Milk and soy allergy

A Review of the Literature on Cow Milk Protein Allergy Management

Cow milk allergy (CMA) is an immune-mediated condition affecting infants and young children, leading to a range of gastrointestinal, respiratory, and skin-related symptoms. This review explores the epidemiology, etiology and pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of CMA. CMA's prevalence varies geographically and is influenced by genetic and environmental factors. In this article, we review how to accurately diagnose CMA to avoid unnecessary dietary restrictions, as well as provide an overview of treatment options that highlight the importance of tailored dietary management and the potential for developing tolerance in affected children. [Pediatr Ann. 2025;54(5):e179-e181.].

Assessment of transglutaminase catalyzed cross-linking on the potential allergenicity and conformation of heterologous protein polymers

Transglutaminase (TGase)-mediated cross-linking has gained significant attention due to its potential to reduce the allergenicity of food proteins. This study investigates the effects of TGase cross-linking on allergenicity and conformational modifications in a dual-protein system comprising soy protein isolate (SPI) and β-lactoglobulin (β-LG). The results showed that TGase cross-linking effectively decreased the allergenic potential of both SPI and β-LG, with a more pronounced reduction observed in the allergenicity of soy protein in the dual-protein system. SDS-PAGE analysis revealed that the 7S and 11S subunits of soy protein were more easily cross-linked than β-LG. Secondary structure analysis indicated that TGase treatment disrupted β-sheet structures, increased the content of random coils, and enhanced protein flexibility. Ultraviolet absorption and intrinsic fluorescence analyses confirmed these structural alterations, with TGase treatment exposing additional aromatic amino acids. A reduction in free sulfhydryl groups and altered intermolecular forces further corroborated the occurrence of cross-linking. These findings suggest that TGase-mediated cross-linking effectively reduced the allergenicity of SPI and β-LG by modifying their conformations, offering potential strategies for the development of hypoallergenic dual-protein food products. PRACTICAL APPLICATION: This study has practical applications in the food industry to develop hypoallergenic food products, particularly those that combine soy and dairy proteins. By using TGase to cross-link these proteins, the allergenicity can be reduced, resulting in products that are safer for consumers with food allergies.

Retrospective Cohort Study Demonstrates Tolerance and Adherence to Pea-Based Complete Enteral Formula When Transitioned from a Previous Hypoallergenic Product

BACKGROUND

Plant-based formulas have become increasingly popular due to their health benefits, environmental concerns, cultural beliefs, improved palatability, and decreased cost. A retrospective chart review of medically stable children transitioning from a hypoallergenic formula to a yellow pea protein plant-based formula (PPPBF) was included. This study aimed to assess gastrointestinal tolerance, weight changes, and adherence to receiving a unique PPPBF.

METHODS

Healthcare providers (HCPs) from pediatric clinics across the United States who requested increased PPPBF samples between the dates of 1 November 2021and 31 January 2022 and again from 1 February 2022 to 15 April 2022 inputted survey data. The HCPs selected participants based on the inclusion criteria.

RESULTS

Seventy-three completed patient surveys were included of children (ages 1-18 years old, 41% females, 59% males). After the transition to PPPBF, 38.4% experienced improvement in GI tolerance, 56.2% experienced no change, and 5.5% reported worsening GI tolerance. There was a 95% adherence rate, and 98.9% reported no adverse reactions or allergic manifestations after formula transition.

CONCLUSIONS

Transitioning from a hypoallergenic formula to a PPPBF showed a trend toward stable GI tolerance, weight gain or stability, and adherence. A PPPBF offers a first-choice option for children who are on hypoallergenic formulas due to intolerance.

Dairy milk: There are alternatives but no equivalents

Dairy milk is a core food in many food-based guides to healthy eating. However, plant-based milk alternatives are becoming increasingly available as substitutes. While these products serve a subset of the population unable or unwilling to consume milk, plant-based milk alternatives can be perceived by consumers as direct equivalents, or even more healthful alternatives to dairy milk. This commentary addresses the significant differences in nutrient content that may have implications for the intake of key nutrients in the case of direct substitutions. Furthermore, while there is a significant body of knowledge demonstrating the significant health benefits associated with dairy milk consumption and a small number of potentially negative associations, there is a paucity of data on the health benefits of plant-based milk alternatives directly. A "health halo" may exist based on matching individual nutrients through fortification, lower energy levels, and the health properties of the unprocessed raw characterizing ingredients of plant-based milk alternatives. This may mislead consumers regarding healthfulness. Similarly, environmental attributes based on volumes of production, without considering contribution to nutrients, may also skew consumer perception. Positioning of plant-based milk alternatives in food-based dietary guidelines, marketing, and personal recommendations should acknowledge the differences in nutritional, bioactive, and health properties between plant-based milk alternatives and dairy milk to ensure appropriate adaptations are made to account for shortfalls in nutrients.

Differential effects of heating modes on the immunogenic potential of soy-derived peptides released after in vitro infant digestion

During production of soy-based infant formula, soy protein undergoes heating processes. This study investigated the differential impact of heating modes on the immunogenic potential of peptides in soy protein digests. Wet or dry heating was applied, followed by in vitro gastrointestinal infant digestion. The released peptides were analyzed by LC-MS/MS. Bioinformatics tools were utilized to predict and identify potential linear B-cell and T-cell epitopes, as well as to explore cross-reactivity with other legumes. Subsequently, the peptide intensities of the same potential epitope across different experimental conditions were compared. As a result, we confirmed the previously observed enhancing effect of wet heating on infant digestion and inhibitory effect of dry heating. A total of 8,546 peptides were detected in the digests, and 6,684 peptides were with a score over 80. Among them, 29 potential T-cell epitopes and 27 potential B-cell epitopes were predicted. Cross-reactivity between soy and other legumes, including peanut, pea, chickpea, lentil, kidney bean, and lupine, was also detected. Overall, heating and digestion time could modulate the potential to trigger peptide-induced immune responses.

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update - XII - Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA

Background

Cow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit.

Objective

These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA.

Methods

WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders.

Results

After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as "conditional" following the GRADE approach due to the very low certainty about the health effects based on the available evidence.

Conclusions

If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers' values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.

The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults

PURPOSE OF REVIEW

This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades.

RECENT FINDINGS

The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.

Local Sources of Protein in Low- and Middle-Income Countries: How to Improve the Protein Quality?

Protein inadequacy is a major contributor to nutritional deficiencies and adverse health outcomes of populations in low- and middle-income countries (LMICs). People in LMICs often consume a diet predominantly based on staple crops, such as cereals or starches, and derive most of their daily protein intakes from these sources. However, plant-based sources of protein often contain low levels of indispensable amino acids (IAAs). Inadequate intake of IAA in comparison with daily requirements is a limiting factor that results in protein deficiency, consequently in the long-term stunting and wasting. In addition, plant-based sources contain factors such as antinutrients that can diminish protein digestion and absorption. This review describes factors that affect protein quality, reviews dietary patterns of populations in LMICs and discusses traditional and novel small- and large-scale techniques that can improve the quality of plant protein sources for enhanced protein bioavailability and digestibility as an approach to tackle malnutrition in LMICs. The more accessible small-scale food-processing techniques that can be implemented at home in LMICs include soaking, cooking, and germination, whereas many large-scale techniques must be implemented on an industrial level such as autoclaving and extrusion. Limitations and considerations to implement those techniques locally in LMICs are discussed. For instance, at-home processing techniques can cause loss of nutrients and contamination, whereas limitations with larger scale techniques include high energy requirements, costs, and safety considerations. This review suggests that combining these small- and large-scale approaches could improve the quality of local sources of proteins, and thereby address adverse health outcomes, particularly in vulnerable population groups such as children, adolescents, elderly, and pregnant and lactating women.

Effect of lactic acid bacteria fermentation on cow milk allergenicity and antigenicity: A review

Cow milk is a major allergenic food. The potential prevention and treatment effects of lactic acid bacteria (LAB)-fermented dairy products on allergic symptoms have garnered considerable attention. Cow milk allergy (CMA) is mainly attributed to extracellular and/or cell envelope proteolytic enzymes with hydrolysis specificity. Numerous studies have demonstrated that LAB prevents the risk of allergies by modulating the development and regulation of the host immune system. Specifically, LAB and its effectors can enhance intestinal barrier function and affect immune cells by interfering with humoral and cellular immunity. Fermentation hydrolysis of allergenic epitopes is considered the main mechanism of reducing CMA. This article reviews the linear epitopes of allergens in cow milk and the effect of LAB on these allergens and provides insight into the means of predicting allergenic epitopes by conventional laboratory analysis methods combined with molecular simulation. Although LAB can reduce CMA in several ways, the mechanism of action remains partially clarified. Therefore, this review additionally attempts to summarize the main mechanism of LAB fermentation to provide guidance for establishing an effective preventive and treatment method for CMA and serve as a reference for the screening, research, and application of LAB-based intervention.

Infant formulae - Key components, nutritional value, and new perspectives

Breastfeeding is the most effective strategy for meeting the nutritional demands of infants, whilst infant formulae are manufactured foods that mimic human milk and can be safely used to replace breastfeeding. In this paper, the compositional differences between human milk and other mammalian milk are reviewed, and thus nutritional profiles and compositions of standard bovine milk-based formulae as well as special formulae are discussed. Differences between breast milk and other mammalian milk in composition and content affect their digestion and absorption in infants. Characteristics and mimicking of breast milk have been intensively studied with the objective of narrowing the gap between human milk and infant formulae. The functions of the key nutritional components in infant formulae are examined. This review detailed recent developments in the formulation of different types of special infant formulae and efforts for their humanization, and summarized safety and quality control of infant formulae.

Early Introduction of Novel and Less-Studied Food Allergens in the Plant-Based Era: Considerations for US and EU Infant Formula Regulations

Early life feeding practices may affect the long-term health of individuals, particularly in terms of the development of non-communicable diseases, such as metabolic and allergic diseases. Accumulating evidence suggests that the interplay of breastfeeding and/or formula feeding followed by the introduction of solids plays a role in the occurrence of non-communicable diseases both in the short and long term. International food allergy guidelines recommend that breastfeeding women do not need to avoid food allergens and do not recommend any infant formula for allergy prevention. Guidelines regarding solid food introduction for food allergy prevention recommend the introduction of well-cooked eggs and peanuts around 4-6 months of age, and not to delay the introduction of other food allergens. There is also an increasing trend to feed infants a plant-based or plant-forward diet and have access to infant formulas based on plant-based ingredients. The use of novel plant-based infant formulas raises a few questions reviewed in this paper: (1) Do fortified, plant-based infant formulas, compliant with US Food and Drug Administration (FDA) regulations and European Food Safety Authority (EFSA) (European) guidelines, support adequate infant growth? (2) Are plant-based infant formulas suitable for the management of cow's milk allergy? (3) Does feeding with novel, plant-based infant formulas increase the risk of food allergies to the food allergens they contain? (4) Does feeding infants plant-based food allergens in early life increase the risk of allergic and severe allergic reactions? The review of the literature indicated that (1) plant-based formulas supplemented with amino acids and micronutrients to comply with FDA regulations and EFSA guidelines, evaluated in sufficiently powered growth studies, can support adequate growth in infants; (2) currently available plant-based infant formulas are suitable for the management of CMA; (3) an early introduction and continuous intake of food allergens are more likely to prevent food allergies than to increase their risk; and (4) an early introduction of food allergens in young infants is safe.

Food allergens in oral care products

Food allergies are a growing concern, especially in Western societies and can dramatically impact the quality of life of affected individuals. In recent years, various food allergens have been introduced into the oral care industry to improve product properties and provide the best possible treatment. Since small doses of food allergens may be sufficient to trigger allergic reactions, the non-discrimination of the sources of certain excipients in the product composition can compromise the patient's health. Therefore, knowledge and awareness of allergies and product composition among health professionals are critical on behalf of patients' and consumers' health. This study aimed to ascertain the presence of dairy products (e.g., cow's milk proteins and lactose), cereals (e.g., gluten, soy, and oats), fruits, nuts, spices, shellfish, and additives as excipients in oral care products for outpatients and products for professional use in the Dental Office. Among the 387 surveyed products, the highest prevalence of food allergens was found in toothpaste, fluoride varnishes, and alginates, mostly in spices and fresh fruits. As food allergies may occur because of erroneous information or a lack of labeling on the allergen list, manufacturers should be more rigorous in declaring allergens on product labeling regarding the safety of consumers.

ELISA Based Immunoreactivity Reduction of Soy Allergens through Thermal Processing

Allergens are proteins and are, therefore, likely to be denatured when subjected to thermal treatment. Traditional cooking has so far been able to reduce allergen sensitivity by around 70–90%. This study was aimed at evaluating the effect of a broad range of thermal treatments on the reduction of soy immunoreactivity (IR) in a 5% slurry using a sandwich ELISA technique. Cooking at 100 °C (10–60 min) and different thermal processing conditions, such as in commercial sterilization (with a process lethality (Fo) between 3 and 5 min) and selected severe thermal processing conditions (Fo > 5 and up to 23 min) were used in the study to evaluate their influence on allergen IR. Based on an IR comparison with an internal soy allergen standard, the allergen concentration in the untreated soy sample was calculated to be equivalent to 333 mg/kg (ppm). Cooking conditions only reduced the IR sensitivity to about 10 mg/kg (~1.5 log reductions), while the thermal processing treatments lowered the allergen IR up to 23 × 10−3 mg/kg (or 23 ppb) (>4 log reductions). FTIR analysis indicated significant changes in protein structure resulting from the thermal processing treatments, with a higher degree of allergen reduction corresponding with a higher value of random coil percentages. The influence of process severity on color and rheological properties was, however, minimal.

Underlying Immune Mechanisms Involved in Cow’s Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis

Of the many symptoms associated with cow’s milk allergy (CMA), many populations face the burden of the appearance or worsening of atopic dermatitis (AD) when consuming milk products. Due to the prevalence and possible severity of symptoms, it is important to understand the underlying immune mechanisms involved in such reactions. Hypersensitivity reactions are exaggerated immune responses to often benign antigens, many times resulting in a cascade of pro-inflammatory processes. Of the four major types, type I and IV are of most relevance when considering atopic dermatitis worsened by cow’s milk. Considered a “true allergy,” type I (immediate) hypersensitivity reactions occur within hours after secondary exposure to an allergen and are primarily driven by antibodies and humoral immune responses. On the contrary, type IV (delayed) hypersensitivity reactions are driven by cell-mediated responses involving T-cell activation. Due to the array of symptoms induced by these complex reactions, it is imperative to diagnose early and treat appropriately. In this literature review, we aim to highlight the primary underlying immune contributors to hypersensitivity reactions, discuss AD as a manifestation of hypersensitivity reactions to cow’s milk, and consider current and future treatment options for combatting hypersensitivities manifesting as AD.

Alternatives to Cow’s Milk-Based Infant Formulas in the Prevention and Management of Cow’s Milk Allergy

Cow’s milk-based infant formulas are the most common substitute to mother’s milk in infancy when breastfeeding is impossible or insufficient, as cow’s milk is a globally available source of mammalian proteins with high nutritional value. However, cow’s milk allergy (CMA) is the most prevalent type of food allergy among infants, affecting up to 3.8% of small children. Hypoallergenic infant formulas based on hydrolysed cow’s milk proteins are commercially available for the management of CMA. Yet, there is a growing demand for more options for infant feeding, both in general but especially for the prevention and management of CMA. Milk from other mammalian sources than the cow, such as goat, sheep, camel, donkey, and horse, has received some attention in the last decade due to the different protein composition profile and protein amino acid sequences, resulting in a potentially low cross-reactivity with cow’s milk proteins. Recently, proteins from plant sources, such as potato, lentil, chickpeas, quinoa, in addition to soy and rice, have gained increased interest due to their climate friendly and vegan status as well as potential lower allergenicity. In this review, we provide an overview of current and potential future infant formulas and their relevance in CMA prevention and management.

Role of selenium in IgE mediated soybean allergy development

Food allergy is a pathological immune reaction triggered by normal innocuous dietary proteins. Soybean is widely used in many food products and has long been recognized as a source of high-quality proteins. However, soybean is listed as one of the 8 most significant food allergens. The prevalence of soybean allergy is increasing worldwide and impacts the quality of life of patients. Currently, the only strategy to manage food allergy relies on strict avoidance of the offending food. Nutritional supplementation is a new prevention strategy which is currently under evaluation. Selenium (Se), as one of the essential micronutrients for humans and animals, carries out biological effects through its incorporation into selenoproteins. The use of interventions with micronutrients, like Se, might be an interesting new approach. In this review we describe the involvement of Se in a variety of processes, including maintaining immune homeostasis, preventing free radical damage, and modulating the gut microbiome, all of which may contribute to in both the prevention and treatment of food allergy. Se interventions could be an interesting new approach for future treatment strategies to manage soybean allergy, and food allergy in general, and could help to improve the quality of life for food allergic patients.

Predictive Factors for Oral Immune Modulation in Cow Milk Allergy

Aim: The present study analyzed clinical and biological factors that might predict achievement of tolerance in patients with IgE-mediated cow milk allergy (CMA). Method: Seventy patients with IgE-mediated CMA (44.24 ± 24.16 months) were included in the study. The patients were evaluated clinically through skin prick test and sIgE to whole milk, casein, beta-lactoglobulin and alpha-lactalbumin. An eviction diet of 6 months was established, followed by oral food challenge test (OFC) and oral immunotherapy (OIT) with baked milk for 6 months. The tolerance was assessed after 2 years follow up. Results: Thirty percent of patients presented anaphylaxis of different degrees of severity as first manifestation of CMA. Sixty-two patients followed OIT or an accelerated reintroduction of milk. Ten patients (14.28%) did not obtain tolerance to milk within 2 years. A larger wheal in SPT and higher sIgE to milk, casein and betalactoglobulin were noted in patients with positive OFC. A basal level of <2.5 kU/l for sIgE to milk and <11.73 kU/l for sIgE to caseins predicted the occurrence of tolerance in patients with all types of clinical manifestations, including anaphylaxis. Conclusion: Basal levels of sIgE to milk and casein may help to identify patients that could become tolerant to milk.

Development of a light-initiated chemiluminescence assay for the quantitative detection of cow's milk allergen-specific IgE

BACKGROUND

Cow's milk allergy is a common food allergy in children. Clinically, cow's milk-specific IgE (CM-sIgE) antibody test is often used to diagnose milk allergy. An inexpensive light-initiated chemiluminescence assay (LICA), with fast detection speed and small sample volume demand, has application prospects in the field of quantitative detection of CM-sIgE.

METHODS

Chemibeads coated with five major milk allergens, serum samples, biotinylated anti-human IgE antibodies, and streptavidin-coated sensibeads constitute a system to establish a LICA method for the quantitative detection of CM-sIgE. A series of experiments were performed to optimize its reaction conditions and evaluated its performance.

RESULTS

The optimal conditions for LICA were 10:4 mass ratio of chemibeads to milk allergen, 20 μg/mL chemibeads, 1.0 μg/mL biotinylated anti-human IgE antibodies and a 1/10 dilution of serum for 30-min incubation. The limit of Quantitation (LoQ) was 0.22 kU_A/L. For repeatability, the CV ranged from 3.71% to 8.11%. For intermediate precision, the CV ranged from 4.08% to 14.71%. It was linear within 0.20-18.20 kU_A/L. This method did not interfere with common interfering substances and total IgE in serum, and there was no obvious cross-reaction with milk-specific IgG and non-milk-specific IgE.

CONCLUSION

We have established a method to quantitatively detect CM-sIgE based on light-initiated chemiluminescence assay, which has good analytical performance and could meet the needs of clinical laboratories.

Lactobacillus rhamnosus GG for Cow's Milk Allergy in Children: A Systematic Review and Meta-Analysis

Objective: Cow's milk allergy (CMA) is a common allergic disease. Probiotics have been suggested as a treatment for CMA, with Lactobacillus rhamnosus GG (LGG) being one of the important predominant choices. Despite reports on this topic, the effectiveness of application in CMA remains to be firmly established. Methods: To assess the effects of LGG on CMA in children, the PubMed/Medline, Embase, Cochrane Library, and Web of Science databases were searched for studies on LGG in treatment of CMA, which were published in the English language. Results: Ten studies were finally included. Significantly higher tolerability rates favoring LGG over controls were observed [risk ratio (RR), 2.22; 95% confidence interval (CI), 1.86-2.66; I 2 = 0.00; moderate-quality evidence]. There were no significant differences in SCORAD values favoring LGG over the placebo (mean difference, 1.41; 95% CI, -4.99-7.82; p = 0.67; very low-quality evidence), and LGG may have improved fecal occult blood (risk ratio, 0.36; 95% CI, 0.14-0.92; p = 0.03; low-quality evidence). Conclusion: We found that LGG may have moderate-quality evidence to promote oral tolerance in children with CMA and may facilitate recovery from intestinal symptoms. However, this finding must be treated with caution, and more gpowerful RCTs are needed to evaluate the most effective dose and treatment time for children with CMA. Registration number: CRD42021237221.

Separation of Storage Proteins (7S and 11S) from Soybean Seed, Meals and Protein Isolate Using an Optimized Method Via Comparison of Yield and Purity

The primary purpose of this study was to extract β-conglycinin (7S) and glycinin (11S) from soybean seed, soybean meals and soybean protein isolate and compare their yield and purity. The previous methods were modified for the extraction and isolation of 7S and 11S globulins. The adjustment mainly included sample to solution ratio of 1:10 (previously 1:15). Comparing the yield of 11S fraction in Tris-HCl and water as extractable solutions, it was almost doubled in soybean seed (16.97% to 32.41%) with purity from 96 to 98% respectively. In case of soybean meal, samples yield increased from 45.46 to 61.86% with purity from 94 to 98%. On contrary, 7S yield was significantly improved in soybean protein isolate sample from 30.33 to 53.81% along with no contamination in its purity while soybean seed and soybean meal samples had less increase in both yield and purity in Tris-HCl and water as extractable solutions. Results of this study will bring new insights into soybean 7S and 11S separation and purification techniques as well as pave the way for their application in food industry.

Recent advances in alleviating food allergenicity through fermentation

The increasing prevalence of food allergies is a significant challenge to global food health and safety. Various strategies have been deployed to decrease the allergenicity of food for preventing and reducing related disorders. Compared to other methods, fermentation has unique advantages in reducing the allergenicity of food and may represent a new trend in preventing food-induced allergies. This review introduces the characteristics of allergens in various foods, including shellfish, soy, peanut, milk, tree nut, egg, wheat, and fish. The mechanism and pathological symptoms of allergic reactions are then summarized. Furthermore, the advantages of fermentation for reducing the allergenicity of these foods and preventing allergies are evaluated. Fermentation is an efficient approach for reducing or eliminating food allergenicity. Simultaneously, it improved the nutritional value and physicochemical properties of food materials. It is conceivable that a combination of mixed strain fermentation with additional processing, such as heat treatment, pulsed light, and ultrasonication, will efficiently reduce the allergenicity of various foods and preserve their unique taste and nutritional components, providing significance for patients with allergies.

Food irradiation: a promising technology to produce hypoallergenic food with high quality

The increasing incidence of food allergy cases is a public health problem of global concern. Producing hypoallergenic foods with high quality, low cost, and eco-friendly is a new trend for the food industry in the coming decades. Food irradiation, a non-thermal food processing technology, is a powerful tool to reduce the allergenicity with the above advantages. This review presents a summary of recent studies about food irradiation to reduce the allergenicity of food, including shellfish, soy, peanut, milk, tree nut, egg, wheat and fish. Principles of food irradiation, including mechanisms of allergenicity-reduction, irradiation types and characteristics, are discussed. Specific effects of food irradiation are also evaluated, involving microbial decontamination, improvement or preservation of nutritional value, harmful substances reduction of food products. Furthermore, the advantages, disadvantages and limitations of food irradiation are analyzed. It is concluded that food irradiation is a safety tool to reduce the allergenicity of food effectively, with high nutritional value and long shelf-life, making it a competitive alternative technology to traditional techniques such as heating treatments. Of note, a combination of irradiation with additional processing may be a trend for food irradiation.

Tackling Food Allergy in Infancy

Atopic dermatitis and food allergy are the most common allergic conditions affecting the infant population. Both immunoglobulin E (IgE)-mediated and non-IgE-mediated food allergy are seen in infancy. Early life feeding guidelines have changed dramatically over the past 30 years, more recently because of an improved understanding of IgE-mediated food allergy. This article focuses on identification, diagnosis, management, and prevention of food allergy in the infant population.

A novel approach to ameliorate experimental milk allergy based on the oral administration of a short soy cross-reactive peptide

Food allergy is on the rise, and preventive/therapeutic procedures are needed. We explored a preventive protocol for milk allergy with the oral administration of a Gly-m-Bd-30K soy-derived peptide that contains cross-reactive epitopes with bovine caseins. B/T-cross-reactive epitopes were mapped using milk-specific human sera and monoclonal antibodies on overlapping and recombinant peptides of Gly-m-Bd-30K by SPOT and cell proliferation assays. Bioinformatics tools were used to characterize epitopes on the 3D-modelled molecule, and to predict the binding to HLA alleles. The peptide was orally administrated to mice that were then IgE-sensitized to milk proteins. Immunodominant B-epitopes were mainly located on the surface of the Nt-fragment. The use of a soy-peptide-containing an immunodominant cross-reactive T-epitope, along with a single B epitope, prevents IgE-mediated milk sensitization through the induction of Th1-mediated immunity and induction of blocking IgG. The use of a safe soy-peptide may represent a promising alternative for preventing milk allergy.

Systemic reaction to an extensively hydrolyzed formula in an infant with cow's milk anaphylaxis

Background

Cow's milk allergy is the most common cause of food allergy in young children. Ingestion of milk products in children with a milk protein allergy can lead to anaphylaxis and must be avoided. Some guidelines suggest the use of an extensively hydrolyzed formula (EHF) in these cases; however, rare allergic reactions can still occur. Here, we presented a 3-month-old boy who developed anaphylaxis to a cow's milk formula. Subsequently, he developed a rare systemic reaction to soy and to an EHF.

Case

The patient had an unremarkable medical history and presented with signs and symptoms consistent with anaphylaxis after being fed cow's milk formula for the first time. Symptoms included immediate vomiting, wheezing, stridor, angioedema of eyelids and lips. Although intramuscular epinephrine was given, the patient continued to clinically deteriorate, becoming more lethargic and necessitating admission to the pediatric intensive care unit. Subsequently, a trial of soy formula ingestion reproduced the symptoms and an EHF was given. However, immediately after taking an EHF, he developed facial angioedema and diffuse urticarial lesions.

Conclusion

In most patients with a cow's milk allergy, an extensively based formula can be tolerated safely due to a hydrolyzed protein chain. However, medical providers must be vigilant when switching formula because a rare systemic allergic reaction to EHF can still occur.

Whey Proteins and Its Derivatives: Bioactivity, Functionality, and Current Applications

With the increased consumer demand for nutritional foods, it is important to develop value-added products, which will not only catch the attention of a wider consumer group but also provide greater benefits in terms of enhanced nutrition and functionality. Milk whey proteins are one of the most valued constituents due to their nutritional and techno-functional attributes. Whey proteins are rich in bioactive peptides, possessing bioactive properties such as being antioxidant and antihypertensive as well as having antimicrobial activities, which, when ingested, confers several health benefits. These peptides have the potential to be used as an active food ingredient in the production of functional foods. In addition to their bioactivities, whey proteins are known to possess enhanced functional attributes that allow them to be utilized in broad applications, such as an encapsulating agent or carrier materials to entrap bioactive compounds, emulsification, and in edible and active packaging. Hence, over the recent years, several whey protein-based ingredients have been developed and utilized in making formulations for a wide range of foods to harness their beneficial properties. This review highlights the bioactive properties, functional characteristics, associated processing limitations, and applications of different whey protein fractions and derivatives in the field of food formulations, encapsulation, and packaging.

Digestomics of Cow's Milk: Short Digestion-Resistant Peptides of Casein Form Functional Complexes by Aggregation

The aim of this study was to identify short digestion-resistant peptides (SDRPs) released by pepsin digestion of the whole cow’s milk and examine their IgE reactivity and allergenicity. Raw milk was subjected to simulated gastric digestion. SDRPs were fractionated from the digests and identified by MS. Milk SDRPs were evaluated for aggregability, propensity to compete for IgE binding with individual milk allergens, and ability to bind IgG4 from allergic and milk-tolerant individuals. The majority of milk SDRPs originated from caseins (97% of peptides) and overlapped with the known IgE epitopes of cow’s milk allergens. SDRPs competed with milk proteins for binding to human IgE and readily formed aggregates. The average peptide length was 10.6 ± 3.5 amino acids. The ability to provoke allergenic in vivo responses was confirmed by skin-prick testing (SPT) in five milk-allergic subjects. This was attributed to the peptide ability to aggregate into non-covalent complexes. SDRPs are able to induce response in SPT, but only in 50% of the sera SDRPs were able to inhibit IgG4 binding to caseins. Hence, SDRPs corresponding to the mainly continuous epitopes of milk proteins induce allergenic in vivo responses in milk-allergic subjects due to aggregation.

Design, quality, safety and efficacy of extensively hydrolyzed formula for management of cow's milk protein allergy: What are the challenges?

Cow's milk protein allergy (CMPA) is one of the most common food allergies in infancy. Clinical food allergy guidelines recommend an extensively hydrolyzed formula (EHF) as the first-line treatment in nonbreastfed infants with CMPA. Designing and commercializing EHF poses both technical and regulatory challenges. Each manufacturing step, from sourcing of raw materials to release of the final product, needs to be managed in accordance with comprehensive quality systems. To avoid cross-contamination via externally sourced ingredients, suppliers should be carefully selected based on quality requirements. Strict zoning of the manufacturing areas according to contamination risk and air flow control are effective strategies to prevent accidental allergen contamination. Furthermore, dedicated manufacturing lines for hypoallergenic products are used to prevent potential cross-contamination from other products produced on the same line. The enzymatic hydrolysis, heat treatment and ultrafiltration used are specific to each manufacturer. Consequently, EHF are a heterogenous group of products with differences in the molecular weight profile of peptides, content of residual immunogenic cow's milk allergens, and residual in-vitro allergenicity. These differences are likely to affect clinical efficacy and safety. As not all commercialized EHF products have undergone formal testing in the laboratory and clinical trials, there is a need to develop guidelines for minimum technical and regulatory requirements for EHF products, including validated assays for ongoing quality control. Clinical trials assessing new EHF products for their hypoallergenicity and ability to support normal growth remain the definitive proof of efficacy and safety in infants and young children with CMPA.

Discrimination of bovine milk from non-dairy milk by lipids fingerprinting using routine matrix-assisted laser desorption ionization mass spectrometry

An important sustainable development goal for any country is to ensure food security by producing a sufficient and safe food supply. This is the case for bovine milk where addition of non-dairy milks such as vegetables (e.g., soya or coconut) has become a common source of adulteration and fraud. Conventionally, gas chromatography techniques are used to detect key lipids (e.g., triacylglycerols) has an effective read-out of assessing milks origins and to detect foreign milks in bovine milks. However, such approach requires several sample preparation steps and a dedicated laboratory environment, precluding a high throughput process. To cope with this need, here, we aimed to develop a novel and simple method without organic solvent extractions for the detection of bovine and non-dairy milks based on lipids fingerprint by routine MALDI-TOF mass spectrometry (MS). The optimized method relies on the simple dilution of milks in water followed by MALDI-TOF MS analyses in the positive linear ion mode and using a matrix consisting of a 9:1 mixture of 2,5-dihydroxybenzoic acid and 2-hydroxy-5-methoxybenzoic acid (super-DHB) solubilized at 10 mg/mL in 70% ethanol. This sensitive, inexpensive, and rapid method has potential for use in food authenticity applications.

Fifteen-minute consultation: The EATERS method for the diagnosis of food allergies

The EATERS mnemonic is a novel method for taking an allergy focused clinical history. It provides a degree of certainty for diagnosing food allergy and can be used in both IgE and non IgE mediated reactions. EATERS will allow health care professionals to use their existing clinical skills to interpret the history of an allergic reaction, and by doing so will help to make sense of allergy test results.

Food Allergy Testing

Although the gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy is an oral food challenge, clinically relevant biomarkers of IgE sensitization, including serum-specific IgE and skin prick testing, can aid in diagnosis. Clinically useful values have been defined for individual foods. More recently, specific IgE to particular protein components has provided additional diagnostic value. In summary, food allergy diagnostics to evaluate IgE sensitization are clinically useful and continue to evolve to improve evaluation of IgE-mediated food allergies.

Skin Prick Testing to Identify Food Allergens in 8393 Children and Adolescents with Asthma in Chongqing, Southwest China

BACKGROUND The prevalence of food allergies in asthmatic children and adolescents has significantly increased over recent years. Nevertheless, the relevant clinical analyses are still lacking in China. Therefore, the present study aimed to determine common food allergens in pediatric patients with asthma in Chongqing, Southwest China. MATERIAL AND METHODS A total of 8393 asthmatic patients from Children's Hospital of Chongqing Medical University (CHCMU) were enrolled in this retrospective study between October 2014 and July 2017. All patients underwent skin prick test (SPT) with 10 food allergens and recorded history of clinical reactivity. The correlations among the positive rates, categories of allergens, gender, age, and living environment were analyzed. RESULTS A total of 2544 patients (30.31%) had a positive SPT, while the prevalence of food allergy was 8%. Sea crab, peanut, and sea shrimp were the most common food allergens found in the studied population. The frequent food allergies were sea crab, peanuts, and sea shrimp. CONCLUSIONS Identifying allergens is important for the diagnosis and management of allergic disorders, and for performing immunotherapy.

Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy

Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.

Epidemiology of Cow's Milk Allergy

Immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing the epidemiology of CMA. However, assessment is complicated by the presence of other immune-mediated reactions to cow's milk. These include non-IgE and mixed (IgE and non-IgE) reactions and common non-immune mediated reactions, such as lactose intolerance. Estimates of prevalence and population-level patterns are further complicated by the natural history of CMA (given its relatively high rate of resolution) and variation in phenotype (with a large proportion of patients able to tolerate baked cow's milk). Prevalence, natural history, demographic patterns, and long-term outcomes of CMA have been explored in several disparate populations over the past 30 to 40 years, with differences seen based on the method of outcome assessment, study population, time period, and geographic region. The primary aim of this review is to describe the epidemiology of CMA. The review also briefly discusses topics related to prevalence studies and specific implications of CMA, including severity, natural course, nutritional impact, and risk factors.

Development and Structural Behaviour of Soybean Gelato

The aim of this study is to elaborate and evaluate structural characteristics of soybean gelato by varying the content of soybean protein concentrate (2.95 to 17.05%) and vegetable fat (7.95 to 22.05%) using experimental design. The replacement of milk by hydrosoluble extract and soybean protein concentrate presented itself as an alternative to gelato production with unique characteristics, especially in terms of protein, solubility, viscosity, melting point, overrun and acceptability. The addition of up to 5% (m/V) protein concentrate, 14% (by volume) soybean hydrosoluble extract, and 15% (by mass) vegetable fat to gelato formulations resulted in better structural characteristics, with viscosity ranging from 0.45–0.70 Pa∙s at 10 °C, a non-Newtonian behaviour and protein stability (total protein content 8.44% and solubility 41%). Soybean gelato structural analysis using X-ray diffraction revealed 15° and 35° diffraction angles at 2Θ, characterizing the crystalline part of the product. The thermal analyses showed four bands of mass loss in the temperature range of 40–600 °C, characterizing loss of moisture, decomposition of the soy protein and the fat/emulsifier of the formulations. Thus, the soybean gelato is an innovative product, lactose and milk protein-free with outstanding characteristics for the general public, mainly, for the populations with intolerance to such components.

Soy extract and maltodextrin as microencapsulating agents for Lactobacillus acidophilus: a model approach

The present study aimed to optimise the microencapsulation of Lactobacillus acidophilus La-05 by spray drying, using soy extract and maltodextrin as encapsulants. Air inlet temperature, maltodextrin/soy extract ratio and feed flow rate were investigated through Central Composite Rotational Design (CCRD). Probiotic viability increased with increasing the proportion of soy extract. Temperature and feed flow rate had a negative effect. Particle diameter ranged from 4.97 to 8.82 μm, water activity from 0.25 to 0.52 and moisture from 2.30 to 7.01 g.100g-1 Particles produced following the optimised conditions (air temperature of 87 °C, maltodextrin/soy extract ratio of 2:3 w.w-1, feed flow rate of 0.54 L.h-1) reached Encapsulation yield (EY) of 83%. Thermogravimetry and FTIR analysis suggested that microcapsules could protect L. acidophilus cells against dehydration and heating. During storage, microencapsulated probiotic had high cell viability (reductions ranged between 0.12 and 1.72 log cycles). Soy extract/maltodextrin presented well-encapsulating properties of Lactobacillus acidophilus La-05.

Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children

Background

Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients.

Objectives

The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria.

Methods

Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016.

Results

A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow’s milk allergy 6%, hen’s egg allergy 5.2% and wheat allergy 1.9%.

Conclusions

Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow’s milk allergy, hen’s egg allergy and wheat allergy.