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Demirci B, Yılmaz Topal Ö, Turgay Yağmur İ, Dibek Mısırlıoğlu E. Development of respiratory allergic diseases according to cow's milk protein allergy mechanisms. Postgrad Med 2025:1-7. [PMID: 40323294 DOI: 10.1080/00325481.2025.2502312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 05/02/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Cow's milk protein allergy (CMPA) is early life's most common food allergy. There is limited data on the development of respiratory allergies in childhood for infants with CMPA. OBJECTIVE This study aimed to evaluate the development of respiratory allergic diseases in childhood according to the mechanism of CMPA in patients with CMPA in the first two years of life. METHODS Patients who were diagnosed with CMPA in the first two years of life and were over five years old during the study period were included in the study. The sociodemographic, clinical, and laboratory data of patients were recorded, and the status of respiratory allergic disease development in patients was assessed using the ISAAC questionnaire. RESULTS A total of 301 patients were included in the study; 182 (60.5%) were male. Most of the patients had mixed-type (87;28.9%) and had non-IgE-mediated (n:87;28.9%) CMPA. Of CMPA cases, 27.9% developed doctor-diagnosed asthma and 31.2% developed doctor-diagnosed allergic rhinitis. Doctor-diagnosed asthma was observed mostly with IgE-mediated CMPA (n:30;37%), and doctor-diagnosed allergic rhinitis was observed mostly with non-IgE-mediated CMPA (n:32;36.8%), and these differences were not statistically significant (p = 0.094, p = 0.385). Also, maternal asthma increased the risk of doctor-diagnosed asthma, while parental consanguinity, allergic rhinitis in mother/sibling, and paternal eczema were risk factors for doctor-diagnosed allergic rhinitis. CONCLUSION In this study, 27.9% of patients with CMPA in the first two years of life developed doctor-diagnosed asthma, and 31.2% developed allergic rhinitis. There was no difference in the frequency of occurrence based on the mechanism of CMPA development.
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Affiliation(s)
- Büşra Demirci
- Ankara Bilkent City Hospital, Division of Pediatric, Ankara, Turkey
| | - Özge Yılmaz Topal
- Ankara City Hospital, Division of Pediatric Allergy and Immunology, Ankara, Turkey
| | - İrem Turgay Yağmur
- Ankara City Hospital, Division of Pediatric Allergy and Immunology, Ankara, Turkey
| | - Emine Dibek Mısırlıoğlu
- Ankara City Hospital, Division of Pediatric Allergy and Immunology, Ankara, Turkey
- Department of Pediatric Allergy/Immunology, University of Health Sciences, Ankara, Turkey
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Xie A, Shen X, Hong R, Xie Y, Zhang Y, Chen J, Li Z, Li M, Yue X, Quek SY. Unlocking the potential of donkey Milk: Nutritional composition, bioactive properties and future prospects. Food Res Int 2025; 209:116307. [PMID: 40253152 DOI: 10.1016/j.foodres.2025.116307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 02/27/2025] [Accepted: 03/15/2025] [Indexed: 04/21/2025]
Abstract
Donkey milk has garnered increasing attention due to its remarkable similarity to human milk and its diverse bioactive properties. Analysis of its composition shows that donkey milk is characterized by high lactose content, low protein, low fat, a balanced calcium-to‑phosphorus ratio, and abundant in vitamins C and D, making it a promising human milk alternative. Additionally, donkey milk contains a unique composition of whey proteins and polyunsaturated fatty acids, contributing to its beneficial health effects such as antimicrobial, anti-inflammatory, antioxidant, and hypoallergenic properties. This review provides a comprehensive analysis of the nutritional profile of donkey milk in comparison to other mammalian milk sources. Furthermore, it highlights its bioactive potential and discusses the current challenges and future opportunities for expanding its applications in the dairy and health industries. Despite its valuable properties, the development of donkey milk products remains limited due to low milk yield and high production costs. Further research and technological advancements are necessary to optimize its utilization and commercial potential.
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Affiliation(s)
- Aijun Xie
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 119077, Singapore
| | - Xinyu Shen
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Ruiyao Hong
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Yuanfang Xie
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Yumeng Zhang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Jiali Chen
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Zhiwei Li
- Jiangsu Key Laboratory of Oil & Gas Storage and Transportation Technology, Changzhou University, Jiangsu 213164, China
| | - Mohan Li
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China.
| | - Xiqing Yue
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China.
| | - Siew Young Quek
- Food Science, School of Chemical Sciences, The University of Auckland, Auckland, 1010, New Zealand; Riddet Institute, Centre for Research Excellence in Food Research, Palmerston North 4474, New Zealand.
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3
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Nocerino R, Aquilone G, Stea S, Rea T, Simeone S, Carucci L, Coppola S, Berni Canani R. The Burden of Cow's Milk Protein Allergy in the Pediatric Age: A Systematic Review of Costs and Challenges. Healthcare (Basel) 2025; 13:888. [PMID: 40281837 PMCID: PMC12027034 DOI: 10.3390/healthcare13080888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 04/01/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
Background. Cow's Milk Protein Allergy (CMPA) is a prevalent pediatric food allergy affecting 2-5% of infants globally. CMPA presents significant clinical and economic challenges, requiring specialized diagnostic procedures, dietary management with hypoallergenic formulas, and multidisciplinary care. The financial burden on families and healthcare systems includes direct costs (e.g., diagnostic tests, medical consultations, and formula expenses), indirect costs (e.g., caregiver absenteeism and productivity loss), and intangible costs (e.g., psychological distress and impaired quality of life). Economic disparities further exacerbate these challenges, particularly in low-resource settings where access to specialized care is limited. Methods. A systematic review was conducted following PRISMA guidelines using PubMed, CINAHL, Scopus, and Cochrane databases to identify studies on the economic and psychosocial burden of CMPA. Studies published between 2010 and 2024 were analyzed. From an initial search of 11,565 articles, 802 duplicates were removed, leaving 10,763 articles for title and abstract screening. Twenty full-text articles meeting the inclusion criteria were included in the final analysis. Thematic categories focused on direct, indirect, and intangible costs, with findings synthesized to highlight global disparities and policy gaps. Results. CMPA management imposes substantial economic burdens, with hypoallergenic formulas alone accounting for up to 15% of household income in some regions. Indirect costs, including lost workdays and additional childcare expenses, further strain families. Intangible costs, such as heightened caregiver anxiety and reduced social participation, are significant yet frequently overlooked. Healthcare system disparities, particularly regarding insurance coverage for diagnostic tests and therapeutic formulas, contribute to financial inequities. The use of extensively hydrolyzed casein formulas with probiotics has demonstrated cost-effectiveness in promoting immune tolerance while reducing healthcare utilization. Conclusions. Addressing the economic impact of CMPA would benefit from standardized cost assessment frameworks and equitable access to cost-effective therapeutic options. Further analysis of reimbursement policies across diverse healthcare systems may provide insights into optimizing support for essential treatments. Integrating clinical and economic strategies can alleviate the burden on affected families and optimize healthcare resource allocation. Future research should prioritize longitudinal analyses and cross-regional comparisons to guide sustainable and equitable management strategies.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy; (G.A.); (L.C.); (S.C.); (R.B.C.)
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Greta Aquilone
- Department of Translational Medical Science, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy; (G.A.); (L.C.); (S.C.); (R.B.C.)
| | - Stefania Stea
- Master’s Degree Course in Nursing and Midwifery Sciences, Faculty of Medicine, University Nostra Signora del Buon Consiglio, 1000 Tirana, Albania;
| | - Teresa Rea
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy; (G.A.); (L.C.); (S.C.); (R.B.C.)
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy; (G.A.); (L.C.); (S.C.); (R.B.C.)
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy; (G.A.); (L.C.); (S.C.); (R.B.C.)
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples “Federico II”, 80131 Naples, Italy
- Task Force for Microbiome Studies, University of Naples “Federico II”, 80131 Naples, Italy
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Nowak-Wegrzyn A, Sicherer SH, Akin C, Anvari S, Bartnikas LM, Berin MC, Bingemann TA, Boyd S, Brown-Whitehorn T, Bunyavanich S, Cianferoni A, du Toit G, Fortunato JE, Goldsmith JD, Groetch M, Leonard SA, Rao M, Schultz F, Schwaninger JM, Venter C, Westcott-Chavez A, Wood RA, Togias A. Current status and future directions in food protein-induced enterocolitis syndrome: An NIAID workshop report of the June 22, 2022, virtual meeting. J Allergy Clin Immunol 2025; 155:336-356. [PMID: 39521282 DOI: 10.1016/j.jaci.2024.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 10/10/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy characterized by delayed, protracted vomiting and accompanied by lethargy and pallor, usually 1 to 4 hours after ingesting the food allergen. The pathophysiology of FPIES remains unknown, and currently there are no diagnostic biomarkers available to assess disease activity or its resolution. Over the last 2 decades, FPIES has become increasingly recognized in both pediatric and adult patients. Forty years after the initial FPIES description, the first FPIES code appeared in the International Classification of Diseases, Tenth Revision (ICD-10), and the first international consensus guidelines for the diagnosis and management of FPIES were published. On June 22, 2022, the National Institute of Allergy and Infectious Diseases (NIAID) held its first virtual multidisciplinary workshop on FPIES. Various clinical and translational aspects of FPIES as well as important areas of unmet needs were discussed as priorities for future research during this 2-day virtual workshop. Our report provides a summary of content of the workshop, including updated literature on the topic areas, and also provides critical commentary on the state of FPIES.
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Affiliation(s)
- Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, and the Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland; Department of Pediatrics, Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Scott H Sicherer
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cem Akin
- Department of Medicine, University of Michigan, Division of Allergy and Clinical Immunology, Ann Arbor, Mich
| | - Sara Anvari
- Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, and Texas Children's Hospital, William T. Shearer Center for Human Immunobiology, Houston, Tex
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, and Harvard Medical School, Boston, Mass
| | - M Cecilia Berin
- Department of Medicine, Division of Allergy/Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Theresa A Bingemann
- Department of Allergy, Immunology and Rheumatology and the Department of Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Scott Boyd
- Stanford University School of Medicine, Palo Alto, Calif
| | - Terri Brown-Whitehorn
- Division of Pediatric Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Supinda Bunyavanich
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Antonella Cianferoni
- Division of Pediatric Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - George du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, and the Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom
| | - John E Fortunato
- Gastroenterology, Hepatology and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jeffrey D Goldsmith
- Department of Pathology, Boston Children's Hospital, Boston, and Harvard Medical School, Boston, Mass
| | - Marion Groetch
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, San Diego, Calif
| | - Meenakshi Rao
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, and Harvard Medical School, Boston, Mass
| | - Fallon Schultz
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Rockville, Md
| | | | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Denver, Colo
| | | | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Alkis Togias
- Allergy, Immunology and Transplantation, NIAID, National Institutes of Health, Rockville, Md
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5
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Gil MV, Gutiérrez-Díaz G, Higuero N, Palma E, Fernández-Rivera N, Parrón-Ballesteros J, Betancor D, Pastor-Vargas C, Cintas P, Delgado-Adamez J. Targeting cow's milk allergy using hypoallergenic protein-polyphenol formulas: A proof of concept. Food Chem 2025; 463:141285. [PMID: 39316908 DOI: 10.1016/j.foodchem.2024.141285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/06/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
Cow's milk allergy caused by a hypersensitivity to milk proteins has increased over the last years. Hypoallergenic responses can be induced by altering the structure of such proteins with chemical modifiers; this paper is about the creation of edible matrices based on polyphenols from orange peel. Some compounds were able to significantly lower the IgE binding from β-lactoglobulin allergic serum in sensitized patients. Such effects could also be observed for casein allergic serum in patients sensitized to both proteins. A certain inter-individual variability is observed, although polyphenols do actually induce salient structural changes. This indicates that molecular modifications aimed at oral treatments against food allergy may or may not correlate with reduced allergenicity, and hence the necessity for serum monitoring through immunological assays. Overall, the results are promising enough to validate the polyphenol-fortified approach. In addition, this study highlights the upgrading of vegetable waste, consistent with a circular economy in food chemistry.
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Affiliation(s)
- M Victoria Gil
- IACYS-Green Chemistry and Sustainable Development Unit, Department of Organic and Inorganic Chemistry, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain.
| | - Gloria Gutiérrez-Díaz
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Nieves Higuero
- IACYS-Green Chemistry and Sustainable Development Unit, Department of Organic and Inorganic Chemistry, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Esther Palma
- IACYS-Green Chemistry and Sustainable Development Unit, Department of Organic and Inorganic Chemistry, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Nuria Fernández-Rivera
- IACYS-Green Chemistry and Sustainable Development Unit, Department of Organic and Inorganic Chemistry, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Jorge Parrón-Ballesteros
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Diana Betancor
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Carlos Pastor-Vargas
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, Complutense University of Madrid, Madrid, Spain.
| | - Pedro Cintas
- IACYS-Green Chemistry and Sustainable Development Unit, Department of Organic and Inorganic Chemistry, Faculty of Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Jonathan Delgado-Adamez
- Technological Institute of Food and Agriculture (INTAEX), Centro de Investigaciones Científicas y Tecnológicas de Extremadura (CICYTEX). Avda. Adolfo Suárez s/n, 06007, Badajoz, Spain
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Zhang Q, Liu T, Yuan X, Zhao X, Zhou L. Aptasensors application for cow's milk allergens detection and early warning: Progress, challenge, and perspective. Talanta 2025; 281:126808. [PMID: 39260252 DOI: 10.1016/j.talanta.2024.126808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/30/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
Cow's milk allergy (CMA) is considered one of the most prevalent food allergies and a public health concern. Modern medical research shows that the effective way to prevent allergic reactions is to prevent allergic patients from consuming allergenic substances. Therefore, the development of rapid and accurate detection technology for milk allergens detection and early warning is critical to safeguarding those with a cow milk allergy. As the oligonucleotide sequences with high specificity and selectivity, aptamers frequently assemble with transduction elements forming multifarious aptasensors for quantitative detection owing to their high-affinity binding to the target. Current aptasensors in the field of cow's milk allergen detection in recent years are explored in this review. This review takes a look back at a few common assays, including ELISA and PCR, before presenting a clear overview of the aptamer and threshold doses. It delves into a detailed discussion of the current aptamer-based detection techniques and related theories for milk allergen identification. Last but not least, we conclude with a discussion and outlook of the advancements made in allergen detection with aptamers. We sincerely hope that there will be more extensive applications for aptasensors in the future contributing to reducing the possibility of patients suffering from adverse reactions.
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Affiliation(s)
- Qingya Zhang
- College of Food Science and Engineering, Central South University of Forestry and Technology, Changsha, Hunan, 410004, China
| | - Ting Liu
- College of Food Science and Engineering, Central South University of Forestry and Technology, Changsha, Hunan, 410004, China
| | - Xiaomin Yuan
- College of Food Science and Engineering, Central South University of Forestry and Technology, Changsha, Hunan, 410004, China
| | - Xiongjie Zhao
- College of Chemistry and Biological Engineering, Hunan University of Science and Engineering, Yongzhou, Hunan, 425199, China.
| | - Liyi Zhou
- College of Food Science and Engineering, Central South University of Forestry and Technology, Changsha, Hunan, 410004, China.
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7
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Canbolat AA, Lombardo M, Mondragon ADC, López JMM, Bechelany M, Karav S. Bovine Colostrum in Pediatric Nutrition and Health. Nutrients 2024; 16:4305. [PMID: 39770926 PMCID: PMC11677144 DOI: 10.3390/nu16244305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 12/04/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025] Open
Abstract
Bovine colostrum (BC), the first milk secreted by mammals after birth, is a trending alternative source for supplementing infants and children, offering benefits for gut and immune health. Its rich components, such as proteins, immunoglobulins, lactoferrin, and glycans, are used to fortify diets and support development. Preterm development is crucial, especially in the maturation of essential systems, and from 2010 to 2020, approximately 15% of all premature births occurred at less than 32 weeks of gestation worldwide. This review explores the composition, benefits, and effects of BC on general infants and children, along with preterm infants who require special care, and highlights its role in growth and development. BC is also associated with specific pediatric diseases, including necrotizing enterocolitis (NEC), infectious diarrhea, inflammatory bowel disease (IBD), short-bowel syndrome (SBS), neonatal sepsis, gastrointestinal and respiratory infections, and some minor conditions. This review also discusses the clinical trials regarding these specific conditions which are occasionally encountered in preterm infants. The anti-inflammatory, antimicrobial, immunomodulatory, and antiviral properties of BC are discussed, emphasizing its mechanisms of action. Clinical trials, particularly in humans, provide evidence supporting the inclusion of BC in formulas and diets, although precise standards for age, feeding time, and amounts are needed to ensure safety and efficacy. However, potential adverse effects, such as allergic reactions to caseins and immunoglobulin E, must be considered. More comprehensive clinical trials are necessary to expand the evidence on BC in infant feeding, and glycans, important components of BC, should be further studied for their synergistic effects on pediatric diseases. Ultimately, BC shows promise for pediatric health and should be incorporated into nutritional supplements with caution.
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Affiliation(s)
- Ahmet Alperen Canbolat
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Türkiye;
| | - Mauro Lombardo
- Department for the Promotion of Human Science and Quality of Life, San Raffaele Open University, Via di 11 Val Cannuta 247, 00166 Rome, Italy;
| | - Alicia del Carmen Mondragon
- Laboratorio de Higiene Inspección y Control de Alimentos, Departamento de Química Analítica, Nutrición Bromatología, Universidade de Santiago de Compostela, Campus Terra, 27002 Lugo, Spain; (A.d.C.M.); (J.M.M.L.)
| | - Jose Manuel Miranda López
- Laboratorio de Higiene Inspección y Control de Alimentos, Departamento de Química Analítica, Nutrición Bromatología, Universidade de Santiago de Compostela, Campus Terra, 27002 Lugo, Spain; (A.d.C.M.); (J.M.M.L.)
| | - Mikhael Bechelany
- Institut Européen des Membranes (IEM), UMR 5635, University Montpellier, ENSCM, CNRS, F-34095 Montpellier, France;
- Functional Materials Group, Gulf University for Science and Technology (GUST), Masjid Al Aqsa Street, Mubarak Al-Abdullah 32093, Kuwait
| | - Sercan Karav
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Türkiye;
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8
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张 馨, 刘 立, 包 蕾, 史 源. [Interpretation of key points from the "Expert Consensus on Diagnosis and Management of Neonatal Cow Milk Protein Allergy (2023)"]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:1127-1134. [PMID: 39587739 PMCID: PMC11601108 DOI: 10.7499/j.issn.1008-8830.2408079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/14/2024] [Indexed: 11/27/2024]
Abstract
The clinical manifestations of cow's milk protein allergy (CMPA) in neonates are non-specific and involve multiple organ systems. CMPA may also adversely affect physical growth and central nervous system development in neonates, lead to functional disorders, and increase anxiety and stress among family members. Due to the lack of specific clinical manifestations and diagnostic methods, the diagnosis and management of CMPA in neonates continue to pose significant clinical challenges. To facilitate standardized diagnosis and treatment of CMPA in neonates, the Neonatology Group of the Pediatric Branch of the Chinese Medical Association and the Editorial Committee of the Chinese Journal of Pediatrics have jointly developed the "Expert Consensus on Diagnosis and Management of Neonatal Cow's Milk Protein Allergy (2023)". This article presents and interprets the key points of the consensus regarding dietary and nutritional management of CMPA in neonates.
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Ogata M, Kido J, Watanabe S, Yoshida T, Nishi N, Shimomura S, Hirai N, Tanaka K, Mizukami T, Yanai M, Nakamura K. The Efficacy and Safety of Stepwise Oral Food Challenge in Children with Cow's Milk Allergy. Int Arch Allergy Immunol 2024; 186:232-242. [PMID: 39419014 DOI: 10.1159/000541272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/30/2024] [Indexed: 10/19/2024] Open
Abstract
INTRODUCTION Stepwise oral food challenge (OFC) tests begin with low doses of allergens and progress to full doses. We previously reported the safety and efficacy of stepwise OFC for reintroducing hen eggs. In this study, we discuss its application for cow's milk (CM) allergy. METHODS We included 927 children (median age, 3.2 years) who underwent CM-OFC between 2017 and 2021. The target challenge dose was classified as low (<10 mL), middle (≥10 mL but <100 mL), or full. When participants reacted to the low dose, they underwent a very low-dose OFC using baked milk or <1 mL of CM. RESULTS Positive reactions occurred in 210 cases (22.7%), including 69 anaphylactic reactions (7.4%). A lower target dose resulted in more positive OFC results (p < 0.001) and anaphylaxis (p = 0.001). The lower dose group included more children with complete elimination of CM (p < 0.001), with numerous histories of anaphylaxis induced by CM (p < 0.001), and higher levels of total IgE (p = 0.033) and CM-sIgE (p < 0.001). A multivariate analysis indicated that in the low-dose-OFC group, higher CM-sIgE levels (p = 0.034), younger age (p = 0.005), and complete elimination of CM (p = 0.002) were associated with positive OFC results. CONCLUSION The stepwise OFC could reintroduce small amounts of CM, even in cases with high CM-sIgE levels or a history of anaphylaxis. Performing CM-OFC at younger ages, specifically from infancy, with very low doses, might facilitate the safe reintroduction of CM.
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Affiliation(s)
- Mika Ogata
- Department of Pediatrics, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan
- Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
| | - Jun Kido
- Department of Pediatrics, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Suguru Watanabe
- Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
| | - Takanobu Yoshida
- Department of Pediatrics, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
| | - Natsuko Nishi
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Sachiko Shimomura
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Nami Hirai
- Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
- Kumamoto Pediatric Allergy and Immunology Study Group, Kumamoto, Japan
| | - Kenichi Tanaka
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomoyuki Mizukami
- Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Masaaki Yanai
- Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan
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10
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Rueda García AM, Fracassi P, Scherf BD, Hamon M, Iannotti L. Unveiling the Nutritional Quality of Terrestrial Animal Source Foods by Species and Characteristics of Livestock Systems. Nutrients 2024; 16:3346. [PMID: 39408313 PMCID: PMC11478523 DOI: 10.3390/nu16193346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/29/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
Background. It is well-established that a range of macronutrients, micronutrients and bioactive compounds found in animal-source foods play unique and important roles in human health as part of a healthy diet. Methods. This narrative review focuses on terrestrial animal source foods (TASFs). It particularly analyzes five groups: poultry eggs, milk, unprocessed meat, foods from hunting and wildlife farming, and insects. The objectives were as follows: (1) examine the nutrient composition of TASFs within and across livestock species, drawing on the country and regional food composition databases; (2) analyze the influence of intrinsic animal characteristics and production practices on TASF nutritional quality. Results. TASFs are rich in high-quality proteins and fats, as well as micronutrients such as vitamin B12, iron or zinc. This study found differences in the nutritional quality of TASFs by livestock species and animal products, as well as by characteristics of livestock production systems. Our findings suggest that there may be public health opportunities by diversifying TASF consumption across species and improving certain aspects of the production systems to provide products that are both more sustainable and of higher quality. Conclusions. Future research should adopt a more holistic approach to examining the food matrix and the dietary patterns that influence TASF digestibility. It is necessary to include meat from hunting and wildlife farming and insects in global food composition databases, as limited literature was found. In addition, scarce research focuses on low- and middle-income countries, highlighting the need for further exploration of TASF food composition analysis and how intrinsic animal characteristics and livestock production system characteristics impact their nutritional value.
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Affiliation(s)
| | - Patrizia Fracassi
- Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - Beate D Scherf
- Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - Manon Hamon
- Food and Agriculture Organization of the United Nations, 00153 Rome, Italy
| | - Lora Iannotti
- E3 Nutrition Lab, Washington University in St. Louis, St. Louis, MO 63130, USA
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11
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Czaja-Bulsa G, Bulsa K, Łokieć M, Drozd A. Can Faecal Zonulin and Calprotectin Levels Be Used in the Diagnosis and Follow-Up in Infants with Milk Protein-Induced Allergic Proctocolitis? Nutrients 2024; 16:2949. [PMID: 39275265 PMCID: PMC11397570 DOI: 10.3390/nu16172949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/20/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
OBJECTIVE The aim of our study was to investigate whether a 1-month-long milk-free diet results in a reduction in faecal calprotectin (FC) and faecal-zonulin-related proteins (FZRP) in children with milk-protein-induced allergic proctocolitis (MPIAP). MATERIALS AND METHODS This is a single-centre, prospective, observational cohort study involving 86 infants with MPIAP, aged 1-3 months, and 30 healthy controls of the same age. The FC and FZRP were marked using the ELISA method (IDK® Calprotectin or Zonulin ELISA Kit, Immunodiagnostik AG, Bensheim, Germany). The diagnosis of MPIAP was confirmed with an open milk challenge test. RESULTS FFC and FZRP proved useful in evaluating MPIAP treatment with a milk-free diet, and the resolution of allergic symptoms and a significant (p = 0.0000) decrease in the concentrations of both biomarkers were observed after 4 weeks on the diet. The FC and FZRP concentrations were still higher than in the control group. A high variability of FC concentrations was found in all the study groups. An important limitation is the phenomenon of FZRP not being produced in all individuals, affecting one in five infants. CONCLUSIONS FC and FZRP can be used to monitor the resolution of colitis in infants with MPIAP treated with a milk-free diet, indicating a slower resolution of allergic inflammation than of allergic symptoms. The diagnosis of MPIAP on the basis of FC concentrations is subject to considerable error, due to the high individual variability of this indicator. FZRP is a better parameter, but this needs further research, as these are the first determinations in infants with MPIAP.
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Affiliation(s)
- Grażyna Czaja-Bulsa
- Chair and Department of Paediatrics and Paediatric Nursing, Pomeranian Medical University, 70-204 Szczecin, Poland
| | | | - Monika Łokieć
- Clinical Department of Paediatrics University Hospital, 65-046 Zielona Góra, Poland
| | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 70-204 Szczecin, Poland
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12
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Sathya P, Fenton TR. L'allergie aux protéines du lait de vache chez les nourrissons et les enfants. Paediatr Child Health 2024; 29:382-396. [PMID: 39539787 PMCID: PMC11557140 DOI: 10.1093/pch/pxae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/31/2023] [Indexed: 11/16/2024] Open
Abstract
L'allergie aux protéines du lait de vache (APLV) est une réaction à médiation immunitaire aux protéines du lait de vache, qui peut toucher de multiples systèmes organiques, y compris le tractus gastro-intestinal. Une réaction induite par les immunoglobulines E (IgE) entraîne l'apparition rapide de symptômes allergiques faciles à reconnaître. Cependant, des réactions tardives (non induites par les IgE ou les cellules) ou mixtes (induites par les IgE et les cellules) entraînent une série de symptômes qui ressemblent à d'autres affections et dont le moment d'apparition et la gravité sont très variables. Il est difficile de déterminer si les symptômes sont attribuables à une APLV à médiation immunitaire, à une réaction non immunologique au lait de vache ou à autre chose que l'exposition au lait de vache, mais il est essentiel d'y parvenir pour proposer une prise en charge efficace. Le tableau clinique de l'APLV non induite par les IgE peut varier, mais cette affection, généralement autorésolutive, disparaît entre l'âge de un et six ans. Il faut éviter les batteries de dosages des immunoglobulines G (IgG) pour déceler les intolérances alimentaires spécifiques aux antigènes qui ne reposent pas sur des données probantes, parce qu'elles peuvent entraîner un surdiagnostic de prétendues intolérances alimentaires. Le surdiagnostic d'APLV peut être responsable de la surutilisation de préparations fortement hydrolysées, ce qui a des répercussions financières importantes pour les familles. Le présent document de principes, qui traite de l'APLV non induite par les IgE ou les cellules, aide les professionnels de la santé à distinguer et reconnaître les diverses réactions au lait de vache, aborde le rôle des tests diagnostiques et fournit des recommandations de prise en charge en fonction des données probantes exemplaires.
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Affiliation(s)
- Pushpa Sathya
- Société canadienne de pédiatrie, comité de nutrition et de gastroentérologie, Ottawa (Ontario)Canada
| | - Tanis R Fenton
- Société canadienne de pédiatrie, comité de nutrition et de gastroentérologie, Ottawa (Ontario)Canada
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13
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Sathya P, Fenton TR. Cow's milk protein allergy in infants and children. Paediatr Child Health 2024; 29:382-396. [PMID: 39539784 PMCID: PMC11557147 DOI: 10.1093/pch/pxae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/31/2023] [Indexed: 11/16/2024] Open
Abstract
Cow's milk protein allergy (CMPA) is an immune-mediated reaction to cow's milk proteins, which can involve multiple organ systems including the gastrointestinal tract. Immunoglobulin E (IgE)-mediated response results in rapid onset of allergic symptoms that are easily recognizable. However, delayed (i.e., non-IgE/cell-mediated) or mixed (IgE- and cell-mediated) reactions produce a host of symptoms that overlap with other conditions and vary widely in onset and severity. Determining whether symptoms represent immune-mediated CMPA, non-immunologic reaction to cow's milk, or are unrelated to cow's milk exposure is challenging yet essential for effective management. While the clinical presentation of non-IgE-mediated CMPA can vary, this condition is usually self-limited and resolves by 1 to 6 years of age. Food antigen-specific immunoglobulin G (IgG) panels that are not evidence-based should be avoided because they can lead to overdiagnosis of presumed food intolerances. Overdiagnosis of CMPA can result in overuse of extensively hydrolyzed formulas and have significant cost implications for families. This statement focuses on delayed non-IgE/cell-mediated CMPA and assists health care providers to distinguish between and identify varied reactions to cow's milk, discusses the role of diagnostic testing, and provides management recommendations based on best evidence.
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Affiliation(s)
- Pushpa Sathya
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Tanis R Fenton
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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14
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Abstract
Diet plays an important role in human health and disease. Of all human diseases, diarrheal illnesses bring diet into sharp focus as it has a direct causal and therapeutic relationship. With the advent and widespread use of next generation sequencing, significant advances have been made in unraveling the etiologies of congenital diarrheas and enteropathies, some of which are eminently treatable with dietary modification. Early institution of appropriate dietary therapy is lifesaving in congenital osmotic diarrheas. Chronic diarrhea in older children and adolescents often have an underlying dietary basis, depending on the etiology. Identification and exclusion of the offending food in the diet results in dramatic improvement in symptoms. It is equally important to be prudent and cautious in the use of exclusion diets in management of chronic diarrhea as it is associated with micronutrient deficiencies, needless escalation of cost and enable maladaptive food intake behaviors. In this review, authors discuss etiology specific dietary management of diarrhea in children with emphasis on congenital diarrheas and enteropathies.
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Affiliation(s)
- Sahana Shankar
- Division of Pediatric Gastroenterology, Department of Pediatrics, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India.
| | - Emmany Durairaj
- Department of Clinical Nutrition and Dietetics, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India
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15
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Bahna SL. History of food allergy and where we are today. World Allergy Organ J 2024; 17:100912. [PMID: 38800498 PMCID: PMC11126526 DOI: 10.1016/j.waojou.2024.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
The food allergy (FA) entity went through a long difficult road which led to much delay in its recognition. After long periods of denial and misdiagnosis, it attained its current designation as food hypersensitivity or allergy. This review will briefly address the evolution of the FA entity from the early BC era until our 21st century and highlight the milestones in the main aspects of diagnosis, treatment, prevention, and research. A great recognition of the allergy specialty was gained by the discovery of its main mediator -immunoglobulin E in 1967 - which also helped in classifying FA into IgE-mediated (immediate-type) and non-IgE-mediated. The cause of the increasing prevalence during the past few decades may be attributed to an increased food consumption and the consequences of modern lifestyle (the hygiene hypothesis). In addition to a skillful medical history-taking, helpful tests have been developed involving the skin or blood. The scratch test was modified to the prick test and in certain instances prick-by-prick. The use of intradermal test has been markedly reduced. Blood testing began by measuring specific-IgE antibodies (sIgE) in the serum using the radioallergosorbent test which went through multiple modifications to avoid radioisotope material and increase the test's sensitivity. The test was advanced to measure sIgE to individual allergen components. Recently, cellular tests were developed in the form of basophil activation or mast cell activation. In most cases, FA needs verification by appropriately-designed challenge testing. Regarding treatment, strict avoidance remains the basic approach. Certain food-labeling regulations led to some improvement in the problem of hidden food allergens but more is desired. Recently some protocols for oral immunotherapy (OIT) showed reasonable safety and efficacy in preventing reactions to accidental exposures. The protocol for peanut has been approved in the United States and other foods are expected to follow. Epicutaneous immunotherapy showed higher safety and promising efficacy. Sublingual immunotherapy might follow as well. Studies on the use of certain biologicals, alone or in combination of OIT, showed promising findings. Very recently, omalizumab was approved in the United States for patients with multiple FA. A major change in the strategy of prevention is the benefit of introducing allergenic foods at an early age (4-6 months). Research on FA markedly flourished in recent decades with increasing numbers of investigators, funding, publications, and education. Despite the major strides, still more awaits exploration with expected better understanding and practice of FA.
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Affiliation(s)
- Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA
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16
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Tel Adiguzel K, Ercan N, Kahraman E. Longitudinal Growth Trajectories in Children with Cow's Milk Allergy: Effects of Elimination Diet and Post-Termination Period. Int Arch Allergy Immunol 2024; 185:536-544. [PMID: 38447540 DOI: 10.1159/000536432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION The primary dietary approach for managing cow's milk allergy (CMA) is the elimination diet. We aimed to compare the growth patterns of children with CMA during and after the elimination diet with healthy peers and identify influencing factors. METHODS We compared 74 CMA children with age-matched healthy peers. Anthropometric data were collected during the third month of cow's milk elimination (CME) diet (T1), 3 months after diet cessation (T2), and after ≥3 months of normal diet (T3). Control group measurements coincided. Nutrient intake was assessed by a 3-day record, and patient laboratory results were noted at T3. RESULTS CMA children had consistently lower weight-for-age (WFA) and height-for-age (HFA) z-scores than controls. WtHt z-score of patients was lower than those of the healthy group at T2. HC z-scores of patients were lower than those of the healthy group at T0, T2, and T3. At T3, the HFA z-score of the CME group demonstrated a negative correlation with the duration of the elimination diet (p = 0.045). Inadequate intake of energy, vitamins A, E, B1, B6, C, folic acid, magnesium, and iron was significantly higher in CMA children (p < 0.05). T3 WFA z-score correlated positively with fiber, vitamin B1, magnesium, and iron intake (p < 0.05). T3 WtHt showed a positive moderate correlation with energy, protein, vitamin E, vitamin B1, vitamin B2, vitamin B6, calcium, magnesium, phosphor, iron intake (p < 0.05). CONCLUSIONS Post-elimination diet, children with CMA need sustained monitoring and potentially micronutrient supplementation to match healthy peers' growth.
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Affiliation(s)
- Kubra Tel Adiguzel
- Department of Nutrition and Dietetics, Gülhane Faculty of Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| | - Nazli Ercan
- Division of Pediatric Immunology and Allergy, Department of Pediatrics, University of Health Sciences Turkey, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Esin Kahraman
- Department of Pediatrics, University of Health Sciences Turkey, Gülhane Education and Research Hospital, Ankara, Turkey
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17
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Tosi M, Montanari C, Bona F, Tricella C, Agostinelli M, Dolor J, Chillemi C, Di Profio E, Tagi VM, Vizzuso S, Fiore G, Zuccotti G, Verduci E. Dietary Inflammatory Potential in Pediatric Diseases: A Narrative Review. Nutrients 2023; 15:5095. [PMID: 38140353 PMCID: PMC10745369 DOI: 10.3390/nu15245095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Inflammatory status is one of the main drivers in the development of non-communicable diseases (NCDs). Specific unhealthy dietary patterns and the growing consumption of ultra-processed foods (UPFs) may influence the inflammation process, which negatively modulates the gut microbiota and increases the risk of NCDs. Moreover, several chronic health conditions require special long-term dietary treatment, characterized by altered ratios of the intake of nutrients or by the consumption of disease-specific foods. In this narrative review, we aimed to collect the latest evidence on the pro-inflammatory potential of dietary patterns, foods, and nutrients in children affected by multifactorial diseases but also on the dietetic approaches used as treatment for specific diseases. Considering multifactorial diet-related diseases, the triggering effect of pro-inflammatory diets has been addressed for metabolic syndrome and inflammatory bowel diseases, and the latter for adults only. Future research is required on multiple sclerosis, type 1 diabetes, and pediatric cancer, in which the role of inflammation is emerging. For diseases requiring special diets, the role of single or multiple foods, possibly associated with inflammation, was assessed, but more studies are needed. The evidence collected highlighted the need for health professionals to consider the entire dietary pattern, providing balanced and healthy diets not only to permit the metabolic control of the disease itself, but also to prevent the development of NCDs in adolescence and adulthood. Personalized nutritional approaches, in close collaboration between the hospital, country, and families, must always be promoted together with the development of new methods for the assessment of pro-inflammatory dietary habits in pediatric age and the implementation of telemedicine.
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Affiliation(s)
- Martina Tosi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Federica Bona
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Chiara Tricella
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Marta Agostinelli
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Jonabell Dolor
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Claudia Chillemi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
| | - Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
| | - Sara Vizzuso
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.T.); (C.M.); (F.B.); (C.T.); (M.A.); (J.D.); (C.C.); (E.D.P.); (V.M.T.); (S.V.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
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McWilliam V, Netting MJ, Volders E, Palmer DJ. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy. World Allergy Organ J 2023; 16:100830. [PMID: 38020284 PMCID: PMC10656250 DOI: 10.1016/j.waojou.2023.100830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms. Current clinical practice recommendations advise a 2-4 week trial of maternal cow's milk dietary elimination for: a) IgE-mediated cow's milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow's milk allergy; and c) infants with moderate to severe eczema/atopic dermatitis, unresponsive to topical steroids and sensitized to cow's milk protein. There should be a clear plan for home reintroduction of cow's milk into the maternal diet for a period of 1 week to determine that the cow's milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow's milk reintroduction. The evidence base to support the use of maternal cow's milk avoidance for the treatment of a breastfed infant with cow's milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow's milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow's milk allergy maternal cow's milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essential.
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Affiliation(s)
- Vicki McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Nutrition Department, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Evelyn Volders
- Nutrition, Dietetics & Food, Monash University, Clayton, Vic, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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Xiao J, Ma J, Khan MZ, Alugongo GM, Chen T, Liu S, Li S, Cao Z. Unlocking the potential of milk whey protein components in colorectal cancer prevention and therapy. Crit Rev Food Sci Nutr 2023; 64:12961-12998. [PMID: 37846905 DOI: 10.1080/10408398.2023.2258970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Extensive research from large prospective cohort studies and meta-analytical investigations over recent decades have consistently indicated that dairy foods have protective effects, reducing the risk of colorectal cancer. Most of the literature has explored the potential role of milk minerals and vitamins in managing colorectal cancer. Yet, there is a paucity of a comprehensive summary of the anticancer attributes of milk protein components and their underlying mechanisms of action. Recent advancements have spotlighted the potential of whey proteins, including β-lactoglobulin, α-lactalbumin, serum albumin, and lactoferrin, as promising candidates for both the prevention and treatment of colorectal cancer. Notably, whey proteins have demonstrated a more pronounced capacity for suppressing carcinogen-induced tumors when compared to casein. Their strong binding affinity enables them to serve as effective carriers for small molecules or drugs targeting colon cancer therapy. Furthermore, numerous studies have underscored the anti-inflammatory and antioxidant prowess of whey proteins in cancer prevention. Additionally, whey proteins have been shown to trigger apoptosis, hinder tumor cell proliferation, and impede metastasis. This comprehensive review, therefore, not only substantiates the significance of incorporating whey protein components into a balanced daily diet but also underscores their potential in safeguarding against the onset and progression of colorectal cancer.
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Affiliation(s)
- Jianxin Xiao
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Jiaying Ma
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Muhammad Zahoor Khan
- Faculty of Veterinary and Animal Sciences, University of Agriculture Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
| | - Gibson Maswayi Alugongo
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Tianyu Chen
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Shuai Liu
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Shengli Li
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Zhijun Cao
- State Key Laboratory of Animal Nutrition and Feeding, Beijing Engineering Technology Research Center of Raw Milk Quality and Safety Control, College of Animal Science and Technology, China Agricultural University, Beijing, China
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El-Shafie AM, Omar ZA, El Zefzaf HMS, Basma EM, Al Sabbagh NM, Bahbah WA. Evaluation of Cow's Milk Related Symptom Score [CoMiSS] accuracy in cow's milk allergy diagnosis. Pediatr Res 2023; 94:987-995. [PMID: 36871030 PMCID: PMC10444607 DOI: 10.1038/s41390-023-02539-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Cow's Milk-related Symptom Score (CoMiSS) is an awareness tool to recognize cow's milk allergy (CMA) symptoms in infants. We aimed to assess the best cut-off point of CoMiSS in our country and investigate other parameters suggested to raise the strength of CoMiSS in CMA diagnosis. METHODS We enrolled 100 infants with CMA-suggestive symptoms with documentation of CoMiSS initially and 4 weeks after cow milk-free diet (CMFD) followed by an open food challenge (OFC) test. Infants with symptom recurrence upon challenge were diagnosed with confirmed CMA. RESULTS Initial mean CoMiSS was 15.76 ± 5.29, being higher in the confirmed CMA group (84% of infants). Following CMFD, median CoMiSS significantly reduced to 1.5 in the confirmed CMA group compared to 6.5 in the negative group. Receiver operation characteristic (ROC) curve identified a CoMiSS score of ≥12 as the best cut-off value with 76.19% sensitivity, 62.50% specificity and overall accuracy of 74.00%. Mucoid stool, bloody stool and faltering growth were reported in 80, 41 and 52% of confirmed CMA infants, respectively, with considerable improvement following CMFD. CONCLUSIONS Our study revealed a CoMiSS score of ≥12 to be the best cut-off point. However, CoMiSS cannot be used alone for accurate diagnosis of CMA. IMPACT CoMiSS ≥12 can predict a positive response to CMFD; nevertheless, CoMiSS is a good awareness tool and cannot be regarded as a stand-alone CMA diagnostic test. CoMiSS reduction following CMFD was predictive of a reaction to OFC to diagnose CMA as well as for monitoring symptom improvement. Symptoms commonly associated with CMA as mucoid stool, bloody stool, marked abdominal distention not responding to medical treatment and faltering growth, in addition to their improvements in response to CMA are suggested parameters to be added to CoMiSS to improve its accuracy.
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Affiliation(s)
- Ali M El-Shafie
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Zein A Omar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Heba M S El Zefzaf
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.
| | - Elsayedamr M Basma
- Department of Bioinformatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Nahla M Al Sabbagh
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Wael A Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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21
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Nocerino R, Coppola S, Carucci L, de Giovanni di Santa Severina AF, Oglio F, de Michele R, di Sessa I, Masino A, Bedogni G, Berni Canani R. The step-down approach in children with cow's milk allergy: Results of a randomized controlled trial. Allergy 2023; 78:2477-2486. [PMID: 37087638 DOI: 10.1111/all.15750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The Step-Down Approach for Cow's Milk Allergy (SDACMA) trial evaluated the tolerability and the rate of immune tolerance acquisition in CMA children starting dietary treatment with amino acid-based formula (AAF) and then switching to EHCF containing the probiotic Lacticaseibacillus rhamnosus GG (EHCF + LGG). METHODS Randomized controlled trial involving IgE-mediated CMA children receiving AAF from at least 4 weeks. EHCF + LGG tolerance was evaluated by the results of double-blind placebo-controlled food challenge (DBPCFC). Subjects tolerating EHCF + LGG were randomly allocated to remain on AAF, or to switch to EHCF + LGG. Immune tolerance acquisition to cow's milk proteins was evaluated with DBPCFC after 12 months of treatment. Allergy screening tests and body growth were also monitored. RESULTS Sixty IgE-mediated CMA children were enrolled. The proportion of children treated with AAF who resulted tolerant to the first exposure of EHCF + LGG was 0.98 (exact 95% CI 0.91-0.99). The rate of the immune tolerance acquisition to cow milk proteins after 12 months treatment was higher in the EHCF + LGG (0.48, 95% exact CI 0.29-0.67, n/N = 14/29) than in the AAF group (0.03, 95% exact CI 0.001-0.17, n/N = 1/30). There was an absolute benefit increase (ABI) of tolerance rate equal to 0.45 (95% CI 0.23-0.63, Newcombe method 10) for EHCF + LGG versus AAF, corresponding to a NNT of 2 (2-4, Bender's method). A normal body growth pattern was observed in the two study groups. CONCLUSION In IgE-mediated CMA children the step-down from AAF to EHCF + LGG is well tolerated and could facilitate the immune tolerance acquisition.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Anna Fiorenza de Giovanni di Santa Severina
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Roberta de Michele
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Ilaria di Sessa
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonio Masino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
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22
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Martín-Masot R, Díaz-Martín JJ, Santamaría-Orleans A, Navas-López VM. Spanish Pediatricians' Positions Regarding Prevention, Diagnosis, Nutritional Management, and Challenges in Cow's Milk Protein Allergy. Nutrients 2023; 15:3586. [PMID: 37630776 PMCID: PMC10458855 DOI: 10.3390/nu15163586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Management of cow's milk protein allergy (CMPA) can vary depending on the experience and area of expertise of the clinician responsible for the patient's follow-up, which may or may not align with the recently published literature. To analyze the perspectives of Spanish pediatricians on this topic, a survey was conducted. The survey aimed to determine the current opinions and attitudes of 222 primary care and hospital pediatricians toward CMPA prevention and nutritional management. Participating pediatricians completed the questionnaire, providing insights into their daily clinical practices, including access to testing, attitudes with respect to various aspects of CMPA diagnosis, prevention, oral food challenges, and treatment. The findings revealed that pediatricians generally agree on the use of extensively hydrolyzed formulas (eHFs) to prevent CMPA in high-risk atopic children, despite limited evidence supporting the widespread use of this practice. However, consensus was lacking regarding the utility of formulas with prebiotics and probiotics for expediting tolerance development. In most cases, pediatricians preferred eHFs for the nutritional management of CMPA, followed by hydrolyzed rice formulas (HRFs), with amino-acid-based formulas (AAFs) being the third option. Certain issues remained controversial among pediatricians, such as prevention methods, symptom assessment, and the role of probiotics. These variations in management approaches reflect the influence of clinician experience and area of expertise, underscoring the need for standardized guidelines in this field.
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Affiliation(s)
- Rafael Martín-Masot
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain (V.M.N.-L.)
| | - Juan José Díaz-Martín
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | | | - Víctor Manuel Navas-López
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain (V.M.N.-L.)
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Xu K, Phue WH, Basu N, George S. The potential of dietary nanoparticles to enhance allergenicity of milk proteins: an in vitro investigation. Immunol Cell Biol 2023; 101:625-638. [PMID: 37157183 DOI: 10.1111/imcb.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
In recent years, the popularity of dietary nanoparticles (NPs) in the food industry as additives has raised concerns because of the lack of knowledge about potential adverse health outcomes ensuing from the interactions of NPs with components of the food matrix and gastrointestinal system. In this study, we used a transwell culture system that consisted of human colorectal adenocarcinoma (Caco-2) cells in the apical insert and Laboratory of Allergic Diseases 2 mast cells in the basal compartment to study the effect of NPs on milk allergen delivery across the epithelial layer, mast cell responses and signaling between epithelial and mast cells in allergenic inflammation. A library of dietary particles (silicon dioxide NPs, titanium dioxide NPs and silver NPs) that varied in particle size, surface chemistry and crystal structures with or without pre-exposure to milk was used in this investigation. Milk-interacted particles were found to acquire surface corona and increased the bioavailability of milk allergens (casein and β-lactoglobulin) across the intestinal epithelial layer. The signaling between epithelial cells and mast cells resulted in significant changes in the early phase and late-phase activation of the mast cells. This study suggested that antigen challenge in mast cells with the presence of dietary NPs may cause the transition of allergic responses from an immunoglobulin E (IgE)-dependent mechanism to a mixed mechanism (both IgE-dependent and IgE-independent mechanisms).
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Affiliation(s)
- Ke Xu
- Department of Food Science and Agricultural Chemistry, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Wut Hmone Phue
- Department of Food Science and Agricultural Chemistry, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Niladri Basu
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Saji George
- Department of Food Science and Agricultural Chemistry, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
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24
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Kansu A, Urganci N, Bukulmez A, Kutluk G, Gulcu Taskin D, Sahin Keskin L, Igde M, Molon L, Dogan Y, Sekerel BE, Yuksek M, Bostanci I, Gerenli N, Polat E, Dalgic B, Ayyildiz H, Usta M, Basturk A, Yuce Kirmemis O, Tuna Kirsaclioglu C, Gulerman HF, Alptekin Sarioglu A, Erdogan S. Growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula in infants with cow's milk protein allergy. Front Pediatr 2023; 11:1230905. [PMID: 37601126 PMCID: PMC10433168 DOI: 10.3389/fped.2023.1230905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow's milk protein allergy (CMPA). METHODS A total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z-scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5). RESULTS From baseline to visit 2 and visit 3, WFA z-scores (from -0.60 ± 1.13 to -0.54 ± 1.09 at visit 2, and to -0.44 ± 1.05 at visit 3, p < 0.001) and WFL z-scores (from -0.80 ± 1.30 to -0.71 ± 1.22 at visit 2, and to -0.64 ± 1.13 at visit 3, p = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%). CONCLUSIONS In conclusion, eHCF was well-accepted and tolerated by an intended use population of infants ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction.
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Affiliation(s)
- Aydan Kansu
- Department of Pediatric Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Nafiye Urganci
- Clinic of Pediatric Gastroenterology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Bukulmez
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Gunsel Kutluk
- Clinic of Pediatric Gastroenterology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Didem Gulcu Taskin
- Clinic of Pediatric Gastroenterology, Adana City Training and Research Hospital, Adana, Turkey
| | - Lutfiye Sahin Keskin
- Clinic of Pediatric Gastroenterology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mahir Igde
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Lutfi Molon
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Yasar Dogan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Bulent Enis Sekerel
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mutlu Yuksek
- Department of Pediatric Immunology and Allergy, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Ilknur Bostanci
- Clinic of Pediatric Immunology and Allergy, Health Sciences University Dr. Sami Ulus Gynecology, Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nelgin Gerenli
- Clinic of Pediatric Gastroenterology, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Esra Polat
- Clinic of Pediatric Gastroenterology, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasret Ayyildiz
- Clinic of Pediatric Gastroenterology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Merve Usta
- Clinic of Pediatric Gastroenterology, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Basturk
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ozlem Yuce Kirmemis
- Clinic of Pediatric Gastroenterology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ceyda Tuna Kirsaclioglu
- Department of Pediatric Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey
| | - Hacer Fulya Gulerman
- Department of Pediatric Gastroenterology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | | | - Simge Erdogan
- Abbott Nutrition, Abbott Laboratories, Istanbul, Turkey
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Matsubara T, Ishikawa F, Inuo C, Fujita M, Tsukahara A, Koyama T, Iwamoto H, Miyaji K. Allergenicity of partially hydrolyzed whey and casein formulas evaluated by ImmunoCAP inhibition assay and basophil activation test. FRONTIERS IN ALLERGY 2023; 4:1207924. [PMID: 37546176 PMCID: PMC10403286 DOI: 10.3389/falgy.2023.1207924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Background When exclusive breastfeeding is not possible, partially hydrolyzed formula (PHF) is often used as a starter formula for infants. Some children develop allergic symptoms, including anaphylaxis, after the first intake of cow protein. Therefore, the tolerability of PHF in infants with cow's milk allergy (CMA) is important information. Partially hydrolyzed whey formula (PHWF) is well characterized, but those containing both whey and casein are also available. We evaluated the characteristics of two whey and casein PHFs, PHF1 and PHF2, in vitro and ex vivo, and compared them with a PHWF, PHWF1. Methods Residual antigenicity of β-lactoglobulin (β-LG) and casein in the formulas was measured using ELISA. The molecular weight profile was determined using high-pressure liquid chromatography. IgE reactivity and allergenic activity of the formulas were evaluated by ImmunoCAP inhibition assay and by basophil activation test using blood from patients with CMA, respectively. Results All the participants (n = 10) had casein-specific IgE. The antigenicity of β-LG in PHF1 was similar to that in PHWF1, but it was slightly higher than that in PHWF1 for casein. PHF1 had a higher IgE reactivity than PHWF1. However, PHF1 and PHWF1 had a similar ability to activate basophils. PHF2 had lower antigenicity of casein and β-LG, IgE reactivity and basophil activation than PHWF1. Conclusion These results suggest that the tolerability of PHF1 and PHF2 in patients with CMA is similar to and higher than that of PHWF1, respectively, and that the degree of IgE binding to PHFs does not necessarily correspond to basophil activation.
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Affiliation(s)
- Takeshi Matsubara
- Health Care & Nutrition Science Institute, R&D Section, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
| | - Fuka Ishikawa
- Health Care & Nutrition Science Institute, R&D Section, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
| | - Chisato Inuo
- Department of Allergy, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, Japan
| | - Mayumi Fujita
- Department of Allergy, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, Japan
| | - Ayumi Tsukahara
- Department of Allergy, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, Japan
| | - Takahiro Koyama
- Health Care & Nutrition Science Institute, R&D Section, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
| | - Hiroshi Iwamoto
- Health Care & Nutrition Science Institute, R&D Section, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
| | - Kazuhiro Miyaji
- Health Care & Nutrition Science Institute, R&D Section, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
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Alghasham YA, Alharbi AM, Alhumaidi KA, Alkhalifah YS. Primary Healthcare Center's Healthcare Providers' Perception and Practice Toward Pediatric Cow's Milk Allergy in Qassim Region, Saudi Arabia. Cureus 2023; 15:e41719. [PMID: 37575801 PMCID: PMC10414770 DOI: 10.7759/cureus.41719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Cow's milk allergy (CMA) typically first manifests in the first year of life, and it is the most challenging food allergy to detect since the clinical symptoms can vary significantly in both types and severity. This study is carried out to evaluate the level of knowledge and practice of healthcare providers (HCPs) in the Qassim Region regarding CMA. RESEARCH METHODOLOGY This is a cross-sectional study conducted among HCPs in the Qassim Region, Saudi Arabia. A self-administered questionnaire was distributed among HCPs using face-to-face interviews compromising four governorates of Qassim such as Buraydah, Unaizah, AlRass, and Albukairyah. The questionnaire includes socio-demographic characteristics and questions to assess the knowledge and practice of HCPs regarding CMA. RESULTS Among 124 HCPs, 29% were aged between 25 and 30 years, 50.8% were males and 49.2% were females. Over three-quarters (77.4%) were categorized as having poor knowledge levels, while poor practice was also prevalent (83.1%). Factors associated with increased knowledge and practice were being non-Saudi, being a consultant/specialist, and having more than 10 years of experience. There was a significant positive correlation between knowledge and practice scores (p<0.001). CONCLUSION The knowledge and practice of HCPs regarding CMA were insufficient. Non-Saudi consultants/specialists with more years of experience tend to be more knowledgeable and have better skills in managing the disease. Further longitudinal studies are required to establish the level of knowledge and practices toward CMA.
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Affiliation(s)
- Yazeed A Alghasham
- Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Aeshah M Alharbi
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Kadi A Alhumaidi
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Meyer R, Venter C, Bognanni A, Szajewska H, Shamir R, Nowak-Wegrzyn A, Fiocchi A, Vandenplas Y. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update - VII - Milk elimination and reintroduction in the diagnostic process of cow's milk allergy. World Allergy Organ J 2023; 16:100785. [PMID: 37546235 PMCID: PMC10401347 DOI: 10.1016/j.waojou.2023.100785] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 08/08/2023] Open
Abstract
The diagnosis of cow's milk allergy (CMA) in infants and young children remains a challenge because many of the presenting symptoms are similar to those experienced in other diagnoses. Both over- and under-diagnosis occur frequently. Misdiagnosis carries allergic and nutritional risks, including acute reactions, growth faltering, micronutrient deficiencies and a diminished quality of life for infants and caregivers. An inappropriate diagnosis may also add a financial burden on families and on the healthcare system. Elimination and reintroduction of cow's milk (CM) and its derivatives is essential for diagnosing CMA as well as inducing tolerance to CM. In non-IgE mediated CMA, the diagnostic elimination diet typically requires 2-4 weeks before reintroduction, while for IgE mediated allergy the time window may be shorter (1-2 weeks). An oral food challenge (OFC) under medical supervision remains the most reliable diagnostic method for IgE mediated and more severe types of non-IgE mediated CMA such as food protein induced enterocolitis syndrome (FPIES). Conversely, for other forms of non-IgE mediated CMA, reintroduction can be performed at home. The OFC cannot be replaced by the milk ladder after a diagnostic elimination diet. The duration of the therapeutic elimination diet, once a diagnosis was confirmed, can only be established through testing changes in sensitization status, OFCs or home reintroduction, which are directed by local protocols and services' availability. Prior non-evidence-based recommendations suggest that the first therapeutic elimination diet should last for at least 6 months or up to the age of 9-12 months, whichever is reached first. After a therapeutic elimination diet, a milk-ladder approach can be used for non-IgE mediated allergies to determine tolerance. Whilst some centers use the milk ladder also for IgE mediated allergies, there are concerns about the risk of having immediate-type reactions at home. Milk ladders have been adapted to local dietary habits, and typically start with small amounts of baked milk which then step up in the ladder to less heated and fermented foods, increasing the allergenicity. This publication aims to narratively review the risks associated with under- and over-diagnosis of CMA, therefore stressing the necessity of an appropriate diagnosis and management.
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Affiliation(s)
- Rosan Meyer
- Faculty Medicine, Imperial College London, Department Nutrition and Dietetics, Winchester University, UK and Faculty Medicine, KU Leuven, Belgium
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence in Allergy Group; Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Fiocchi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, Rome, Italy
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - WAO DRACMA Guideline Group
- Faculty Medicine, Imperial College London, Department Nutrition and Dietetics, Winchester University, UK and Faculty Medicine, KU Leuven, Belgium
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence in Allergy Group; Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, Rome, Italy
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Suratannon N, Prapansilp P, Srinarongsook A, Tanpowpong P, Chatchatee P, Pongpirul K. Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management. Front Nutr 2023; 10:1099462. [PMID: 37346906 PMCID: PMC10281430 DOI: 10.3389/fnut.2023.1099462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 06/23/2023] Open
Abstract
Cow's milk protein allergy (CMPA) is children's most common food allergy. Therapeutic infant formulas for CMPA lead to symptom-free and potentially benefit early tolerance induction and reducing the allergic march in non-breastfed babies. This study assessed the cost-effectiveness of CMPA management with different therapeutic infant formulas in Thailand, which may reflect situations in developing countries throughout Asia. An analytic decision model was developed to simulate the occurrence of eczema, urticaria, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA over 36 months. Extensively hydrolyzed casein formula with added probiotic Lacticaseibacillus rhamnosus (previously Lactobacillus rhamnosus) strain GG (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), soy protein-based formula (SPF), and amino acid formula (AAF) were compared from the healthcare payer perspective. The results from a prospective cohort study were used for comparative effectiveness measures, while local experts were interviewed to estimate the healthcare resource used in the management of CMPA. The costs of healthcare resources were obtained from standard, publicly available sources. The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881). Compared with other formulas, EHCF+LGG was expected to save USD 370 (SPF), USD 1,071 (EHWF), and USD 6,161 (AAF) in the total cost of CMPA management over 36 months. In conclusion, EHCF+LGG was the most cost-effective strategy for managing non-breastfed infants with CMPA. This strategy was associated with more children developing immune tolerance to cow's milk and being symptom-free, contributing to overall cost-saving potential.
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Affiliation(s)
- Narissara Suratannon
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Panote Prapansilp
- Medical Sciences, Reckitt | Mead Johnson Nutrition, Bangkok, Thailand
| | | | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Pantipa Chatchatee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Krit Pongpirul
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Garib V, Trifonova D, Freidl R, Linhart B, Schlederer T, Douladiris N, Pampura A, Dolotova D, Lepeshkova T, Gotua M, Varlamov E, Beltyukov E, Naumova V, Taka S, Kiyamova A, Katsamaki S, Karaulov A, Valenta R. Milk Allergen Micro-Array (MAMA) for Refined Detection of Cow's-Milk-Specific IgE Sensitization. Nutrients 2023; 15:nu15102401. [PMID: 37242284 DOI: 10.3390/nu15102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Immunoglobulin-E(IgE)-mediated hypersensitivity to cow's milk allergens is a frequent cause of severe and life-threatening anaphylactic reactions. Besides case histories and controlled food challenges, the detection of the IgE antibodies specific to cow's milk allergens is important for the diagnosis of cow-milk-specific IgE sensitization. Cow´s milk allergen molecules provide useful information for the refined detection of cow-milk-specific IgE sensitization. METHODS A micro-array based on ImmunoCAP ISAC technology was developed and designated milk allergen micro-array (MAMA), containing a complete panel of purified natural and recombinant cow's milk allergens (caseins, α-lactalbumin, β-lactoglobulin, bovine serum albumin-BSA and lactoferrin), recombinant BSA fragments, and α-casein-, α-lactalbumin- and β-lactoglobulin-derived synthetic peptides. Sera from 80 children with confirmed symptoms related to cow's milk intake (without anaphylaxis: n = 39; anaphylaxis with a Sampson grade of 1-3: n = 21; and anaphylaxis with a Sampson grade of 4-5: n = 20) were studied. The alterations in the specific IgE levels were analyzed in a subgroup of eleven patients, i.e., five who did not and six who did acquire natural tolerance. RESULTS The use of MAMA allowed a component-resolved diagnosis of IgE sensitization in each of the children suffering from cow's-milk-related anaphylaxis according to Sampson grades 1-5 requiring only 20-30 microliters of serum. IgE sensitization to caseins and casein-derived peptides was found in each of the children with Sampson grades of 4-5. Among the grade 1-3 patients, nine patients showed negative reactivity to caseins but showed IgE reactivity to alpha-lactalbumin (n = 7) or beta-lactoglobulin (n = 2). For certain children, an IgE sensitization to cryptic peptide epitopes without detectable allergen-specific IgE was found. Twenty-four children with cow-milk-specific anaphylaxis showed additional IgE sensitizations to BSA, but they were all sensitized to either caseins, alpha-lactalbumin, or beta-lactoglobulin. A total of 17 of the 39 children without anaphylaxis lacked specific IgE reactivity to any of the tested components. The children developing tolerance showed a reduction in allergen and/or peptide-specific IgE levels, whereas those remaining sensitive did not. CONCLUSIONS The use of MAMA allows for the detection, using only a few microliters of serum, of IgE sensitization to multiple cow's milk allergens and allergen-derived peptides in cow-milk-allergic children with cow-milk-related anaphylaxis.
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Affiliation(s)
- Victoria Garib
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- International Center of Molecular Allergology, Ministry of Innovation Development, Tashkent 100174, Uzbekistan
| | - Daria Trifonova
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Raphaela Freidl
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Birgit Linhart
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Schlederer
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Nikolaos Douladiris
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexander Pampura
- Department of Allergology and Clinical Immunology, Research and Clinical Institute for Pediatrics Named after Yuri Veltischev at the Pirogov Russian National Research Medical University of the Russian Ministry of Health, 117997 Moscow, Russia
| | - Daria Dolotova
- Department of Bioinformatics, Department of Pediatric Surgery, Pirogov Russian National Research Medical University of the Russian Ministry of Health, 117997 Moscow, Russia
| | - Tatiana Lepeshkova
- Department of Faculty Therapy, Endocrinology, Allergology and Immunology, Ural State Medical University, 620028 Ekaterinburg, Russia
| | - Maia Gotua
- Center of Allergy and Immunology, 123182 Tbilisi, Georgia
| | - Evgeniy Varlamov
- Department of Allergology and Clinical Immunology, Research and Clinical Institute for Pediatrics Named after Yuri Veltischev at the Pirogov Russian National Research Medical University of the Russian Ministry of Health, 117997 Moscow, Russia
| | - Evgeny Beltyukov
- Department of Faculty Therapy, Endocrinology, Allergology and Immunology, Ural State Medical University, 620028 Ekaterinburg, Russia
| | - Veronika Naumova
- Department of Faculty Therapy, Endocrinology, Allergology and Immunology, Ural State Medical University, 620028 Ekaterinburg, Russia
| | - Styliani Taka
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alina Kiyamova
- International Center of Molecular Allergology, Ministry of Innovation Development, Tashkent 100174, Uzbekistan
| | - Stefani Katsamaki
- International Center of Molecular Allergology, Ministry of Innovation Development, Tashkent 100174, Uzbekistan
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Rudolf Valenta
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- NRC Institute of Immunology FMBA of Russia, 115478 Moscow, Russia
- Karl Landsteiner University for Health Sciences, 3500 Krems, Austria
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30
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6 Wochen/m – Blut in der Windel. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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31
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Lajnaf R, Feki S, Ben Ameur S, Attia H, Kammoun T, Ayadi MA, Masmoudi H. Cows' milk alternatives for children with cows' milk protein allergy - Review of health benefits and risks of allergic reaction. Int Dairy J 2023. [DOI: 10.1016/j.idairyj.2023.105624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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32
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Gurung M, Rosa F, Yelvington B, Terry N, Read QD, Piccolo BD, Moody B, Tripp P, Pittman HE, Fay BL, Ross TJ, Sikes JD, Flowers JB, Fox R, LeRoith T, Talatala R, Bar-Yoseph F, Yeruva L. Evaluation of a Plant-Based Infant Formula Containing Almonds and Buckwheat on Gut Microbiota Composition, Intestine Morphology, Metabolic and Immune Markers in a Neonatal Piglet Model. Nutrients 2023; 15:383. [PMID: 36678256 PMCID: PMC9861483 DOI: 10.3390/nu15020383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
A controlled-neonatal piglet trial was conducted to evaluate the impact of a plant-based infant formula containing buckwheat and almonds as the main source of protein compared to a commercially available dairy-based formula on the gut health parameters. Two day old piglets were fed either a plant-based or a dairy-based formula until day 21. Gut microbiome, cytokines, growth and metabolism related outcomes, and intestinal morphology were evaluated to determine the safety of the plant-based infant formula. This study reported that the plant-based formula-fed piglets had a similar intestinal microbiota composition relative to the dairy-based formula-fed group. However, differential abundance of specific microbiota species was detected within each diet group in the small and large intestinal regions and fecal samples. Lactobacillus delbrueckii, Lactobacillus crispatus, and Fusobacterium sp. had higher abundance in the small intestine of plant-based formula-fed piglets compared to the dairy-based group. Bacteroides nordii, Enterococcus sp., Lactobacillus crispatus, Prevotella sp., Ruminococcus lactaris, Bacteroides nordii, Eisenbergiella sp., Lactobacillus crispatus, Prevotella sp., and Akkermansia muciniphila had greater abundance in the large intestine of the plant based diet fed piglets relative to the dairy-based diet group. In the feces, Clostridiales, Bacteroides uniformis, Butyricimonasvirosa, Cloacibacillus porcorum, Clostridium clostridioforme, and Fusobacterium sp. were abundant in dairy-based group relative to the plant-based group. Lachnospiraceae, Clostridium scindens, Lactobacillus coleohominis, and Prevetolla sp. had greater abundance in the feces of the plant-based group in comparison to the dairy-based group. Gut morphology was similar between the plant and the dairy-based formula-fed piglets. Circulatory cytokines, magnesium, triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), vitamin D, vitamin K, and IgE levels were similar among all piglets independent of dietary group. Overall, the present study demonstrated that a plant-based formula with buckwheat and almonds as the primary source of protein can support similar gut microbiota growth and health outcomes compared to a dairy-based infant formula.
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Affiliation(s)
- Manoj Gurung
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Fernanda Rosa
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79409, USA
| | - Brooke Yelvington
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Nathan Terry
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Quentin D. Read
- USDA-ARS, Southeast Area, North Carolina State University, Raleigh, NC 27695, USA
| | - Brian D. Piccolo
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Becky Moody
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Patricia Tripp
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Hoy E. Pittman
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Bobby L. Fay
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Talyor J. Ross
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - James D. Sikes
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | | | - Renee Fox
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | - Tanya LeRoith
- Department of Biomedical Sciences & Pathobiology, Virginia Tech, Blacksburg, VA 24061, USA
| | - Rachelanne Talatala
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | | | - Laxmi Yeruva
- USDA-ARS, South East Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
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33
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Ursino FG, Orsi M, Mehaudy R, Micheletti ME, Parisi C, Petriz N, Parente C, Jauregui MB, Pagoto V. Cultural adaptation and validation of the Spanish version of the Cow's Milk-related Symptom Score (CoMiSS) for cow's milk protein allergy. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:44-49. [PMID: 34887216 DOI: 10.1016/j.rgmxen.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS The prevalence of cow's milk protein allergy in the first year of life varies from 1.8 to 7.5%. The Cow's Milk-related Symptom Score (CoMiSS) was published in 2014 and facilitates the diagnosis of cow's milk protein allergy. It is not meant to replace the clinical diagnosis, but rather to guide the treating team in the diagnostic process and reduce unnecessary diets. The aim was to translate the CoMiSS from English to Spanish and culturally adapt and validate the resulting Spanish version. MATERIALS AND METHODS An adaptation and validation study on the CoMiSS questionnaire was carried out in two phases: First, the CoMiSS was translated from English to Spanish, after which interrater reliability of the translated score was assessed. Second, interrater reliability tests were carried out on 32 pediatric patients under 7 years of age that were treated for the first time at the Food Allergy Clinic of the Hospital Italiano de Buenos Aires, were suspected of having cow's milk protein allergy, and had not received any treatment, within the time frame of May 2018 and May 2019. RESULTS Thirty-two patients were evaluated, 14 of whom were females (45%), and the median patient age was 3 months (IQR 2-4). The median result of the first measurement of the scale was 7.0 (IQR 4.5-9.0) and the median of the second measurement was 5.0 (IQR 4.0-8.0). The final intraclass correlation coefficient was 0.80 (95% CI 0.63-0.9). CONCLUSION The Spanish translation of the CoMiSS was comparable to the original English version, with excellent interrater reliability. This simple and little-known tool has the benefit of being a noninvasive, rapid, reliable, and easy-to-use strategy.
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Affiliation(s)
- F G Ursino
- Departamento de Gastroenterología infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Orsi
- Departamento de Gastroenterología infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Mehaudy
- Departamento de Gastroenterología infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M E Micheletti
- Departamento de Gastroenterología infantil, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Parisi
- Sección de Alergia Pediátrica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N Petriz
- Sección de Alergia Pediátrica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Parente
- Sección de Alergia Pediátrica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M B Jauregui
- Servicio de Alimentación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Pagoto
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Ribes-Koninckx C, Amil-Dias J, Espin B, Molina M, Segarra O, Diaz-Martin JJ. The use of amino acid formulas in pediatric patients with allergy to cow's milk proteins: Recommendations from a group of experts. Front Pediatr 2023; 11:1110380. [PMID: 37033186 PMCID: PMC10073469 DOI: 10.3389/fped.2023.1110380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
One of the most common food allergies in children is cow's milk allergy (CMA). In breast-fed infants with CMA, the mother is encouraged to avoid dairy products. If this is not possible, or in formula fed infants, use of hypoallergenic replacement formulas such as extensively hydrolyzed formulas (EHF) is recommended. However, in ∼5% of patients EHFs are not tolerated and/or allergy symptoms can persist. When EHFs are ineffective and in severe forms of CMA, amino acid-based formulas (AAF) should be considered. Six pediatric gastroenterologists with extensive experience in food allergy management reviewed scientific publications and international clinical practice guidelines to provide practical recommendations on AAF. The guidelines reviewed had discrepancies and ambiguities around the specific indications for using formulas as a milk substitute. The panel recommends AAFs as the first therapeutic option in anaphylaxis due to CMA, in acute and chronic severe food protein-induced enterocolitis syndrome, in CMA associated with multiple food allergy, and in cases of eosinophilic esophagitis not responding to an extended exclusion diet or not eating solids. The main benefit of AAF is its absence of residual allergenicity, making it a safe treatment option in severe CMA patients who do not tolerate or respond to an EHF.
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Affiliation(s)
- Carmen Ribes-Koninckx
- Pediatric Gastroenterology, Hepatology and Nutrition La Fe University and Politechnic Hospital & La Fe Research Institute, Valencia, Spain
- Correspondence: Carmen Ribes-Koninckx
| | - Jorge Amil-Dias
- Emeritus, S. João University Hospital Center, Porto, Portugal
| | - Beatriz Espin
- Pediatric Gastroenterology and Nutrition Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - Manuel Molina
- Department of Pediatric Gastroenterology and Nutrition, La Paz University Hospital, Madrid, Spain
| | - Oscar Segarra
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Juan J. Diaz-Martin
- Pediatric Gastroenterology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain
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36
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Collinson A, Waddell L, Freeman-Hughes A, Hickson M. Impact of a dietitian in general practice: paediatric food allergy. J Hum Nutr Diet 2022; 36:707-715. [PMID: 36562089 DOI: 10.1111/jhn.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. METHODS Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. RESULTS In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% (p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits (p = 0.001); and input from secondary care was also lower, 8 versus 25 patients (p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% (p < 0.001) in dietetic community care. CONCLUSIONS Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.
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Affiliation(s)
- Avril Collinson
- Plymouth Institute of Health Research, University of Plymouth, Plymouth, UK
| | - Lisa Waddell
- Department of Community Childrens Nutrition and Dietetic, Nottingham CityCare Partnership, Nottingham, UK
| | - Amy Freeman-Hughes
- Department of Nutrition and Dietetics, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mary Hickson
- Plymouth Institute of Health Research, University of Plymouth, Plymouth, UK.,NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Plymouth, Plymouth, UK
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Hydrolyzed rice formula for dietary management of infants with cow's milk allergy. World Allergy Organ J 2022; 15:100717. [PMID: 36438193 PMCID: PMC9678766 DOI: 10.1016/j.waojou.2022.100717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Allergic diseases are increasing globally and are a significant public health challenge, especially in children. Cow's milk allergy (CMA) is one of the most common food allergies in early childhood. When CMA is diagnosed and exclusive breastfeeding is not possible, current guidelines recommend extensively hydrolyzed formulas (eHF) or amino acid-based formulas (AAF), depending on the diagnosis and severity of symptoms. Hydrolyzed rice formulas (HRF) are considered an alternative to eHF and AAF where available. Objectives & methods We aimed to understand how HRF are being used and their position in the management of CMA, and to generate consensus on indications for use. Two virtual roundtables of international healthcare experts in pediatric food allergy focused on HRF were convened in May and October 2021. Experts provided multiple perspectives due to different specialties, locations, healthcare settings, and availability of HRF. Following discussion of international CMA guidelines and HRF use, identification of challenges along the diagnosis and treatment pathway, and translation of guidelines into clinical practice, an expert consensus on the use of HRF for CMA was developed. This involved repeated voting followed by statement amendment to reach 100% agreement. This publication summarizes insights from these meetings. Results There was 100% agreement on all 8 statements: (1) While breastmilk is the best source of nutrition for infants with CMA, when breastfeeding is not possible, a hypoallergenic formula can be used; (2) Per definition, a HRF is cow's milk protein-free; (3) A minority of infants with immunoglobulin (Ig)E-mediated CMA react to eHF due to residual cow's milk protein; (4) More infants with non-IgE-mediated CMA than IgE-mediated CMA react to eHF likely due to residual cow's milk protein; (5) When a diagnostic elimination diet is indicated, HRF can be used; (6) A HRF can be recommended as a first-line option for CMA, where available, as outlined in the Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines; (7) HRFs have proven hypoallergenicity and are suitable for the dietary management of CMA; (8) HRFs have been shown to support growth in infants with CMA, similar to other hypoallergenic formulas. Participants recommend healthcare professionals take these statements as guidance to use HRF in clinical practice. Based on efficacy and growth evidence, the experts found HRF a suitable option for the dietary management of CMA. Conclusion HRF can be recommended as a first-line alternative to cow's milk-based eHF or AAF, where available, in the dietary management of CMA.
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Practice Variations in the Management of Infants With Non-IgE-Mediated Cow's Milk Protein Allergy. J Pediatr Gastroenterol Nutr 2022; 75:444-449. [PMID: 35797449 DOI: 10.1097/mpg.0000000000003556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Infants with non-IgE-mediated food allergies are often referred to gastroenterologists or immunologists. We hypothesized that there are practice variations between these disciplines in the diagnosis and management of such infants. METHODS A computerized questionnaire was distributed between pediatric gastroenterologists and immunologists. The questions addressed diagnosis, management, and follow-up in 3 scenarios of infants with concern for food protein-induced allergic proctocolitis (FPIAP) due to non-IgE-mediated responses to cow's milk. RESULTS Three cases of infants with suspected FPIAP were presented: milk-based formula-fed (case 1) or breast-fed (case 2) infants that are well appearing and thriving, and a breast-fed infant who is not growing appropriately along with a personal and family history of atopy (case 3). Fifty-eight pediatric gastroenterologists and 32 immunologists completed the questionnaire. Significant differences between gastroenterologists and immunologists were noted regarding the recommended dietary changes in these scenarios. Moreover, despite available guidelines generated by both societies, most physicians confirm the diagnosis based on resolution of symptoms after the dietary change, without re-exposure to the the suspected trigger. In addition, time for recommended re-exposure in infants with FPIAP was also different; most gastroenterologists recommended waiting until 12 months of age, while immunologists suggested reintroduction earlier, up to 6 months of age. CONCLUSIONS We identified significant practice variations in diagnosis and management of FPIAP between pediatric gastroenterologists and immunologists, with lack of adherence to society guidelines. Joint task forces of primary care pediatricians, gastroenterologists, and immunologists should provide uniform guidelines to standardize care.
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Pulvirenti G, Sortino V, Manti S, Parisi GF, Papale M, Giallongo A, Leonardi S. Pathogenesis, diagnosis, dietary management, and prevention of gastrointestinal disorders in the paediatric population. Ital J Pediatr 2022; 48:172. [PMID: 36089576 PMCID: PMC9465927 DOI: 10.1186/s13052-022-01366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Nutrition has a central role in child growth with long-term effects, and nutrition management in gastrointestinal disorders has great importance for child health and disease outcomes. Breast milk is the first choice for infant nutrition. When it is not available, special milk formulas are adopted in specific conditions, as a medical treatment. Moving from the strong guidelines, recommendations and the new possibilities of special diet treatment, this review will analyse the current diet treatment in different gastrointestinal disorders, including food allergy, cystic fibrosis, inflammatory bowel diseases, short-bowel syndrome, gastroesophageal reflux, and eosinophilic esophagitis. The review also aimed at understanding the role of diet and its effects on these diseases. The growth monitoring can prevent malnutrition and improve disease outcomes, particularly in children, and an appropriate dietary management targeted to specific disorders is the best therapeutic choice alone or in combination with pharmacological therapy.
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Affiliation(s)
- Giulio Pulvirenti
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Vincenzo Sortino
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Sara Manti
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
- Pediatric Unit, Department of Human and Pediatric Pathology "Gaetano Barresi", AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy.
| | - Giuseppe Fabio Parisi
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Maria Papale
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Alessandro Giallongo
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Respiratory and Cystic Fibrosis Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Exploring the Potential of Human Milk and Formula Milk on Infants’ Gut and Health. Nutrients 2022; 14:nu14173554. [PMID: 36079814 PMCID: PMC9460722 DOI: 10.3390/nu14173554] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Early-life gut microbiota plays a role in determining the health and risk of developing diseases in later life. Various perinatal factors have been shown to contribute to the development and establishment of infant gut microbiota. One of the important factors influencing the infant gut microbial colonization and composition is the mode of infant feeding. While infant formula milk has been designed to resemble human milk as much as possible, the gut microbiome of infants who receive formula milk differs from that of infants who are fed human milk. A diverse microbial population in human milk and the microbes seed the infant gut microbiome. Human milk contains nutritional components that promote infant growth and bioactive components, such as human milk oligosaccharides, lactoferrin, and immunoglobulins, which contribute to immunological development. In an attempt to encourage the formation of a healthy gut microbiome comparable to that of a breastfed infant, manufacturers often supplement infant formula with prebiotics or probiotics, which are known to have a bifidogenic effect and can modulate the immune system. This review aims to elucidate the roles of human milk and formula milk on infants’ gut and health.
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Cawood AL, Meyer R, Grimshaw KE, Sorensen K, Acosta-Mena D, Stratton RJ. The health economic impact of cow's milk allergy in childhood: A retrospective cohort study. Clin Transl Allergy 2022; 12:e12187. [PMID: 36036235 PMCID: PMC9412243 DOI: 10.1002/clt2.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cow's milk allergy (CMA) is one of the most common food allergies among children. Whilst avoidance of cow's milk protein is the cornerstone of management, further treatment of symptoms including those affecting the gastrointestinal, skin and respiratory systems plus other allergic comorbidities, maybe required. This study aimed to quantify the wider economic impact of CMA and its management in the United Kingdom (UK). METHODS We conducted a retrospective matched cohort study on children with CMA (diagnosis read code and/or hypoallergenic formula prescription for ≥3 months) examining healthcare data (medication prescriptions and healthcare professional contacts) from case records within The Health Improvement Network (A Cegedim Proprietary Database) in the UK. A comparative cost analysis was calculated based on healthcare tariff and unit costs in the UK. RESULTS 6998 children (54% male; mean observation period 4.2 years) were included (n = 3499 with CMA, mean age at diagnosis 4.04 months; n = 3499 matched controls without CMA). Compared to those without CMA, medications were prescribed to significantly more children with CMA (p < 0.001) at a higher rate (p < 0.001). Children with CMA also required significantly more healthcare contacts (p < 0.001) at higher rate (p < 0.001) compared to those without CMA. CMA was associated with additional potential healthcare costs of £1381.53 per person per year. CONCLUSION The findings of this large cohort study suggest that CMA and its associated co-morbidities presents a significant additional healthcare burden with economic impact due to higher prescribing of additional medications. Further research into management approaches that may impact these clinical and economic outcomes of CMA is warranted.
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Affiliation(s)
- Abbie L Cawood
- Institute of Human Nutrition, Faculty of Medicine, Southampton General Hospital, Southampton, UK
- Medical Affairs, Nutricia Ltd, White Horse Business Park, Trowbridge, UK
| | - R Meyer
- Department of Paediatrics, St Mary's Hospital, London, UK
| | - Kate E Grimshaw
- Institute of Human Nutrition, Faculty of Medicine, Southampton General Hospital, Southampton, UK
- Dietetic Department, Salford Care Organisation, Salford Royal NHS Foundation Trust, Salford, UK
| | - Katy Sorensen
- Medical Affairs, Nutricia Ltd, White Horse Business Park, Trowbridge, UK
| | | | - Rebecca J Stratton
- Institute of Human Nutrition, Faculty of Medicine, Southampton General Hospital, Southampton, UK
- Medical Affairs, Nutricia Ltd, White Horse Business Park, Trowbridge, UK
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Cogurlu MT, Simsek IE, Aydogan M, Uncuoglu A, Acar HC. Prospective evaluation of tolerance to unheated milk-boiled egg after baked milk-egg tolerance under 2 years. Ann Allergy Asthma Immunol 2022; 129:742-750. [PMID: 35779844 DOI: 10.1016/j.anai.2022.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The time to acquisition of tolerance to unheated milk and regular egg after achievement of tolerance to baked goods is not known. OBJECTIVE To determine the time to acquisition of unheated-milk-regular-egg tolerance, after the tolerance of the baked forms, in children younger than 2 years. METHODS An initial oral food challenge with baked milk (BM) and baked egg (BE) was performed on patients who were reactive to unheated milk-regular egg, respectively. Patients who were BM-BE tolerant were offered unheated-milk-regular-egg challenges, and patients who were BM-BE reactive were offered BM-BE challenges at an average of 3-month intervals. Food-induced atopic dermatitis was included. RESULTS Thirty-six children with unheated-milk allergy (median age, 7.3 months [interquartile range (IQR), 6.0-13.5]) and 65 with regular-egg allergy (median age, 7 months [IQR, 5.8-11.0]) were included. Seven of 13 children who were BM tolerant acquired unheated-milk tolerance after a median 4.0 months (IQR, 2.0-7.0). Twelve of 23 children who were BM reactive acquired unheated-milk tolerance after a median 5.0 months (IQR, 3.0-8.0) after BM tolerance. Twenty-one of 29 children who were BE tolerant acquired regular-egg tolerance after a median 3.0 months (IQR, 1.0-6.0). Sixteen of 36 children who were BE reactive acquired regular-egg tolerance after a median 4.0 months (IQR, 2.0-6.8) after BE tolerance. CONCLUSION Different tolerance rates were determined for baked products at different time points in the first 2 years of life. Unheated-milk-regular-egg allergy resolved in up to 65.5% and 75.5% of cases, respectively, in an average 4 to 5 months after acquisition of BM-BE tolerance. Baked-milk-baked-egg tolerance may be regarded as a precursor of tolerance.
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Affiliation(s)
- Mujde Tuba Cogurlu
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
| | - Isıl Eser Simsek
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Metin Aydogan
- Division of Pediatric Allergy and Immunology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Aysen Uncuoglu
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Hazal Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, İstanbul University Cerrahpasa, Istanbul, Turkey
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Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow's Milk Related Symptom Score: The 2022 Update. Nutrients 2022; 14:nu14132682. [PMID: 35807862 PMCID: PMC9268587 DOI: 10.3390/nu14132682] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan 101, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-475748794
| | - Katerina Bajerova
- Department of Pediatrics, University Hospital Brno and Masaryk’s University, 625 00 Brno, Czech Republic;
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´s University, 625 00 Brno, Czech Republic
| | - Christophe Dupont
- Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, 75004 Paris, France;
| | - Philippe Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK;
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital, Instituto de Iinvestigacion Sanitaria La FE Valencia, 46026 Valencia, Spain;
| | - Silvia Salvatore
- Department of Paediatrics, University of Insubria, 21100 Varese, Italy;
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and Arieh Pickel for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel;
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-014 Warsaw, Poland;
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Franco C, Fente C, Sánchez C, Lamas A, Cepeda A, Leis R, Regal P. Cow's Milk Antigens Content in Human Milk: A Scoping Review. Foods 2022; 11:1783. [PMID: 35741982 PMCID: PMC9222876 DOI: 10.3390/foods11121783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022] Open
Abstract
The functionality of breast milk in terms of immunity is well-known. Despite this, a significant proportion of breastfed infants exhibit sensitization to different potentially allergenic proteins and clinical reactivity (including anaphylaxis) early in life and before the introduction of complementary feeding for the first time. The potential induction of early oral tolerance to overcome early allergic sensitization through exposure to allergens in breast milk also remains controversial and not yet well-established. The objective of this scoping review is to provide a critical appraisal of knowledge about the content of cow's milk antigens in human milk. The amount of dietary derived milk antigens found in human milk and the analytical methodologies used to detect and quantify these antigens, the allergic status of the mother, the stage of lactation, the time of sampling (before or after ingestion of food), and the impact of human milk allergen on the infant were the outcomes that were assessed. Allergy risk was explored in all reviewed studies and could help to better elucidate its role in the context of allergic disease development. According to the included literature, we can conclude that there are mainly fragments derived from bovine proteins in human milk, and the presence of potentially allergenic molecules is greater in the milk of mothers with an allergic tendency. A clear relationship between maternal diet and allergen content in breast milk could not be firmly concluded though. Also, infants receiving milk from human milk banks, where donor milk is pasteurized for preservation, may be subject to greater risk of allergy development, especially for β-lactoglobulin.
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Affiliation(s)
- Carlos Franco
- Department of Pediatrics, Medicine Faculty, Santiago de Compostela University, 15705 Santiago de Compostela, Spain; (C.F.); (R.L.)
| | - Cristina Fente
- Department of Analytical Chemistry, Nutrition and Bromatology, Santiago de Compostela University, 27002 Lugo, Spain; (C.S.); (A.L.); (A.C.); (P.R.)
| | - Cristina Sánchez
- Department of Analytical Chemistry, Nutrition and Bromatology, Santiago de Compostela University, 27002 Lugo, Spain; (C.S.); (A.L.); (A.C.); (P.R.)
| | - Alexandre Lamas
- Department of Analytical Chemistry, Nutrition and Bromatology, Santiago de Compostela University, 27002 Lugo, Spain; (C.S.); (A.L.); (A.C.); (P.R.)
| | - Alberto Cepeda
- Department of Analytical Chemistry, Nutrition and Bromatology, Santiago de Compostela University, 27002 Lugo, Spain; (C.S.); (A.L.); (A.C.); (P.R.)
| | - Rosaura Leis
- Department of Pediatrics, Medicine Faculty, Santiago de Compostela University, 15705 Santiago de Compostela, Spain; (C.F.); (R.L.)
| | - Patricia Regal
- Department of Analytical Chemistry, Nutrition and Bromatology, Santiago de Compostela University, 27002 Lugo, Spain; (C.S.); (A.L.); (A.C.); (P.R.)
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Hubbard GP, Atwal K, Graham L, Narayanan S, Cooke L, Casewell C, Denton SA, Gavin J, Browne RM, Kinnear FJ, McHardy AJ, Evans D, Vallis R, Venkataraman D, Cawood AL, Donohoe S, Steele V, Armstrong S, Stratton RJ. Synbiotic containing extensively hydrolyzed formula improves gastrointestinal and atopic symptom severity, growth, caregiver quality of life, and hospital-related healthcare use in infants with cow's milk allergy. Immun Inflamm Dis 2022; 10:e636. [PMID: 35634950 PMCID: PMC9119008 DOI: 10.1002/iid3.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/13/2022] Open
Abstract
Background Healthy gut microbiota is important for prognosis in cow's milk allergy (CMA). The application of synbiotics (specific pre‐ and probiotics) in extensively hydrolyzed formulae (eHFs) is a relatively new concept. Aims To evaluate a synbiotic‐containing, whey‐based eHF (SeHF) with galacto‐oligosaccharides, fructo‐oligosaccharides, and bifidobacterium breve M‐16V in infants with CMA. Materials and Methods A 31‐day one‐arm pilot study in 29 infants with CMA (mean age 30.8 weeks [SD 11]) was undertaken, with outcomes including gastrointestinal tolerance, atopic dermatitis symptoms, dietary intake, growth, SeHF acceptability, caregiver quality of life, and hospital‐related healthcare use. Results Significant improvements (p < .05) in the severity of abdominal pain (in 57%), burping (in 46%), flatulence (in 79%), constipation (in 14%), rhinitis (41%), and itchy eyes (73%), as well as atopic dermatitis in those with severe baseline symptoms (PO‐SCORAD© reduction: 34.7–18.2 (p = .003), n = 6) were observed over time. Growth and caregiver quality of life scores significantly increased (+26.7%, p < .05) over time. Hospital visits and medications significantly reduced (−1.61 and −2.23, respectively, p < .005) in the 6 months after SeHF initiation. Discussion In this small, single‐arm, pilot study, the use of SeHF enhanced the management of infants with non‐IgE mediated CMA who were already established on eHF. Conclusion: Whilst this study adds to the evidence base for the use of SeHF in CMA, further robust research to explore the longer‐term benefits of synbiotics, specifically the blend used in this study, for the clinical management of infants with CMA is warranted.
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Affiliation(s)
| | | | - Lynne Graham
- West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Lisa Cooke
- Bristol Royal Hospital for Children, Bristol, UK
| | | | - Sally-Ann Denton
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Joan Gavin
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Ailsa J McHardy
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Debbie Evans
- Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | | | | | - Sarah Donohoe
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Victoria Steele
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sonia Armstrong
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Rebecca J Stratton
- Nutricia Ltd, Trowbridge, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
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Dahdah L, Roelofs M, Knipping K, de Vries E, Rijnierse A, Garssen J, Brand PLP, Fiocchi A. Hypoallergenicity assessment of an extensively hydrolyzed whey-protein formula in cow's milk allergic infants. Pediatr Allergy Immunol 2022; 33:e13814. [PMID: 35754130 PMCID: PMC9542408 DOI: 10.1111/pai.13814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extensively hydrolyzed formulas are recommended for the dietary management of infants with cow's milk allergy (CMA). OBJECTIVES Hypoallergenicity, growth, and gastrointestinal (GI) tolerability of a new extensively hydrolyzed whey-protein formula (eHWF) in CMA children were assessed. METHODS In this prospective, randomized, international, multi-center study (Trial NL3889), 34 children with confirmed CMA (74% IgE-mediated) underwent a double-blind, placebo-controlled food challenge (DBPCFC) with an eHWF developed with non-porcine enzymes, supplemented with prebiotic short-chain galacto- and long-chain fructo-oligosaccharides (0.8 g/L, ratio 9:1), arachidonic acid (0.35/100 g), and docosahexaenoic acid (0.35/100 g). If tolerant to the eHWF, children participated in a 7-day open food challenge with this eHWF. Anthropometrics and GI tolerability were assessed in an optional 16-weeks follow-up. RESULTS Of the 34 children who started the DBPCFC with the eHWF, 25 subjects (19 boys, mean age: 61 weeks, 18 with IgE-mediated CMA) completed the DBPCFC and 7-day open challenge without major protocol deviations and tested negative at both challenges. One child experienced a late moderate eczematous allergic reaction in the optional follow-up period, indicating the need for close monitoring of subjects starting new formula. Weight and length gain followed the World Health Organization growth curves. Changes in frequency and consistency of stools upon test formula intake were transient. CONCLUSIONS The newly developed eHWF is a suitable option in CMA treatment as all subjects tolerated the product. This result is in line with the international criteria for hypoallergenicity (American Academy of Pediatrics) that state that more than 90% of CMA children must tolerate the formula. Use of the formula is also associated with normal growth curves and GI tolerability. TRIAL REGISTRATION Trial NL3889, https://www.trialregister.nl/trial/3889.
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Affiliation(s)
- Lamia Dahdah
- Allergy Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Karen Knipping
- Danone Nutricia Research, Utrecht, the Netherlands.,Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Esther de Vries
- Department of Pediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | | | - Johan Garssen
- Danone Nutricia Research, Utrecht, the Netherlands.,Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Paul L P Brand
- Isala Women and Children's Hospital, Zwolle, the Netherlands
| | - Alessandro Fiocchi
- Allergy Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
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Gold MS, Quinn PJ, Campbell DE, Peake J, Smart J, Robinson M, O’Sullivan M, Vogt JK, Pedersen HK, Liu X, Pazirandeh-Micol E, Heine RG. Effects of an Amino Acid-Based Formula Supplemented with Two Human Milk Oligosaccharides on Growth, Tolerability, Safety, and Gut Microbiome in Infants with Cow's Milk Protein Allergy. Nutrients 2022; 14:nu14112297. [PMID: 35684099 PMCID: PMC9182596 DOI: 10.3390/nu14112297] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
This open-label, non-randomized, multicenter trial (Registration: NCT03661736) aimed to assess if an amino acid-based formula (AAF) supplemented with two human milk oligosaccharides (HMO) supports normal growth and is well tolerated in infants with a cow's milk protein allergy (CMPA). Term infants aged 1-8 months with moderate-to-severe CMPA were enrolled. The study formula was an AAF supplemented with 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT). Infants were fed the study formula for 4 months and were offered to remain on the formula until 12 months of age. Tolerance and safety were assessed throughout the trial. Out of 32 infants (mean age 18.6 weeks; 20 (62.5%) male), 29 completed the trial. During the 4-month principal study period, the mean weight-for-age Z score (WAZ) increased from -0.31 at the baseline to +0.28 at the 4-months' follow-up. Linear and head growth also progressed along the WHO child growth reference, with a similar small upward trend. The formula was well tolerated and had an excellent safety profile. When comparing the microbiome at the baseline to the subsequent visits, there was a significant on-treatment enrichment in HMO-utilizing bifidobacteria, which was associated with a significant increase in fecal short-chain fatty acids. In addition, we observed a significant reduction in the abundance of fecal Proteobacteria, suggesting that the HMO-supplemented study formula partially corrected the gut microbial dysbiosis in infants with CMPA.
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Affiliation(s)
- Michael S. Gold
- Department of Allergy & Immunology, Women’s and Children’s Hospital, University of Adelaide, Adelaide, SA 5006, Australia;
- Correspondence:
| | - Patrick J. Quinn
- Department of Allergy & Immunology, Women’s and Children’s Hospital, University of Adelaide, Adelaide, SA 5006, Australia;
| | - Dianne E. Campbell
- Department of Allergy & Clinical Immunology, Children’s Hospital at Westmead, University of Sydney, Sydney, NSW 2145, Australia;
| | - Jane Peake
- Queensland Paediatric Immunology and Allergy Service, Queensland Children’s Hospital, University of Queensland, South Brisbane, QLD 4101, Australia;
| | - Joanne Smart
- Paediatric Allergy Services, Epworth Hospital, Richmond, VIC 3121, Australia;
| | - Marnie Robinson
- Melbourne Allergy Centre & Children’s Specialists Medical Group, Parkville, VIC 3152, Australia;
| | - Michael O’Sullivan
- Department of Immunology, Perth Children’s Hospital, Nedlands, WA 6009, Australia
| | | | | | - Xiaoqiu Liu
- Biostatistics and Data Science Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
| | | | - Ralf G. Heine
- Nestlé Health Science, CH-1800 Vevey, Switzerland; (E.P.-M.); (R.G.H.)
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48
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Allen HI, Pendower U, Santer M, Groetch M, Cohen M, Murch SH, Williams HC, Munblit D, Katz Y, Gupta N, Adil S, Baines J, de Bont EGPM, Ridd M, Sibson VL, McFadden A, Koplin JJ, Munene J, Perkin MR, Sicherer SH, Boyle RJ. Detection and management of milk allergy: Delphi consensus study. Clin Exp Allergy 2022; 52:848-858. [PMID: 35615972 DOI: 10.1111/cea.14179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy. METHODS Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback. FINDINGS Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialized formula. INTERPRETATION These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialized formula, compared with current guidelines.
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Affiliation(s)
- Hilary I Allen
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ursula Pendower
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Marion Groetch
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mitchell Cohen
- Department of Paediatrics, University of Alabama at Birmingham & Children's of Alabama, Birmingham, Alabama, USA
| | | | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yitzhak Katz
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Department of Paediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neeraj Gupta
- Division of Paediatric Allergy, Department of Paediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Sabeen Adil
- International Lactation Consultant Association, Raleigh, North Carolina, USA
| | | | - Eefje G P M de Bont
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Matthew Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Alison McFadden
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Josephine Munene
- Certified Lactation Educator, Kenya Association for Breastfeeding and La Leche League South Africa, Nairobi, Kenya
| | - Michael R Perkin
- Population Health Research Institute, St George's University of London, London, UK
| | - Scott H Sicherer
- Department of Paediatrics, University of Alabama at Birmingham & Children's of Alabama, Birmingham, Alabama, USA
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
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49
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Madrazo JA, Alrefaee F, Chakrabarty A, de Leon JC, Geng L, Gong S, Heine RG, Järvi A, Ngamphaiboon J, Ong C, Rogacion JM. International Cross-Sectional Survey among Healthcare Professionals on the Management of Cow's Milk Protein Allergy and Lactose Intolerance in Infants and Children. Pediatr Gastroenterol Hepatol Nutr 2022; 25:263-275. [PMID: 35611371 PMCID: PMC9110852 DOI: 10.5223/pghn.2022.25.3.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow's milk protein allergy (CMPA) and lactose intolerance (LI) in infants. METHODS A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. RESULTS Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. CONCLUSION The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.
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Affiliation(s)
- J Armando Madrazo
- Department of Pediatrics, Universidad Nacional Autónoma de México, México City, México
| | - Fawaz Alrefaee
- Pediatric Department, Al Adan Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Anjan Chakrabarty
- Department of Paediatrics, West Middlesex University Hospital, Isleworth, United Kingdom
| | - Julia C de Leon
- Department of Pediatrics, Cardinal Santos Medical Center, Manila, Philippines
| | - Lanlan Geng
- Department of Gastroenterology, Guangzhou Women's and Children's Medical Center, Guangzhou, China
| | - Sitang Gong
- Department of Pediatrics, Guangzhou Women's and Children's Medical Center, Guangzhou, China
| | | | | | | | - Christina Ong
- Department of Paediatric Gastroenterology, KK Women's and Children's Hospital, Singapore
| | - Jossie M Rogacion
- Department of Pediatrics, University of the Philippines, Philippine General Hospital, Manila, Philippines
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50
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Maeda M, Kuwabara Y, Tanaka Y, Nishikido T, Hiraguchi Y, Yamamoto-Hanada K, Okafuji I, Yamada Y, Futamura M, Ebisawa M. Is oral food challenge test useful for avoiding complete elimination of cow's milk in Japanese patients with or suspected of having IgE-dependent cow's milk allergy? Allergol Int 2022; 71:214-220. [PMID: 34593320 DOI: 10.1016/j.alit.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cow's milk, along with hen's egg, are common causes of food allergies in children worldwide. Accidental ingestion of milk is common and often induces severe allergic reactions. Oral food challenge test (OFC) is usually performed in patients with or suspected of having a food allergy. However, the evidence of whether cow's milk OFC is useful in IgE-dependent cow's milk allergy patients to avoid total elimination is not known. METHODS After setting the clinical question and outcomes, we performed a systematic review for relevant articles published from January 1, 2000 to August 31, 2019 using PubMed® and Ichushi-Web databases. Each article was then evaluated for the level of evidence. All positive results of the OFC were defined as adverse events. RESULTS Forty articles were selected in this study. Our review revealed that cow's milk OFC was able to avoid the complete elimination of cow's milk in 66% of the patients with cow's milk allergy. We also found that adverse events occurred frequently (50.5%). CONCLUSIONS This analysis supports the recommendation of conducting cow's milk OFC to avoid complete elimination of cow's milk, however the test should be conducted with careful consideration of the patient's safety. As the methods of OFC and subjects varied among the articles selected in this study, further studies are needed to obtain higher quality evidence.
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Affiliation(s)
- Mayu Maeda
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yu Kuwabara
- Department of Pediatrics, Ehime University Graduate School of Medicine Ehime, Japan
| | - Yuya Tanaka
- Department of Allergy, Kobe Children's Hospital, Hyogo, Japan
| | - Tomoki Nishikido
- Department of Pediatrics Pulmonology and Allergy, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yukiko Hiraguchi
- Department of Pediatrics, Center of Allergy and Clinical Immunology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yoshiyuki Yamada
- Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan; Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Masaki Futamura
- Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergology and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
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