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Benjamin-van Aalst O, Dupont C, van der Zee L, Garssen J, Knipping K. Goat Milk Allergy and a Potential Role for Goat Milk in Cow's Milk Allergy. Nutrients 2024; 16:2402. [PMID: 39125282 PMCID: PMC11314217 DOI: 10.3390/nu16152402] [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: 06/21/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
In many parts of the world, goat milk has been part of the human diet for millennia. Allergy to goat's milk, not associated with allergy to cow's milk, is a rare disorder, although some cases have been described. Goat milk proteins have substantial homology with cow's milk proteins and even show cross-reactivity; therefore, they are not advised as an alternative to cow's milk for infants with IgE-mediated cow's milk allergies. However, there are indications that, due to the composition of the goat milk proteins, goat milk proteins show lower allergenicity than cow's milk due to a lower αS1-casein content. For this reason, goat milk might be a better choice over cow's milk as a first source of protein when breastfeeding is not possible or after the breastfeeding period. Additionally, some studies show that goat milk could play a role in specific types of non-IgE-mediated cow milk allergy or even in the prevention of sensitization to cow's milk proteins. This review discusses a possible role of goat milk in non-IgE mediated allergy and the prevention or oral tolerance induction of milk allergy.
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Affiliation(s)
- Olga Benjamin-van Aalst
- Noordwest Hospital Group, 1815 JD Alkmaar, The Netherlands
- Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, 1091 AC Amsterdam, The Netherlands
| | - Christophe Dupont
- Ramsay Group, Pediatric Gastroenterology Department, Marcel Sembat Clinic, 75004 Paris, France
| | | | - Johan Garssen
- Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Karen Knipping
- Ausnutria B.V., 8025 BM Zwolle, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
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Lajnaf R, Feki S, Ben Ameur S, Attia H, Kammoun T, Ayadi MA, Masmoudi H. Recent advances in selective allergies to mammalian milk proteins not associated with Cow's Milk Proteins Allergy. Food Chem Toxicol 2023; 178:113929. [PMID: 37406758 DOI: 10.1016/j.fct.2023.113929] [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: 04/09/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
Cow's milk proteins allergy (CMA) is an atypical immune system response to cow's milk and dairy products. It's one of the most common food allergies in children affecting 8% of the total pediatric population pediatric population. This comprehensive review examines recent studies in CMA, especially regarding mammalian milk allergies such as goat's, sheep's, buffalo's, camel's, mare's and donkey's milk allergies in order to increase awareness of these selective allergies and to reduce allergy risks for those who have them. The consumption of other mammalian milk types is not recommended because of the significant homology between milk proteins from cow, sheep, goat and buffalo resulting in clinical cross-reactivity. However, camel's, mare's or donkey's milk may be tolerated by some allergic patients. Selective mammalian milk allergies are unusual and rare disorders characterized by severe symptoms including angio-oedema, urticaria, respiratory manifestations and anaphylaxis. Based on the reported allergic cases, cheese products including Ricotta, Romano, Pecorino and Mozzarella, are considered as the most common source of allergens especially in goat's, sheep's and buffalo's milk allergies, while the major allergens in donkey's and mare's milk seems to be whey proteins including lysozyme, α-lactalbumin and β-lactogloblin due to the low casein/whey proteins ratio in equine's milk.
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Affiliation(s)
- Roua Lajnaf
- Alimentary Analysis Unit, National Engineering School of Sfax, BPW 3038, Sfax, Tunisia; Immunology Department, Habib Bourguiba University Hospital, Sfax, Tunisia; Pediatric Department, Hédi Chaker University Hospital, Sfax, Tunisia.
| | - Sawsan Feki
- Immunology Department, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Ben Ameur
- Pediatric Department, Hédi Chaker University Hospital, Sfax, Tunisia
| | - Hamadi Attia
- Alimentary Analysis Unit, National Engineering School of Sfax, BPW 3038, Sfax, Tunisia
| | - Thouraya Kammoun
- Pediatric Department, Hédi Chaker University Hospital, Sfax, Tunisia
| | - Mohamed Ali Ayadi
- Department of Food Technology, University of Liege-Gembloux Agro-Bio Tech, Passage des Déportés, 2, Gembloux, B-5030, Belgium
| | - Hatem Masmoudi
- Immunology Department, Habib Bourguiba University Hospital, Sfax, Tunisia
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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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Alternatives to Cow’s Milk-Based Infant Formulas in the Prevention and Management of Cow’s Milk Allergy. Foods 2022; 11:foods11070926. [PMID: 35407012 PMCID: PMC8997926 DOI: 10.3390/foods11070926] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022] Open
Abstract
Cow’s milk-based infant formulas are the most common substitute to mother’s milk in infancy when breastfeeding is impossible or insufficient, as cow’s milk is a globally available source of mammalian proteins with high nutritional value. However, cow’s milk allergy (CMA) is the most prevalent type of food allergy among infants, affecting up to 3.8% of small children. Hypoallergenic infant formulas based on hydrolysed cow’s milk proteins are commercially available for the management of CMA. Yet, there is a growing demand for more options for infant feeding, both in general but especially for the prevention and management of CMA. Milk from other mammalian sources than the cow, such as goat, sheep, camel, donkey, and horse, has received some attention in the last decade due to the different protein composition profile and protein amino acid sequences, resulting in a potentially low cross-reactivity with cow’s milk proteins. Recently, proteins from plant sources, such as potato, lentil, chickpeas, quinoa, in addition to soy and rice, have gained increased interest due to their climate friendly and vegan status as well as potential lower allergenicity. In this review, we provide an overview of current and potential future infant formulas and their relevance in CMA prevention and management.
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Mulé P, Gabrielli S, Upton J, Em A, Ben-Shoshan M. Anaphylaxis to goat/sheep's milk in a 4-year-old boy tolerant to cow's milk. BMJ Case Rep 2020; 13:e232844. [PMID: 31919067 PMCID: PMC6954805 DOI: 10.1136/bcr-2019-232844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 11/04/2022] Open
Abstract
Immune-mediated reactions to dairy products may vary depending on the mammalian source. We present a case of anaphylaxis to goat/sheep's milk with tolerance to cow's milk. A 4-year-old boy of Eastern European descent presented with gastrointestinal and respiratory symptoms within minutes after eating a goat/sheep's milk-derived food product. The tryptase level measured 1 hour post initial symptoms and 1 month after the allergic reaction were 14.6 µg/L and 5.1 µg/L, respectively (norm: 0.0-13.5 µg/L), confirming the diagnosis of anaphylaxis. A skin prick test performed 1 month after the reaction was highly positive for goat/sheep's milk, but negative for cow's milk. Skin prick tests may establish a life-threatening goat/sheep's milk allergy. Goat/sheep's milk allergy should always be considered in cow's milk-tolerant patients who present with an allergic reaction to dairy products, or when undergoing/have completed of oral immunotherapy for cow's milk allergy.
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Affiliation(s)
- Pasquale Mulé
- Department of Pediatrics, Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Sofianne Gabrielli
- Department of Pediatrics, Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Julia Upton
- Department of Pediatrics, Division of Immunology and Allergy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abrams Em
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics, Division of Allergy and Immunology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Moshe Ben-Shoshan
- Department of Pediatrics, Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Québec, Canada
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Hazebrouck S, Ah-Leung S, Bidat E, Paty E, Drumare MF, Tilleul S, Adel-Patient K, Wal JM, Bernard H. Goat's milk allergy without cow's milk allergy: suppression of non-cross-reactive epitopes on caprine β-casein. Clin Exp Allergy 2014; 44:602-10. [PMID: 24372684 DOI: 10.1111/cea.12261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/30/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Goat's milk (GM) allergy associated with tolerance to cow's milk (CM) has been reported in patients without history of CM allergy and in CM-allergic children successfully treated with oral immunotherapy. The IgE antibodies from GM-allergic/CM-tolerant patients recognize caprine β-casein (βcap) without cross-reacting with bovine β-casein (βbov) despite a sequence identity of 91%. In this study, we investigated the non-cross-reactive IgE-binding epitopes of βcap. METHODS Recombinant βcap was genetically modified by substituting caprine domains with the bovine counterparts and by performing site-directed mutagenesis. We then evaluated the recognition of modified βcap by IgE antibodies from 11 GM-allergic/CM-tolerant patients and 11 CM-allergic patients or by monoclonal antibodies (mAb) raised against caprine caseins. The allergenic potency of modified βcap was finally assessed by degranulation tests of humanized rat basophil leukaemia (RBL)-SX38 cells. RESULTS Non-cross-reactive epitopes of βcap were found in domains 44-88 and 130-178. The substitutions A55T/T63P/L75P and P148H/S152P induced the greatest decrease in IgE reactivity of GM-allergic/CM-tolerant patients towards βcap. The pivotal role of threonine 63 was particularly revealed as its substitution also impaired the recognition of βcap by specific mAb, which could discriminate between βcap and βbov. The modified βcap containing the five substitutions was then unable to trigger the degranulation of RBL-SX38 cells passively sensitized with IgE antibodies from GM-allergic/CM-tolerant patients. CONCLUSIONS Although IgE-binding epitopes are spread all over βcap, a non-cross-linking version of βcap was generated with only five amino acid substitutions and could thus provide new insight for the design of hypoallergenic variants.
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Affiliation(s)
- S Hazebrouck
- INRA, UR 496, Unité d'Immuno-Allergie Alimentaire, CEA/iBiTeC-S/SPI, Gif-sur-Yvette, France
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Allergy to goat and sheep cheese with tolerance to cow's milk and its derivatives. Allergol Immunopathol (Madr) 2014; 42:186-90. [PMID: 23253687 DOI: 10.1016/j.aller.2012.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/03/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We present two adult and three paediatric patients who had allergic reactions after cheese ingestion and subsequently tolerated cow's milk derivatives. The objective of this study was to determine possible cross-reactivity between different types of cheese. METHODS Skin tests were performed to cow's milk fractions, and prick-prick tests for goat, sheep and cow cheese. Specific IgE to the fractions of cow's milk and cow, sheep and goat cheese was analysed. The protein profile of cow, sheep and goat cheese extracts was determined by SDS-PAGE and the allergenic profile by immunoblot. Cross-reactivity was investigated by immunoblot inhibition. RESULTS Skin tests were positive for casein in the patients. The prick-prick tests were positive for the three cheeses in patients 1 and 4, for goat and sheep cheese in patients 2 and 3, and for sheep cheese in patient 5. The specific IgE test was positive in patients 1, 3 and 4 for goat and sheep cheese, and negative in patients 2 and 5. Serum 3 and 4 clearly recognised goat and sheep cheese extracts. Goat casein was almost completely inhibited with sheep casein and partially inhibited with goat and sheep serum proteins, while there was no inhibition with cow cheese. Sheep casein was totally inhibited with sheep serum proteins. Sheep casein was inhibited with goat and cow caseins, suggesting cross-reactivity among the three types of cheese. CONCLUSIONS We showed sensitisation to goat and sheep cheese in two patients, and only to sheep cheese in another two of the studied patients.
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Bernard H, Ah-Leung S, Tilleul S, Drumare MF, Paty E, Bidat E, Wal JM, Hazebrouck S. Specificity of IgE antibodies from patients allergic to goat's milk and tolerant to cow's milk determined with plasmin-derived peptides of bovine and caprine β-caseins. Mol Nutr Food Res 2012; 56:1532-40. [DOI: 10.1002/mnfr.201200229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Hervé Bernard
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
| | - Sandrine Ah-Leung
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
| | - Sylvain Tilleul
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
| | - Marie-Françoise Drumare
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
| | - Evelyne Paty
- Université Paris Descartes, Assistance Publique des Hôpitaux de Paris; Hôpital Necker Enfants Malades; Paris France
| | - Etienne Bidat
- Service de Pédiatrie; Assistance Publique des Hôpitaux de Paris; Hôpital Ambroise Paré; Boulogne France
| | - Jean-Michel Wal
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
| | - Stéphane Hazebrouck
- INRA, UR 496; Unité d'Immuno-Allergie Alimentaire; CEA/iBiTeC-S/SPI; CEA de Saclay; Gif-sur-Yvette France
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Abstract
Cow's milk allergy (CMA) affects 2% to 3% of young children and presents with a wide range of IgE and non-IgE-mediated clinical syndromes, which have a significant economic and lifestyle effect. It is logical that a review of CMA would be linked to a review of soy allergy because soy formula is often an alternative source of nutrition for infants who do not tolerate cow's milk. This review examines the epidemiology, pathogenesis, clinical features, natural history, and diagnosis of cow's milk and soy allergy. Cross-reactivity and management of milk allergy are also discussed.
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Affiliation(s)
- Jacob D. Kattan
- Clinical Fellow, Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, NY, USA
| | - Renata R. Cocco
- Clinical Researcher, Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Brazil
| | - Kirsi M. Järvinen
- Assistant Professor, Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, NY, USA
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Affiliation(s)
- R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21, 20037 Paderno Dugnano (MI), Italy.
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Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010; 3:57-161. [PMID: 23268426 PMCID: PMC3488907 DOI: 10.1097/wox.0b013e3181defeb9] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis. Curr Opin Allergy Clin Immunol 2009; 9:251-8. [DOI: 10.1097/aci.0b013e32832b3f33] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Vitte J, Bongrand P. Anaphylaxie fatale au lait de brebis : place de la biologie. REVUE FRANCAISE D ALLERGOLOGIE 2009. [DOI: 10.1016/j.reval.2009.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vitte J, Bongrand P. Anaphylaxie fatale au lait de brebis : place de la biologie. Arch Pediatr 2008; 15:1300-3. [DOI: 10.1016/j.arcped.2008.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 03/10/2008] [Accepted: 04/30/2008] [Indexed: 11/28/2022]
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