Allergenicity of cow milk proteins

Preparation of Hypoallergenic Whey Protein Hydrolysate by a Mixture of Alcalase and Prozyme and Evaluation of Its Digestibility and Immunoregulatory Properties

Whey protein (WP) has nutritional value, but the presence of β-lactoglobulin (β-LG) and α-lactalbumin (α-LA) cause allergic reactions. In this study, hypoallergenic whey protein hydrolyate (HWPH) was prepared by decomposing β-LG and α-LA of WP using exo- and endo-type proteases. The enzyme mixing ratio and reaction conditions were optimized using response surface methodology (RSM). Degradation of α-LA and β-LG was confirmed through gel electrophoresis, and digestion, and absorption rate, and immunostimulatory response were measured using in vitro and in vivo systems. Through RSM analysis, the optimal hydrolysis conditions for degradation of α-LA and β-LG included a 1:1 mixture of Alcalase and Prozyme reacted for 10 h at a 1.0% enzyme concentration relative to substrate. The molecular weight of HWPH was <5 kDa, and leucine was the prominent free amino acid. Both in vitro and in vivo tests showed that digestibility and intestinal permeability were higher in HWPH than in WP. In BALB/c mice, as compared to WP, HWPH reduced allergic reactions by inducing elevated Type 1/Type 2 helper T cell ratio in the blood, splenocytes, and small intestine. Thus, HWPH may be utilized in a variety of low allergenicity products intended for infants, adults, and the elderly.

Milk Allergen Micro-Array (MAMA) for Refined Detection of Cow's-Milk-Specific IgE Sensitization

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.

Relevance of Early Introduction of Cow’s Milk Proteins for Prevention of Cow’s Milk Allergy

Food allergy incidence has increased worldwide over the last 20 years. For prevention of food allergy, current guidelines do not recommend delaying the introduction of allergenic foods. Several groundbreaking studies, such as the Learning Early About Peanut Allergy study, showed that the relatively early introduction of this allergenic food between 4–6 months of age reduces the risk of peanut allergy. However, less is known about the introduction of cow’s milk, as many children already receive cow’s-milk-based formula much earlier in life. This can be regular cow’s milk formula with intact milk proteins or hydrolyzed formulas. Several recent studies have investigated the effects of early introduction of cow’s-milk-based formulas with intact milk proteins on the development of cow’s milk allergy while breastfeeding. These studies suggest that depending on the time of introduction and the duration of administration of cow’s milk, the risk of cow’s milk allergy can be reduced (early introduction) or increased (very early introduction followed by discontinuation). The aim of this narrative review is to summarize these studies and to discuss the impact of early introduction of intact cow’s milk protein—as well as hydrolyzed milk protein formulas—and the development of tolerance versus allergy towards cow’s milk proteins.

Infant feeding practices and asthma in children aged 6 months to 5 years using a propensity score approach

OBJECTIVES

We examined the association between exclusive breastfeeding, early introduction of feeding formula, early weaning, and asthma in children aged six months to five years in a sample of non-institutionalized US children using a propensity score approach.

METHODS

Our study used data from the National Survey of Children's Health (2012-2018) of 3,820 children with physician-diagnosed asthma aged 6 months to 5 years. Propensity score matching (PSM) was applied to control selection bias with age, sex, race, birth weight, Federal Poverty Level, parent's education, and parent smoking history used as covariates in PSM. The total number in the matched sample was 6,904 (3,452 non-asthmatics; 3,452 asthmatics). Matched and unmatched samples were analysed using the χ² test and multiple logistic regression.

RESULTS

Exclusive breastfeeding was protective against asthma in the pre-matching (AOR 0.72; 95% CI: 0.54-0.97; p = 0.03) and post-matching (AOR 0.66; 95% CI: 0.55-0.81; p < 0.001) samples. Formula feeding before 6 months was associated with asthma in unmatched (AOR 1.38; 95% CI: 1.15-1.66; p < 0.001) and matched (AOR 1.31; 95% CI: 1.16-1.47; p < 0.001) sample. Early weaning before 6 months was associated with asthma in unmatched (AOR 1.62; 95% CI: 1.35-1.54; p < 0.001) and matched sample (AOR 1.37; 95% CI: 1.23-1.54; p < 0.001).

CONCLUSION

Public health systems should continue to recommend the implementation of the World Health Organization exclusive breastfeeding guideline in developed countries. Asthma interventions in children under two years should continue to emphasize exclusive breastfeeding to reduce the incidence of infant asthma.

Recent perspective on cow's milk allergy and dairy nutrition

Cow's milk is a highly nutritious biological fluid that provides nourishment and immunity to infants when breastfeeding declines. However, some infants, children, and adults are allergic to cow's milk because milk contains potential allergens in the form of proteins. Casein and whey proteins and their coagulated sub-fractions in the milk such as αS₁-casein, αS₂-casein, β-casein, κ-casein and α-lactalbumin, β-lactoglobulin, bovine serum albumin, immunoglobulins, lactoferrin, respectively are the major etiological determinant of cow's milk allergy (CMA). Moreover, milk processing techniques such as homogenization and pasteurization alter the milk fat and whey protein's molecular structure and serve them as allergens to the immune system of allergic individuals. Strict exclusion of nutrient-rich milk and other dairy products from diet puts children with CMA at higher nutritional risk. Thus, regular nutritional monitoring, the inclusion of protein and mineral-rich supplements as a substitute for cow's milk, management of animal genetics (sheep, goats, buffaloes, camel, mare, donkey, yak), and milk processing to produce non-allergenic milk by inactivating allergic proteins for designer nutrition is essentially required. This review paper details the prevalence, molecular profiling of milk allergens (proteins), body immune response against CMA, consequences of milk processing, treatment, and novel role of galectins as potentially allergy suppressors.

Timing of Cow's Milk or Cow's Milk Formula Introduction to the Infant Diet and Atopic Risk in Children: a Systematic Review and Meta-analysis

Infant feeding is an important early-life exposure that may influence the development of atopic disease. The optimal timing of introduction of food allergens, including cow's milk (CM), is not known. This study aims to systematically review the evidence describing the effects of timing of CM or cow's milk formula (CMF) introduction to the infant diet on the development of atopic diseases during childhood. Pubmed, Embase, CINAHL, Cochrane CENTRAL, and CNKI were searched through May 30, 2019. Study screening and data extraction by two reviewers followed the PRISMA statement. Data were extracted independently in duplicate, and meta-analyses were performed by pooling unadjusted and adjusted odds ratio (OR) separately. Heterogeneity was explored using I² and publication bias by funnel plots and Begg's tests. In total, 45 studies from 20 countries were included. Meta-analyses using adjusted data showed that no associations were observed between early introduction of CM or CMF and the risk of asthma (< 4 vs. ≥ 4 months: OR 1.16, 95% confidence interval (CI) 0.89, 1.51), wheeze (< 6 vs. ≥ 6 months: OR 1.15, 95% CI 0.85, 1.56), and eczema or atopic dermatitis (< 6 vs. ≥ 6 months: OR 0.96, 95% CI 0.65, 1.41). Overall, quite little high-quality evidence was identified to allow for definitive conclusions on the association between early CM or CMF introduction and risk of allergic diseases. Our meta-analysis on this topic highlights the specific gaps in information for public recommendations regarding CM or CMF feeding practice in an early stage of life, particularly before 3 months of age.

The effect of atmospheric cold plasma treatment on the antigenic properties of bovine milk casein and whey proteins

Casein, β-lactoglobulin and α-lactalbumin are major milk protein allergens. In the present study, the structural modifications and antigenic response of these bovine milk allergens as induced by non-thermal treatment by atmospheric cold plasma were investigated. Spark discharge (SD) and glow discharge (GD), as previously characterized cold plasma systems, were used for protein treatments. Casein, β-lactoglobulin and α-lactalbumin were analyzed before and after plasma treatment using SDS-PAGE, FTIR, UPLC-MS/MS and ELISA. SDS-PAGE results revealed a reduction in the casein and α-lactalbumin intensity bands after SD or GD treatments; however, the β-lactoglobulin intensity band remained unchanged. FTIR studies revealed alterations in protein secondary structure induced by plasma, particularly contents of β-sheet and β-turn. The UPLC-MS/MS results showed that the amino acid compositions decreased after plasma treatments. ELISA of casein and α-lactalbumin showed a decrease in antigenicity post plasma treatment, whereas ELISA of β-lactoglobulin showed an increase in antigenicity. The study indicates that atmospheric cold plasma can be tailored to mitigate the risk of bovine milk allergens in the dairy processing and ingredients sectors.

Heat treatment of β-lactoglobulin affects its digestion and translocation in the upper digestive tract

Heat treatment is a commonly applied unit operation in the processing of β-lactoglobulin containing products. This does, however, influence its structure and thereby impacts its activity and digestibility. We describe how various heat-treatments of β-lactoglobulin change the digestibility using a modified version of the current consensus INFOGEST protocol. Additionally, protein was investigated for its translocation over the intestinal epithelial barrier, which would bring them in contact with immune cells. The extent of gastric digestibility was higher when the protein structure was more modified, while the influence of glycation with lactose was limited. Translocation studies of protein across Caco-2 cell monolayers showed a lower translocation rate of protein heated in solution compared to the others. Our study indicates that structural modifications after different heat-treatments of β-lactoglobulin increase in particular gastric digestibility and the translocation efficiency across intestinal epithelial cells.

Enhancement of Tryptic Digestibility of Milk β-Lactoglobulin Through Treatment with Recombinant Rice Glutathione/Thioredoxin and NADPH Thioredoxin Reductase/Thioredoxin Systems

β-Lactoglobulin (BLG), a member of lipocalin family, is one of the major bovine milk allergens. This protein exists as a dimer of two identical subunits and contains two intramolecular disulfide bonds that are responsible for its resistance to trypsin digestion and allergenicity. This study aimed to evaluate the effect of reduction of disulfide bonds of BLG with different rice thioredoxins (Trxs) on its digestibility and allergenicity. Therefore, the active recombinant forms of three rice Trx isoforms (OsTrx1, OsTrx20, and OsTrx23) and one rice NADPH-dependent Trx reductase isoform (OsNTRB) were expressed in Escherichia coli. Based on SDS-PAGE, HPLC analysis, and competitive ELISA, the reduction of disulfide bonds of BLG with OsNTRB/OsTrx23, OsNTRB/OsTrx1, GSH/OsTrx1, or GSH/OsTrx20 increased its trypsin digestibility and reduced its immunoreactivity. The finding of this study opens new insights for application of plant Trxs in the improvement of food protein digestibility. Especially, the use of OsTrx20 and OsTrx1 are more cost-effective than E. coli and animal Trxs due to their reduction by GSH and no need to NADPH and Trx reductase as mediator enzyme.

Good tolerance to goat's milk in patients with recurrent aphthous ulcers with increased immunoreactivity to cow's milk proteins

BACKGROUND

Recurrent aphthous ulcers (RAU) represent a very common, but poorly understood mucosal disorder. The connection between immunity to cow's milk proteins (CMP) and oral diseases was noted earlier. The goal of this study was to determine the prevalence of the increased levels of serum antibodies to goat's milk proteins (GMP), by enzyme-linked immunosorbent assay (ELISA) test, in subjects who have RAU and proven increased immunity to CMP.

METHODS

Fifty subjects with RAU (36 with proven increased immunity to CMP and 14 without this increased immunity) were included in this research. Levels of serum IgA, IgG, and IgE antibodies to the same quantity of the examined antigens were determined by ELISA. The statistical analysis of data was performed by Wilcoxon rank-sum test and Mann-Whitney test.

RESULTS

The levels of serum antifresh cow's milk IgA, IgG, and IgE antibodies were significantly higher than the levels of serum antifresh goat's milk, in subjects with RAU with proven increased immunoreactivity to CMP (P = 0.0003; P < 0.0001; P < 0.0001).

CONCLUSIONS

These results indicate that patients with RAU with increased immunity to CMP could consider the use of goat's milk as the alternative protein source.

Tolerability of a fully maturated cheese in cow's milk allergic children: biochemical, immunochemical, and clinical aspects

BACKGROUND

From patients' reports and our preliminary observations, a fully maturated cheese (Parmigiano-Reggiano; PR) seems to be well tolerated by a subset of cow's milk (CM) allergic patients.

OBJECTIVE AND METHODS

To biochemically and immunologically characterize PR samples at different maturation stage and to verify PR tolerability in CM allergic children. Seventy patients, with suspected CM allergy, were enrolled. IgE to CM, α-lactalbumin (ALA), β-lactoglobulin (BLG) and caseins (CAS) were tested using ImmunoCAP, ISAC103 and skin prick test. Patients underwent a double-blind, placebo-controlled food challenge with CM, and an open food challenge with 36 months-maturated PR. Extracts obtained from PR samples were biochemically analyzed in order to determine protein and peptide contents. Pepsin and trypsin-chymotrypsin-pepsin simulated digestions were applied to PR extracts. Each PR extract was investigated by IgE Single Point Highest Inhibition Achievable assay (SPHIAa). The efficiency analysis was carried out using CM and PR oral challenges as gold standards.

RESULTS

The IgE binding to milk allergens was 100% inhibited by almost all PR preparations; the only difference was for CAS, mainly α(S1)-CAS. Sixteen patients sensitized to CM tolerated both CM and PR; 29 patients tolerated PR only; 21 patients, reacted to both CM and PR, whereas 4 patients reactive to CM refused to ingest PR. ROC analysis showed that the absence of IgE to BLG measured by ISAC could be a good marker of PR tolerance. The SPHIAa using digested PR preparations showed a marked effect on IgE binding to CAS and almost none on ALA and BLG.

CONCLUSIONS

58% of patients clinically reactive to CM tolerated fully maturated PR. The preliminary digestion of CAS induced by PR maturation process, facilitating a further loss of allergenic reactivity during gut digestion, might explain the tolerance. This hypothesis seems to work when no IgE sensitization to ISAC BLG is detected.

Fractionation of whey protein isolate with supercritical carbon dioxide to produce enriched α-lactalbumin and β-lactoglobulin food ingredients

An environmentally friendly protein fractionation process using supercritical carbon dioxide (SCO(2)) as an acid was developed to produce enriched α-lactalbumin (α-LA) and β-lactoglobulin (β-LG) fractions from whey protein isolate solutions containing from 2 to 10% WPI. This study investigated the effects of pH, temperature, WPI concentration, and residence time on the precipitation kinetics and recovery yields of individual whey proteins and the relative enrichment and composition of both protein fractions. At 5.5-34 MPa and 60-65 °C, solubilized SCO(2) decreased solution pH and induced the formation and precipitation of α-LA aggregates. Gel electrophoresis and HPLC of the enriched fractions demonstrated the production of ≥ 60% pure α-LA, and ≥ 70% pure β-LG, under various operating conditions, from WPI containing ∼57% β-LG and 21% α-LA. The enriched fractions are ready-to-use food ingredients with neutral pH, untainted by acids and contaminants.

Peptide array-based analysis of the specific IgE and IgG4 in cow's milk allergens and its use in allergy evaluation

Cow's milk (CM) is one of the major causes of food allergies in children. We constructed a peptide array consisting of a linear 16-mer peptide library with an offset of 3-mer, which corresponds to the primary sequences of six major CM allergens. The immune reactivity to cow's milk proteins diminishes with age and clinical tolerance commonly occurs. Although the central role of IgE in allergy is well established, the role of other specific antibody classes in obtaining immunotolerance is not well known. The hypothesis that patients become tolerant when they develop immunological changes particularly with the IgG4 isotype has been proposed. In this study, the binding pattern of the CM protein-specific IgE and IgG4 epitopes was measured using the peptide array with sera of 12 patients with persistent CM allergy (CMA), sera of 5 children who outgrew CMA, and sera of 7 CM-sensitized children without allergy symptoms. In CMA patients the IgG4/IgE fluorescence intensity ratios varied greatly from peptide to peptide, and the scatter plots of IgE versus IgG4 signals using significant IgE-binding peptides showed different distribution patterns. When setting the boundary line based on the IgG4/IgE ratio (IgG4/IgE=2), patients with persistent CMA and CM-sensitized children can be distinguished by the plot pattern of peptides. Furthermore, the number of peptide plots in these regions was less in children who outgrew CMA. The approach employed in this study will allow for the distinction between CMA and CM-sensitization, and will enable the estimation of CMA outgrow by monitoring the time elapsed data.

WITHDRAWN: Cow's milk protein avoidance and development of childhood wheeze in children with a family history of atopy

BACKGROUND

In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease, when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas.

OBJECTIVES

To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children.

SEARCH STRATEGY

We searched the Cochrane database for eligible trials until February 2002. We obtained the full text papers of all abstracts identified as RCTs and two reviewers independently reviewed them.

SELECTION CRITERIA

We included randomised controlled trials involving children with a family history of atopy in at least one first degree relative, if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein, using soya or other hypoallergenic formula during the initial four months of life or longer.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet.

MAIN RESULTS

Six trials used hydrolysed formula for at least four months, in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk 0.40, 95% Confidence Intervals 0.19 to 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age.

AUTHORS' CONCLUSIONS

Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of four months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.

Maternal consumption of dairy products during pregnancy and lactation, and the development of cow's milk antibodies in the offspring

OBJECTIVE

To assess whether the maternal consumption of milk and milk products affects development of cow's milk (CM) antibodies in infants.

DESIGN

A randomized pilot trial using food frequency questionnaires (mothers) and food records (infants).

SETTING

Families with a newborn infant with increased HLA-DQB1-conferred risk of type 1 diabetes and at least one first-degree relative affected by type 1 diabetes from 16 hospitals in Finland between April 1995 and November 1997.

SUBJECTS AND INTERVENTION

Infants randomized to receive a hydrolysed formula when breast milk was not available during their first 6-8 mo (n=112). Of these, 13 dropped out by the age of 3 mo and two were excluded due to incomplete CM antibody data.

RESULTS

Maternal milk protein intake from cheese during pregnancy was inversely related to IgA-class antibody titres to beta-lactoglobulin (BLG) and casein (CAS) at 3 mo, and to IgA antibody titres to BLG at 6 mo. Maternal consumption of raw milk products during lactation was positively related to the development of IgA antibody titres to CAS at 6 mo, and inversely correlated to IgG antibody titres to bovine serum albumin (BSA) and IgA antibody titres to CAS at 2 y. Maternal cheese consumption was inversely related to the IgG antibody titres to CM formula and CAS and to the IgA antibody titres to CAS in early infancy.

CONCLUSIONS

Few associations were established between maternal CM protein intake and CM protein antibody levels in the infants. The milk and milk products taken by the mother differed in their impact on the emerging CM antibody response in the offspring.

A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants

Breastfeeding benefits preterm infants from a nutritional, gastrointestinal, immunological, developmental, and psychological perspective. Despite the benefits, the incidence and duration of breastfeeding preterm infants continues to be less than that of full-term infants. The lower incidence is probably related to breastfeeding challenges that preterm infants and parents face, including establishing and maintaining a milk supply and transitioning from gavage feeding to breastfeeding. In order to increase the incidence and duration of breastfeeding preterm infants, researchers must examine breastfeeding experiences longitudinally. This way, researchers and clinicians can begin to understand the barriers to breastfeeding at various time periods in the breastfeeding experience and begin implementing strategies to remove these barriers.

Cow's milk allergy in infants with atopic eczema is associated with aberrant production of interleukin-4 during oral cow's milk challenge

OBJECTIVES

A failure in the establishment and maintenance of oral tolerance in infancy may result in food allergy. To further assess the role of the intestinal immune system in cow's milk allergy (CMA), we investigated the systemic production of the pro-allergenic Th2 cytokine interleukin (IL)-4 and anti-allergenic cytokines IL-10, transforming growth factor (TGF)-beta1 and TGF-beta2 in infants suffering from atopic eczema with and without CMA during antigen elimination diet and oral antigen exposure.

METHODS

18 infants (mean age, 9.6 months; 95% confidence interval 8.1-11.1 months) with atopic eczema and CMA and 17 infants (mean age, 9.7 months; 95% confidence interval 8.6-10.9 months) with atopic eczema tolerant to milk as assessed by a double blind, placebo-controlled cow's milk challenge were investigated. Peripheral blood mononuclear cells were obtained during antigen elimination diet and during oral cow's milk challenge and stimulated with Concanavalin-A or cow's milk or were left unstimulated. The cytokine concentrations were measured by enzyme-linked immunosorbent assay.

RESULTS

During antigen elimination, the Concanavalin A-stimulated production of TGF-beta2 was significantly lower in infants with CMA as compared with infants without CMA: 129 pg/mL (interquartile ratio, 124-144 pg/mL) vs. 149 pg/mL (interquartile ratio, 133-169 pg/mL); P = 0.016. During oral antigen exposure, the immune responses in infants with CMA were characterized by significantly higher spontaneous production of IL-4 as compared with those without CMA: 12.0 pg/mL (interquartile ratio, 5.2-28.3 pg/mL) vs. 4.2 pg/mL (interquartile ratio, 1.5-7.6 pg/mL); P = 0.018.

CONCLUSIONS

Infants with atopic eczema and CMA exhibit markedly increased systemic pro-allergenic IL-4 responses on intestinal antigen contact, which may partially be explained by a defective ability to launch anti-allergenic TGF-beta2 responses.

Lactobacillus GG effect in increasing IFN-gamma production in infants with cow's milk allergy

BACKGROUND

Probiotic bacteria are potentially beneficial to maturation of the infant's immune system.

OBJECTIVE

To examine the role of probiotic bacteria in treatment of cow's milk allergy (CMA) and IgE-associated dermatitis, we investigated the immunologic effects of Lactobacillus rhamnosus GG (LGG) and a mixture of 4 bacterial species (MIX).

METHODS

In a randomized, double-blind study design, concomitantly with elimination diet and skin treatment, LGG, MIX, or placebo was given for 4 weeks to infants with suspected CMA. After anti-CD3 (OKT3) and anti-CD28 stimulation of PBMCs, IFN-gamma, IL-4, IL-5, and IL-12 levels were measured in culture supernatants by ELISA. Intracellular IFN-gamma, IL-4, and IL-5 production on CD4 lymphocytes was analyzed with fluorescence-activated cell sorting.

RESULTS

Secretion of IFN-gamma by PBMCs before the treatment was significantly lower in infants with CMA (P=.016) and in infants with IgE-associated CMA (P=.003) than in non-CMA infants. Among the infants who received LGG, the level of secreted IFN-gamma increased in those with CMA (P=.006) and in those with IgE-associated dermatitis (P=.017) when compared with the placebo group. Secretion of IL-4 increased significantly in infants with CMA in the MIX (P=.034) but not in the LGG group.

CONCLUSION

Deficiency in IFN-gamma response appears to be related to CMA. LGG raises IFN-gamma production of PBMC in infants with CMA and in infants with IgE-associated dermatitis and may thus provide beneficial TH1 immunomodulatory signals. MIX, although containing LGG, appears to modulate the immune responses differently.

Parenteral immunization to beta-lactoglobulin modifies the intestinal structure and mucosal electrical parameters in rabbit

Systemic and local immune responses and the intestinal structure were examined in parenterally beta-Lg-sensitized rabbits. Immunization led to high IgG titers against beta-Lg. In a Ussing chamber, a sensitized ileum had a higher short-circuit current (Isc) and potential difference (PD) than a control following in vitro beta-Lg challenge. Histological study indicated that presence of the sensitizing antigen affected and considerably modified the structure of the intestinal mucosa in sensitized rabbits when compared to controls. These alterations were revealed by active atrophy and marked infiltration of the lymphocytes. These findings indicate that antigen exposure results in morphological changes and abnormalities affecting the transport of water and electrolytes. This study provides a clearer understanding of the physiopathological mechanisms of allergy to cow's milk protein.

Isolation and structural elucidation of a peptide derived from Edam cheese that inhibits beta-lactoglobulin transport

A peptide that inhibits beta-lactoglobulin absorption in an in vitro Caco-2 cell model was isolated from Edam cheese. By 1H-NMR and N-terminal amino acid analyses, the active compound was identified as Asp-Lys-Ile-His-Pro-Phe. The sequence of the hexapeptide is the same as the amino acid sequence of residues 47-52 of beta-casein. The hexapeptide shows remarkable inhibition of beta-lactoglobulin transport at a concentration of 10(-7)M. The possibility exists that this peptide can be applied practically to the prevention of milk-sensitive allergy.

Cow's milk proteins/allergens

OBJECTIVE

The primary objective of this review is to provide updated data on the structure and function of the main cow's milk proteins (CMPs) identified as allergens and on the characterization of their epitopes.

DATA SOURCES

The review represents a synthesis of basic literature and most relevant original recent publications on both topics of clinical and epidemiologic aspects of milk allergy and of milk protein's bio- and immunochemistry.

STUDY SELECTION

The expert opinion of the author was used to select the relevant data for the review.

RESULTS

Most CMPs are potential allergens, even the proteins present at very low concentration. There are both conformational and linear epitopes, widely spread all along the protein molecules. They may be short fragments, located in hydrophobic parts of the molecule which comprise highly conserved sequences responsible for immunoglobulin E cross-reactivity with corresponding milk proteins of other mammals, including human beings. Those sequential epitopes have also been proposed as good markers of persistent allergy to CMPs.

CONCLUSIONS

No specific structure nor function is associated with allergenicity of CMPs. Variability and heterogeneity of the human immunoglobulin E response preclude anticipating the allergenic potential of any CMP or fragment thereof, as well as justify the need for being careful before using peptides for desensitization or proposing any milk protein hydrolysate in a diet for highly allergenic children.

Natural course of cow's milk allergy in childhood atopic eczema/dermatitis syndrome

OBJECTIVE

This review was undertaken to determine the role of adverse reactions to bovine proteins in atopic dermatitis, recently called atopic eczema/dermatitis syndrome (AEDS).

DATA SOURCES

A PubMed literature search was conducted with use of the following phrases: atopic dermatitis and food allergy, atopic dermatitis and cow's milk, and cow's milk and eczema.

STUDY SELECTION

The authors' judgment and personal interest guided the literature selection.

RESULTS

Food allergy has a role in at least 20% of the cases of AEDS in children younger than 4 years. Cow's milk is usually the first food given to an infant, and cow's milk hypersensitivity is often the first symptom of an atopic condition. Adverse reactions to cow's milk proteins are usually categorized as immunoglobulin (Ig)E-mediated or non-IgE-mediated cow's milk allergy and nonallergic hypersensitivity (intolerance); the symptoms do not allow differentiation of these entities. In patients with cow's milk allergy and AEDS, resolution occurs in 90% by the age of 4 years. Non-IgE-mediated cow's milk allergy often disappears before the age of 1 year. Associated reactions to other foods develop in approximately 45% of patients. Allergy to potential environmental inhalant allergens has been reported in up to 28% of patients by 3 years of age and up to 80% before puberty. After consumption of large amounts of cow's milk, 45% of 10-year-old children who had become tolerant of cow's milk, but also 15% of control subjects, still had gastrointestinal complaints. The presence of cow's milk allergy during infancy increases the risks for development of other food allergies, respiratory atopy, and persistence of AEDS.

CONCLUSION

Adverse reactions to bovine proteins have an important role in AEDS.

Cross-reactivity between mammalian proteins

BACKGROUND

Cross-reactivity between food allergens occurs when they share part of their amino acid sequence, or when their three-dimensional molecular structure causes them to have a similar capacity to bind specific antibodies.

OBJECTIVES

To review data from our laboratory on cross-reactivity between mammalian proteins (milk and meat allergens).

METHODS

Studies used immunoelectrophoresis (sodium dodecyl sulfate-polyacrylamide gel electrophoresis/polyacrylamide gel electrophoresis and immunoblotting), and animal monoclonal antibodies.

RESULTS

The findings suggest that animal monoclonal antibodies specific for cow's milk proteins are able to recognize the major part of milk proteins from mammals bred in Mediterranean countries (sheep, goat, and buffalo); weak cross-reactivity was observed with milk proteins from mares and donkeys. None of the antibodies used in our studies reacted with proteins from an exotic mammalian species: the camel. Similar cross-reactions were found with human circulating immunoglobulin E from children allergic to milk. With regard to beef allergy, monoclonal antibodies specific for bovine serum albumin cross-reacted only with ovine serum albumin, whereas the number of sera from allergic children able to recognize other mammalian serum albumins depended directly on the closeness of phylogenetic relationship between animal species and inversely on the percent identity with human serum albumin in the main epitopic sequence.

CONCLUSION

An area of heterogeneity between animal and human species in a critical amino acid sequence (epitope) of an allergen can determine the degree of immunogenic activity.

IgG and IgA antibody levels to cow's milk are low at age 10 years in children born preterm

BACKGROUND

Both innate and specific defenses of the preterm infant are even less developed than those of term infants, and the immune systems of preterm infants might be skewed differently at birth. Their immune responses to food antigens started early in life might therefore differ from those of term infants.

OBJECTIVE

We sought to compare antibody levels to cow's milk, ovalbumin, and gliadin at age 10 years in children who had been born either preterm or at term.

METHODS

IgG and IgA isotype antibodies to whole cow's milk, beta-lactoglobulin, alpha-casein, and ovalbumin, as well as IgG antibody levels to gliadin and to tetanus and diphtheria toxoids, were measured for a group of 62 children born preterm and 61 control subjects born at term. These children were studied at the same time for atopy.

RESULTS

Children born preterm had markedly lower levels of antibodies to cow's milk and to its protein fractions (P <.0001 for IgA and IgG antibodies to cow's milk and alpha-casein and IgG beta-lactoglobulin antibodies). IgG gliadin antibodies were also significantly lower in the preterm group (P =.03), although the difference was not significant for IgG ovalbumin antibodies. In the preterm group both those born before gestational week 30 and those given cow's milk-based formula early (before day 50) had the lowest levels of cow's milk antibodies. In the preterm group atopy was associated with low levels of IgG cow's milk antibodies but with high levels of IgG ovalbumin antibodies.

CONCLUSIONS

Early introduction of food antigens into the immature gastrointestinal tract of preterm infants might result in tolerance. The presence of less atopy in these children might also be a result of tolerance development.

Serum immunoglobulin E, IgA, and IgG antibodies to different cow's milk proteins in children with cow's milk allergy: association with prognosis and clinical manifestations

Diverse pathogenic mechanisms elicit different clinical manifestations in cow's milk allergy (CMA). Our aim was to determine the concentration of serum immunoglobulin levels to different cow's milk proteins in patients with CMA and to determine how these values were related to clinical symptoms and prognosis. Fifty children (mean age 10.9 months, range: 1-34 months) with previously confirmed CMA were enrolled in this study. All had various clinical manifestations of CMA, including gastrointestinal, skin, and respiratory symptoms. At the diagnosis of CMA the serum total and the milk-specific immunoglobulin (Ig)E values were measured by enzyme immunoassay and fluoroimmunoassay, respectively, while the relative levels of serum IgA and IgG antibodies against different cow's milk proteins were determined by a sensitive enzyme-linked immunosorbent assay (ELISA). The results were compared to those of 30 non-atopic age-matched control children. On average, after 9.2 months (range 2-31 months) on a milk-free diet, a repeated challenge was performed in 38 children. At the re-challenge, 12 patients had clinical symptoms while the remaining 26 children were symptom-free. The IgG antibody level to bovine serum albumin (BSA) was significantly lower in the patients than in the controls (median: 0.36 vs. 2.94, p < 0.01). There was a close correlation among all individual IgA and IgG antibodies to different cow's milk proteins. The anti-alpha-casein IgG level (of 2.10) in children with a positive reaction at the re-challenge was significantly higher than in those with a negative reaction (0.89) (p < 0.05). The total IgE serum concentration was also significantly higher in those who had symptoms at the re-challenge compared to those who did not have any reaction at this time (22.9 vs. 6.8 kU/l, geometric mean, p < 0.02). There was no association between the clinical manifestations and the IgG and IgA antibody levels to the cow's milk proteins studied, except for the anti-BSA IgA level, which was higher in patients with gastrointestinal symptoms. The serum total IgE and anti-alpha-casein IgG levels could have prognostic values; their increase at the beginning of the disease may indicate the development of tolerance to cow's milk only at a later age and after a longer duration of CMA. However, as there is considerable overlap among the values observed in different groups of patients, there is a limitation of these tests for predicting the prognosis.

Factors affecting the determination of threshold doses for allergenic foods: how much is too much?

BACKGROUND

Ingestion of small amounts of an offending food can elicit adverse reactions in individuals with IgE-mediated food allergies. The threshold dose for provocation of such reactions is often considered to be zero. However, because of various practical limitations in food production and processing, foods may occasionally contain trace residues of the offending food. Are these very low, residual quantities hazardous to allergic consumers? How much of the offending food is too much? Very little quantitative information exists to allow any risk assessments to be conducted by the food industry.

OBJECTIVE

We sought to determine whether the quality and quantity of existing clinical data on threshold doses for commonly allergenic foods were sufficient to allow consensus to be reached on establishment of threshold doses for specific foods.

METHODS

In September 1999, 12 clinical allergists and other interested parties were invited to participate in a roundtable conference to share existing data on threshold doses and to discuss clinical approaches that would allow the acquisition of that information.

RESULTS

Considerable data were identified in clinical files relating to the threshold doses for peanut, cows' milk, and egg; limited data were available for other foods, such as fish and mustard.

CONCLUSIONS

Because these data were often obtained by means of different protocols, the estimation of a threshold dose was very difficult. Development of a standardized protocol for clinical experiments to allow determination of the threshold dose is needed.

Cow's milk protein avoidance and development of childhood wheeze in children with a family history of atopy

BACKGROUND

In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas.

OBJECTIVES

To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children.

SEARCH STRATEGY

The Cochrane database was searched for eligible trials until February 2002. The full text papers of all abstracts identified as RCTs were obtained and reviewed independently by two reviewers.

SELECTION CRITERIA

Randomised controlled trials involving children with a family history of atopy in at least one first degree relative were considered if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein using soya or other hypoallergenic formula during the initial four months of life or longer.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet.

MAIN RESULTS

Six trials used hydrolysed formula for at least 4 months in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk =0.40, 95% Confidence Intervals 0.19, 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age.

REVIEWER'S CONCLUSIONS

Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of 4 months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.

Role of conformational and linear epitopes in the achievement of tolerance in cow's milk allergy

BACKGROUND

Cow's milk (CM) is one of the leading causes of food allergy in children. However, approximately 85% of milk-allergic children become clinically tolerant to CM within the first 3 years of life. The mechanisms involved in the achievement of tolerance remain unknown.

OBJECTIVE

To study whether IgE antibodies from children with persistent cow's milk allergy (CMA) differ from children who become clinically tolerant in their ability to recognize linear and conformational epitopes of alpha(s1)- and beta-casein.

METHODS

Thirty-six milk-allergic children were included in the study: 11 of the children became clinically tolerant, and 25 had persistent CMA. Blood was obtained from all patients during the time they showed clinical reactions to milk challenge. Six non-milk-allergic children served as controls. Specific IgE antibodies against linear (denatured) as well as conformational (native) milk proteins were determined by probing dot-blots with patients' sera. In addition, selected decapeptides from alpha(s1)- and beta-casein, previously found to be suggestive of persistent CMA, were synthesized on a cellulose-derivatized membrane and probed with individual sera from 10 patients who outgrew CMA and from 10 patients with persistent CMA.

RESULTS

Analysis of immunodot-blots showed that, in comparison to tolerant patients, milk-allergic children with persistent symptoms had a significantly higher ratio of specific IgE antibodies to linearized than to native alpha- and beta-casein (P < 0.005 and P < 0.02, respectively). Comparing the selected decapeptides, six of the 10 patients with persistent allergy recognized the peptide corresponding to amino acids 69-78 from alpha(s1)-casein while none of the patients who outgrew CMA had IgE binding to this epitope.

CONCLUSION

Patients with persistent milk allergy possess higher detectable levels of IgE antibodies to linear epitopes from alpha(s1)- and beta-casein than children who have achieved tolerance. Specific IgE binding to particular linear epitopes in alpha(s1)-casein may be a predictive factor for persistence of CMA.

Ingredient and labeling issues associated with allergenic foods

Foods contain a wide range of food ingredients that serve numerous technical functions. Per capita consumer exposure to most of these food ingredients is rather low with a few notable exceptions such as sugar and starch. Some food ingredients including edible oils, hydrolyzed proteins, lecithin, starch, lactose, flavors and gelatin may, at least in some products, be derived from sources commonly involved in IgE-mediated food allergies. These ingredients should be avoided by consumers with allergies to the source material if the ingredient contains detectable protein residues. Other food ingredients, including starch, malt, alcohol and vinegar, may be derived in some cases from wheat, rye or barley, the grains that are implicated in the causation of celiac disease. If these ingredients contain gluten residues, then they should be avoided by celiac sufferers. A few food ingredients are capable of eliciting allergic sensitization, although these ingredients would be classified as rarely allergenic. These ingredients include carmine, cochineal extract, annatto, tragacanth gum and papain. Food manufacturers should declare the presence of allergenic food ingredients in the ingredient listings on product labels so that allergic consumers can know to avoid these potentially hazardous products.

Effects of gamma radiation on the allergenic and antigenic properties of milk proteins

This study was carried out to evaluate the application of food irradiation technology as a method for reducing milk allergies. Bovine alpha-casein (ACA) and beta-lactoglobulin (BLG) were used as milk proteins. Using milk-hypersensitive patients' immunoglobulin E (IgE) and rabbit IgGs individually produced to ACA and BLG, the changes of allergenicity and antigenicity of irradiated proteins were observed by competitive indirect enzyme-linked immunosorbent assay. Allergenicity and antigenicity of the irradiated proteins were changed with different slopes of the inhibition curves. The disappearance of the band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and increase of the turbidity showed that solubility of the proteins decreased by radiation, and this decrease might be caused by agglomeration of the proteins. These results indicated that epitopes on milk allergens were structurally altered by gamma irradiation.

Cellular and humoral immunity against cow's milk proteins in type 1 diabetes

Cow's milk beta-casein has been proposed as a candidate trigger of autoimmunity associated with type 1 diabetes. In this study, cellular and humoral immunity against beta-casein was compared to that against other major cow's milk proteins in patients with recent onset type 1 diabetes and control subjects. T cell responses were found against alpha-casein, beta-casein, beta-lactoglobulin and bovine serum albumin in both patients with type 1 diabetes (stimulation index: 0.2-22.8, n=23) and control subjects (stimulation index: 0.1-18.2, n=22), with no significant differences between groups. Twelve (52%) patients and nine (41%) control subjects had stimulation indices >3 to at least one protein, including 9 (39%) patients and 4 (18%) control subjects against beta-casein, all but one of these also having elevated responses to alpha-casein. The highest responses (stimulation index >9) were against alpha- and beta-casein in some patients and control subjects who had the HLA DR3 allele. Antibody levels against alpha-casein, beta-casein and beta-lactoglobulin were low in both patients (n=59) and control subjects (n=52). Nevertheless, significantly higher IgG binding to both alpha-casein in ELISA (P=0.02) and beta-casein using ELISA (P=0.02) and RIA (P=0.04) was observed in patients aged <15 years compared to control subjects of similar age. No relationship was found between cellular and humoral immunity against individual antigens. These data show that immune responses to cow's milk are not limited to patients with diabetes and not solely against beta-casein.

Cross-reactivity between milk proteins from different animal species

BACKGROUND

Cow's milk allergy is quite frequent in the first years of human life. When breast-feeding is not possible, a cow's milk substitute must be provided for allergic subjects. Different alternatives to cow's milk have been suggested as protein sources (soy, hydrolysed proteins, goat's milk, etc.), but all these dietetic solutions are not without risks for polyallergic or more sensitive subjects.

OBJECTIVE

To obtain new information on the suitability of other mammalian milks for allergic children, we evaluated the cross-reactivity between milk proteins from different animal species.

METHODS

Milk samples were analysed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). To detect antibody-antigen complexes, immunoblotting was performed by using sera from children allergic to cow's and ewe's milk (RAST class >/= 4) and monoclonal antibodies (MoAb) specific for bovine proteins (caseins and beta-lactoglobulin).

RESULTS

IgEs from children allergic to cow's milk are capable of recognizing most part of milk proteins from mammals bred in European countries (ewe, goat, buffalo), while no serum used in this study contains IgEs reacting with camel's milk proteins. Camel's milk was also not recognized from circulating IgEs from a child specifically allergic to ewe's milk. Specific antibovine monoclonal antibodies cross-reacted with proteins from other mammalian species, apart from those of camel.

CONCLUSIONS

Homologies in amino acidic composition could justify the cross-reactivity observed between proteins from different animal species. On the other hand, the phylogenetic difference could be responsible for the failed recognition of camel's proteins by circulating IgEs and monoclonal antibodies.

Thioredoxin treatment increases digestibility and lowers allergenicity of milk

BACKGROUND

By resisting digestion in the stomach, the major bovine milk allergen, beta-lactoglobulin, is believed to act as a transporter of vitamin A and retinol to the intestines. beta-Lactoglobulin has 2 intramolecular disulfide bonds that may be responsible for its allergic effects.

OBJECTIVE

This study was carried out to assess the importance of disulfide bonds to the allergenicity and digestibility of beta-lactoglobulin.

METHODS

beta-Lactoglobulin was subjected to reduction by the ubiquitous protein thioredoxin, which was itself reduced by the reduced form of nicotinamide adenine dinucleotide phosphate by means of nicotinamide adenine dinucleotide phosphate-thioredoxin reductase. Digestibility was measured with a simulated gastric fluid; results were analyzed by SDS-PAGE. Allergenicity was assessed with an inbred colony of high IgE-producing dogs sensitized to milk.

RESULTS

As found for other proteins with intramolecular disulfide bonds, beta-lactoglobulin was reduced specifically by the thioredoxin system. After reduction of one or both of its disulfide bonds, beta-lactoglobulin became strikingly sensitive to pepsin and lost allergenicity as determined by skin test responses and gastrointestinal symptoms in the dog model.

CONCLUSION

The results provide new evidence that thioredoxin can be applied to enhance digestibility and lower allergenicity of food proteins.

Cow's milk protein-specific IgE concentrations in two age groups of milk-allergic children and in children achieving clinical tolerance

BACKGROUND

IgE-mediated cow's milk protein allergy (CMPA) is usually outgrown in children by the age of 3 years. The immunological responses to cow's milk proteins in children who achieve tolerance, in comparison with those who remain allergic, however, are not well described.

OBJECTIVE

To compare the level of cow's milk protein-specific IgE among children with documented CMPA under the age of 3 years, another group over the age of 9 years (persistent allergy), and in another group of children in whom clinical tolerance developed.

METHODS

Stored sera from children with CMPA were analysed for IgE antibodies specific for whole cow's milk, casein, whey, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG), and bovine serum albumin (BSA) using the Pharmacia CAP System FEIA.

RESULTS

Within each group of CMPA children, the concentration of specific IgE antibody to casein proteins was not significantly different from that to whey proteins. However, children in the group with CMPA over 9 years of age had significantly greater concentrations of whole milk (P = 0.02) and casein-specific (P = 0. 04) IgE antibodies compared with the group of children with CMPA under age 3 years. Children under the age of 3 years had a higher median concentration of casein-specific IgE (20.2 vs. 5.5, P = 0.04) than another group of 11 children (mean age 3.5 years), who later lost their milk allergy. Out of 16 children who lost sensitivity to milk, 75% had milk-specific IgE levels below 14.3 kUA/L (median, 1.3 kUA/L).

CONCLUSIONS

Although a dominant allergenic milk protein fraction was not identified within either of the two age groups, those with persistent CMPA over age 9 years had significantly elevated levels of milk and casein-specific IgE compared with younger children with CMPA.