Active formation of tolerance in case of allergy to cow's milk proteins

Food allergy is a potentially life-threatening condition in which there are no approved pathogenetic treatments other than elimination of the causal allergen and relief of acute allergic conditions. IgE- mediated form of food allergy remains a serious and growing problem worldwide. Its prevalence is steadily increasing, and is a severe psychosocial and economic burden for patients and their families. Cow's milk and products based on it are important components of a child's diet, which are introduced into the diet of children of the first year of life, but can cause allergic reactions. The traditional management of children with cow's milk allergy consists in prescribing an elimination dairy-free diet and a significant part of patients form tolerance to milk proteins by the age of 5 years. However, with persistent forms of allergy to cows milk proteins, the question is raised about the need for "active" tactics of patient management in order to form tolerance. Oral immunotherapy is a promising approach to the treatment of food allergies based on a gradual increase in the allergen taken, by analogy with standardized immunotherapy for respiratory allergens, until a maintenance dose is reached. Each stage of oral immunotherapy should be considered as a personalized therapy. This review contains an analysis of available studies on the effectiveness of oral immunotherapy in the treatment of allergy to cow's milk proteins.

Milk and cow’s meat allergy in a child: A clinical case

Allergy to bovine serum albumin is the main predictor of beef allergy associated with cow’s milk proteins allergy. We report a case of a 3-year-old child with cow’s milk proteins allergy since the age of 6 months who, after some ingestions of beef, developed episodes of irritability, urticaria and syncope. Specific IgE to beef, oral food challenge with medium rare cooked beef and specific IgE to bovine serum albumin were all positive, but an oral food challenge with well cooked beef was tolerated. Allergy to bovine serum albumin is not usually associated with severe reactions, since it is a thermolabile protein, however, the process of cooking meat may be insufficient to have an effect on the complex matrix of meat and associated serum albumins. The irregular pattern of the episodes and the previous diagnosis of cow’s milk proteins allergy may act as confounding factors leading to a delayed diagnosis.

Gastrointestinal forms of allergic diseases, which are accompanied by hemorrhagic colitis syndrome, in young children

The article discusses the problem of the spread of allergic diseases among young children. Infant gastrointestinal disorders, caused by a range of allergens, but most often by exposure to cow’s milk proteins, are one of the most frequent and at the same time most difficult clinical problems for the pediatrician. Particular attention in this article is paid to the so-called non-IgE-mediated forms of allergy to cow’s milk proteins, that is, to such forms of allergy in which the epithelium of the child’s digestive tract is damaged in the absence of any skin and/or respiratory manifestations. Some of these forms of allergy are accompanied by hemorrhagic colitis syndrome, which is an alarming signal, or the so-called “red flag”, for pediatricians and family doctors, and which requires attention, differential diagnosis and competent adequate therapy. An essential (and in some cases the only) component of such therapy is elimination of the allergen from the diet of a child or a nursing mother and/or the use of a breast milk substitute that does not contain a causative allergen. To this end, according to the guidelines of the European Academy of Allergo­logy and Clinical Immunology, it is proposed to use in formula-fed children either extensively hydrolyzed formulas as the first choice formulas, or amino acid formulas, but only with intolerance of extensively hydrolyzed formulas.

ЭФФЕКТИВНОСТЬ ИСПОЛЬЗОВАНИЯ ВИТАМИНА D В ЛЕЧЕНИИ ДЕТЕЙ С АЛЛЕРГИЕЙ К БЕЛКАМ КОРОВЬЕГО МОЛОКА

The article presents the results of a study on the level of vitamin D in children of first year with cow's milk proteins allergy. The aim of the work is to evaluate the effectiveness of using an aqueous solution of vitamin D in addition to a therapeutic elimination diet in children who are allergic to cow's milk proteins. It was found that the 57.1±4.8 % children of first year with cow's milk proteins allergy have vitamin D insufficiency. Normal vitamin D levels were found in only 36.2±4.7 % % patients. In turn, vitamin D deficiency were found in 6,7±2,4 % children. The additional intake of vitamin D on the background of the use of elimination therapeutic dairy-free diet can reduce the time of development of tolerance to cow's milk proteins and achieve tolerance for three years in 92 % of children with allergies to cow's milk proteins were found.

The significance of cow’s milk proteins in the development of IgE-mediated food allergy among children

Identification of offending allergens in patients with food allergy is a very important part of an allergist’s activity. Objective. To study the structure оf sensitization to food allergens among children in Moscow and Moscow region and to determine the significance of sensitization to milk proteins . Methods. The level and class of specific IgE in blood serum of children with IgEmediated allergic diseases were examined with RIDA AllergyScreen method. Serum of children with high level of specific IgE to milk allergenic proteins was studied. The level and ratio of specific IgE to individual milk allergens were revealed. Results. The structure of sensitization to food allergens was determined. It was revealed that cow’s milk allergens are the leading triggers of food allergy, especially in early childhood in Moscow and the Moscow region. The features of sensitization to cow’s milk proteins among children were analyzed. Conclusions. According to the study, about half of children with IgEmediated food allergies in Moscow and the Moscow region have sensitization to cow’s milk proteins. The leading role in the frequency of sensitization belongs to whey proteins of milk. Among them sensitization to а-lactalbumin was detected more often. The questions about the selection of hypoallergenic milk formulas for feeding of children with allergy to cow’s milk proteins were discussed.