein ◽

Clinical History ◽

Cow Milk ◽

Cow’S Milk ◽

Published Data ◽

Cow's Milk ◽

Oral Challenge Test ◽

Egyptian Children ◽

Ige Mediated ◽

Cow’S Milk Protein

Abstract Background There are insufficient published data on the prevalence of cow's milk protein allergy (CMPA) in Egypt. Aim of the Work The study aims to estimate the frequency of CMPA among young Egyptian children in a trial to delineate the magnitude of the problem in our population. Methods A cross-sectional, observational study was conducted on 500 young Egyptian children from the general population aged from 6 months to 5 years; 200 males and 300 females. Children were subjected to history taking and clinical examination. Suspected cases with suggestive clinical history of CMPA were subjected to skin prick test (SPT) with standardized cow’s milk protein allergen extract and open oral challenge test (OCT). Results In the present study, 6.2% of screened children had positive clinical history suggestive of CMPA, 35.5% of them had positive SPT and 51.6% had positive OCT. Based on clinical history and OCT, 3.2% were documented to have CMPA, 3% had undocumented CMPA or low probability of CMPA and 93.8% had no CMPA. The highest rate of initial onset of CMPA is seen before the first year of life (96.8%) and 81.3% of children with positive OCT were formula/mixed-fed. The clinical manifestations in infants with suspected CMPA were variable, and the main presenting feature was gastrointestinal tract manifestations (42%). The IgE-mediated CMPA was more common and constituted 56.3% of the CMPA cases. Conclusion The frequency of CMPA among Egyptian children up to 5 years of age is comparable to the reported frequencies worldwide. IgE-mediated CMPA accounts for more than 2/3 of the patients with proven CMPA in this study.

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Microbiota and Derived Parameters in Fecal Samples of Infants with Non-IgE Cow’s Milk Protein Allergy under a Restricted Diet

Nutrients ◽

10.3390/nu10101481 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1481 ◽

Cited By ~ 15

Author(s):

María Díaz ◽

Lucía Guadamuro ◽

Irene Espinosa-Martos ◽

Leonardo Mancabelli ◽

Santiago Jiménez ◽

...

Keyword(s):

Food Allergy ◽

Milk Protein ◽

Transforming Growth Factor ◽

Cow’S Milk ◽

Control Group ◽

Microbiota Composition ◽

Fecal Samples ◽

Cow's Milk ◽

Healthy Infants ◽

Cow’S Milk Protein

Cow’s milk protein allergy (CMPA) is the most common food allergy in infancy. Non-IgE mediated (NIM) forms are little studied and the responsible mechanisms of tolerance acquisition remain obscure. Our aim was to study the intestinal microbiota and related parameters in the fecal samples of infants with NIM-CMPA, to establish potential links between type of formula substitutes, microbiota, and desensitization. Seventeen infants between one and two years old, diagnosed with NIM-CMPA, were recruited. They were all on an exclusion diet for six months, consuming different therapeutic protein hydrolysates. After this period, stool samples were obtained and tolerance development was evaluated by oral challenges. A control group of 10 age-matched healthy infants on an unrestricted diet were included in the study. Microbiota composition, short-chain fatty acids, calprotectin, and transforming growth factor (TGF)-β1 levels were determined in fecal samples from both groups. Infants with NIM-CMPA that consumed vegetable protein-based formulas presented microbiota colonization patterns different from those fed with an extensively hydrolyzed formula. Differences in microbiota composition and fecal parameters between NIM-CMPA and healthy infants were observed. Non-allergic infants showed a significantly higher proportion of Bacteroides compared to infants with NIM-CMPA. The type of protein hydrolysate was found to determine gut microbiota colonization and influence food allergy resolution in NIM-CMPA cases.

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Formula Alternatives for Nutrition Therapy of Children with Cow’s Milk Protein Allergy

Вопросы современной педиатрии ◽

10.15690/vsp.v20i3/2272 ◽

2021 ◽

Author(s):

Gennadiy A. Novik ◽

Maria V. Zhdanova ◽

Yulia O. Zaitseva ◽

Anastasiia S. Demidova

Keyword(s):

Milk Protein ◽

Clinical Manifestations ◽

Nutrition Therapy ◽

Cow Milk ◽

Cow’S Milk ◽

Double Blind ◽

Cow's Milk ◽

Formula One ◽

Cow’S Milk Protein ◽

Hydrolyzed Formula

Well-recognized tactic for the management of formula-fed children with cow’s milk protein allergy (CMPA) is exclusion of whole cow milk protein and its replacement with extensively hydrolyzed or amino acid formula. One of the most topical issue is the choice of therapeutic formula for a child with CMPA. This article presents information about the clinical manifestations of CMPA and describes the principles of nutrition therapy. All the stages of preparation of adapted therapeutic formula are discussed in detail. It has been shown that the choice of therapeutic formula for a child with CMPA depends on the disease clinical manifestations, their severity, and the presence of comorbid conditions. Current requirements for extensively hydrolyzed formula are reduced to limitations in the size of peptides with immunoreactive properties and indicate the need for evidence of the clinical efficacy of such formula in double-blind placebo-controlled studies.

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