Allergy to cow’s milk protein

The prevalence of allergic diseases is increasing year by year. Atopic dermatitis (AD) - the earliest clinical manifestation of atopy. By definition, atopic dermatitis is the allergic skin disease that occurs usually in early childhood in individuals with hereditary predisposition to atopic diseases having a chronic relapsing course, age characteristics of the location and morphology of the foci of inflammation, characterized by pruritus and caused hypersensitivity as to allergens, and to nonspecific irritants. Food and inhalant allergens play an important role in the formation of atopic dermatitis. The protein of cow’s milk is one of the first products to which developing sensitization. This is especially important for children in their first year of life. During this period neonatologists of the maternity hospital and precinct pediatricians are very important to assess the risk of a child’s food allergy and, if necessary, artificial feeding or supplementary feeding to recommend an artificial mixture, taking into account evaluation results. The proper purpose depends largely on whether the risk is realized or not, as well as the effectiveness of treatment in the presence of existing clinical manifestations, because a rational diet is the guiding principle of therapy of atopic dermatitis in infants. Unfortunately, precinct pediatricians do not always assess the situation correctly. The article gives a clinical case, an example of which analyzed the most typical errors made when bottle-fed infants with food allergy to cow’s milk protein.

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The Effectiveness of Probiotic Lactobacillus rhamnosus and Lactobacillus casei Strains in Children with Atopic Dermatitis and Cow’s Milk Protein Allergy: A Multicenter, Randomized, Double Blind, Placebo Controlled Study

Nutrients ◽

10.3390/nu13041169 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1169

Author(s):

Bożena Cukrowska ◽

Aldona Ceregra ◽

Elżbieta Maciorkowska ◽

Barbara Surowska ◽

Maria Agnieszka Zegadło-Mylik ◽

...

Keyword(s):

Atopic Dermatitis ◽

Lactobacillus Casei ◽

Milk Protein ◽

Lactobacillus Rhamnosus ◽

Cow’S Milk ◽

Controlled Study ◽

Symptom Improvement ◽

Cow's Milk ◽

Probiotic Preparation ◽

Cow’S Milk Protein

Probiotics seem to have promising effects in the prevention and treatment of allergic conditions including atopic dermatitis (AD) and food allergy. The purpose of this multicenter randomized placebo-controlled trial was to evaluate the effectiveness of a probiotic preparation comprising Lactobacillus rhamnosus ŁOCK 0900, Lactobacillus rhamnosus ŁOCK 0908, and Lactobacillus casei ŁOCK 0918 in children under 2 years of age with AD and a cow’s milk protein (CMP) allergy. The study enrolled 151 children, who—apart from being treated with a CMP elimination diet—were randomized to receive the probiotic preparation at a daily dose of 109 bacteria or a placebo for three months, with a subsequent nine-month follow-up. The primary outcomes included changes in AD symptom severity assessed with the scoring AD (SCORAD) index and in the proportion of children with symptom improvement (a SCORAD score decreased by at least 30% in comparison with that at baseline). After the three-month intervention, both the probiotic and placebo groups showed a significant (p < 0.0001) decrease in SCORAD scores, which was maintained nine months later. The percentage of children who showed improvement was significantly higher in the probiotic than in the placebo group (odds ratio (OR) 2.56; 95% confidence interval (CI) 1.13–5.8; p = 0.012) after three months. Probiotics induced SCORAD improvement mainly in allergen sensitized patients (OR 6.03; 95% CI 1.85–19.67, p = 0.001), but this positive effect was not observed after nine months. The results showed that the mixture of probiotic ŁOCK strains offers benefits for children with AD and CMP allergy. Further research is necessary to assess the effect of probiotic supplementation on the development of immune tolerance. (ClinicalTrials.gov NCT04738565)

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ASSESSMENT OF CLINICAL-IMMUNOLOGICAL EFFECTIVENESS OF COMPLEX THERAPY OF INFANT ATOPIC DERMATITIS

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja633 ◽

2013 ◽

Vol 10 (5) ◽

pp. 55-60

Author(s):

S N Denisova ◽

T B Sentsova ◽

M Y Belitskaya

Keyword(s):

Atopic Dermatitis ◽

Milk Protein ◽

Protein Hydrolysate ◽

Blood Stream ◽

Diet Therapy ◽

Cow’S Milk ◽

Cow's Milk ◽

Complex Therapy ◽

Specific Igg ◽

Cow’S Milk Protein

The work is aimed at assessment of clinicalimmunological effectiveness of diet therapy based on hypoallergenic formula used for infants with atopic dermatitis. 167 infants with atopic dermatitis associated with cow’s milk protein allergy have been put included under outpatient observation. 52 infants of from the first group were being fed on whole goat milk’s formula, 56 infants of from the the second group — cows’ milk protein hydrolysate and 59 infants of the from the third groupsoy’s isolate formula. The age of infants was 2, 5—9 months. The duration of observation was 3—12 months. Complex therapy has been conducted over the infants and it contained antiallergenic treatment and diet therapy with hypoallergenic baby formula. The majority of patients showed improvement due to applied treatment. The first group’s infants with positive clinical dynamic showed decrease of specific IgG and IgE to cow’s milk protein, casein, β-LH and soy’s protein. The infants of the second and third groups also showed decrease of specific IgG and IgE to cow’s milk protein, casein, β-LH, soy’s protein and goat’s milk at clinical remission. All the infants with positive clinical effect showed trend to decrease of IL12, IL13, sICAM1 and sEselectin’s concentration in the blood stream, that can indicate on leukocyte adherence inhibition and cell migration to the area of inflammation. Based on the results of research, we can conclude that replacement of one product with another one by taking into account their clinicalimmunological effectiveness as the method of treatment the of atopic dermatitis patients let us optimize infant diet therapy.

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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

Current Research in Nutrition and Food Science Journal ◽

10.12944/crnfsj.9.2.02 ◽

2021 ◽

Vol 9 (2) ◽

pp. 375-389

Author(s):

Mashail A Baghlaf ◽

Noura M S Eid

Keyword(s):

Risk Factors ◽

Saudi Arabia ◽

Food Allergy ◽

Clinical Manifestation ◽

Milk Protein ◽

Immunoglobulin E ◽

Cow Milk ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein

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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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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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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