1
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Elizur A, Rachel‐Jossefi S, Rachmiel M, Eisenberg E, Katz Y. Consumption of cow's milk formula in the nursery and the development of milk allergy. Clin Transl Allergy 2024; 14:e12352. [PMID: 38613160 PMCID: PMC11015055 DOI: 10.1002/clt2.12352] [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: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The effect of the amount of transient cow's milk formula (CMF) consumed during the first days of life on IgE-cow's milk allergy (IgE-CMA) is unknown. METHODS A cohort of 58 patients with IgE-CMA was identified from a large scale population-based study of 13,019 infants followed from birth. A group of 116 infants matched for sex and breastfeeding only duration (beyond the nursery period), and another random group of 259 healthy infants were used as controls. Parents were interviewed and the infants' medical records were searched to assess CMF consumption in the nursery. RESULTS While 96% of the mothers of the 174 infants (58 with Cow's milk allergy and 116 controls) reported on exclusive breastfeeding during the stay in the nursery, CMF consumption was documented in 96 (55%) of the infants. Of those, most (57; 59%) received one to three feedings, 20 (21%) received four to nine feedings, and 19 (20%) received ≥10 feedings. Fewer formula feeds (1-3) were significantly more common in the allergic group than ≥4 feeds (p = 0.0003) and no feeds at all (p = 0.02) compared to controls (n = 116). Of those exclusively breastfed in the nursery, 13/23 allergic infants (57%) introduced CMF at age 105-194 days (the period with highest-risk for IgE-CMA) compared to 33/98 (34%) from the random control group (n = 259) (p = 0.04). CONCLUSIONS Most infants end up receiving few CMF feeds in the nursery. Transient CMF in the nursery is associated with increased risk of IgE-CMA.
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Affiliation(s)
- Arnon Elizur
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
| | - Shirel Rachel‐Jossefi
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
| | - Marianna Rachmiel
- Tel Aviv University School of MedicineTel AvivIsrael
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionPediatric Endocrinology and Diabetes InstituteTzrifinIsrael
| | - Eli Eisenberg
- Tel Aviv University School of Physics and AstronomyTal AvivIsrael
| | - Yitzhak Katz
- Shamir Medical Center Assaf Harofeh Pediatrics DivisionInstitute of Allergy Immunology and Pediatric PulmonologyTzrifinIsrael
- Tel Aviv University School of MedicineTel AvivIsrael
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2
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Patil PJ, Usman M, Zhang C, Mehmood A, Zhou M, Teng C, Li X. An updated review on food-derived bioactive peptides: Focus on the regulatory requirements, safety, and bioavailability. Compr Rev Food Sci Food Saf 2022; 21:1732-1776. [PMID: 35142435 DOI: 10.1111/1541-4337.12911] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023]
Abstract
Food-derived bioactive peptides (BAPs) are recently utilized as functional food raw materials owing to their potential health benefits. Although there is a huge amount of scientific research about BAPs' identification, purification, characterization, and physiological functions, and subsequently, many BAPs have been marketed, there is a paucity of review on the regulatory requirements, bioavailability, and safety of BAPs. Thus, this review focuses on the toxic peptides that could arise from their primary proteins throughout protein extraction, protein pretreatment, and BAPs' formulation. Also, the influences of BAPs' length and administration dosage on safety are summarized. Lastly, the challenges and possibilities in BAPs' bioavailability and regulatory requirements in different countries were also presented. Results revealed that the human studies of BAPs are essential for approvals as healthy food and to prevent the consumers from misinformation and false promises. The BAPs that escape the gastrointestinal tract epithelium and move to the stomach are considered good peptides and get circulated into the blood using different pathways. In addition, the hydrophobicity, net charge, molecular size, length, amino acids composition/sequences, and structural characteristics of BAPs are critical for bioavailability, and appropriate food-grade carriers can enhance it. The abovementioned features are also vital to optimize the solubility, water holding capacity, emulsifying ability, and foaming property of BAPs in food products. In the case of safety, the possible allergenic and toxic peptides often exhibit physiological functions and could be produced during the hydrolysis of food proteins. It was also noted that the production of iso-peptides bonds and undesirable Maillard reaction might occur during protein extraction, sample pretreatments, and peptide synthesis.
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Affiliation(s)
- Prasanna J Patil
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Muhammad Usman
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Chengnan Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Arshad Mehmood
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Mingchun Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Chao Teng
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China.,Beijing Engineering and Technology Research Center of Food Additives, School of Food and Chemical Technology, Beijing Technology and Business University, Beijing, China
| | - Xiuting Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China.,Beijing Engineering and Technology Research Center of Food Additives, School of Food and Chemical Technology, Beijing Technology and Business University, Beijing, China
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3
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Liang X, Qian G, Sun J, Yang M, Shi X, Yang H, Wu J, Wang Z, Zheng Y, Yue X. Evaluation of antigenicity and nutritional properties of enzymatically hydrolyzed cow milk. Sci Rep 2021; 11:18623. [PMID: 34545177 PMCID: PMC8452708 DOI: 10.1038/s41598-021-98136-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
While enzymatic hydrolysis is an effective method for lowering the antigenicity of cow milk (CM), research regarding the antigenicity and nutritional traits of CM hydrolysate is limited. Here, we evaluated the protein content, amino acid composition, sensory traits, color, flow behavior, and antigenicity of CM following enzymatic hydrolysis. The results showed that enzymatic hydrolysis increased the degree of hydrolysis, destroyed allergenic proteins, including casein, β-lactoglobulin, and ɑ-lactalbumin, and significantly increased the content of free amino acids and nutritional quality. In particular, the antigenicity of CM was significantly reduced from 44.05 to 86.55% (P < 0.5). Simultaneously, the taste, color, and flow behavior of CM were altered, the sweetness and richness intensity decreased significantly (P < 0.5), and astringency and bitterness were produced. A slightly darker and more yellow color was observed in CM hydrolysate. In addition, apparent viscosity decreased and shear stress significantly increased with increasing shear rate intensity. The results will provide a solid theoretical foundation for the development of high-quality hypoallergenic dairy products.
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Affiliation(s)
- Xiaona Liang
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Guanlin Qian
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Jing Sun
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Mei Yang
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Xinyang Shi
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Hui Yang
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Junrui Wu
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Zongzhou Wang
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China
| | - Yan Zheng
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China.
| | - Xiqing Yue
- College of Food Science, Shenyang Agricultural University, Shenyang, 100866, People's Republic of China.
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4
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Hossain ME. Performance of Black Bengal goat: a 50-year review. Trop Anim Health Prod 2021; 53:71. [PMID: 33399972 DOI: 10.1007/s11250-020-02477-2] [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: 06/08/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Black Bengal goat (BBG) is the most widely recognized legacy goat breed in Bangladesh. The breed is black in color yet likewise earthy, white, or dim colors additionally found. The breed has medium body size with grown-up weight 25-30 kg, little horns, short legs, and tight body structure. The BBG is one of the most compliant, all around adjusted, early maturing, prolific, productive, and tropical disease-resistant goat types of the world that produces incredible quality meat, milk, and skin. The breed is versatile in hot, moist, cruel, climatic conditions and flourishes well on a cacophonous dietary regimen from uncultivable decrepit grounds, residences, riversides, banks, sloping, and hilly territories where crop culture or dairy nourishing is inconceivable. In Bangladesh, the BBG is one of the main red meat-producing small ruminants which shares remarkable local interest during Eid-Ul-Adha, Eid-Ul-Fitr, wedding ceremony, birthday festival, circumcision, memorial programs, and other social celebrations with no social, cultural, and religious limitations. Being little in size, the BBG has been an amazing asset to advance supportable vocations for the negligible, little, and landless ranchers who rely upon free regular grazing lands for raising domesticated animals. Regardless of incredibly exceptional components and features, the production of BBG has not yet been popularized widely since meager consideration has been paid for improving their efficiency. Development of cutting edge hereditary, dietary, and health as well as disease control procedure and utilization of modern management frameworks may procure considerable changes in improving the overall performance of the BBG.
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Affiliation(s)
- Md Emran Hossain
- Department of Animal Science and Nutrition, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh.
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5
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Panahipour L, Tabatabaei AA, Gruber R. Hypoallergenic infant formula lacks transforming growth factor beta activity and has a lower anti-inflammatory activity than regular infant formula. J Dairy Sci 2020; 103:6771-6781. [PMID: 32505409 DOI: 10.3168/jds.2019-18067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 01/02/2023]
Abstract
Hypoallergenic formulas are recommended for infants who are not breastfed and cannot tolerate cow milk formulas due to allergy. These formulas are hydrolyzed to break down larger protein chains into shorter, easy-to-digest, and potentially less allergenic proteins. Hydrolysis, however, possibly occurs at the expense of the transforming growth factor beta (TGF-β) and anti-inflammatory activity that is inherent in regular formula. Our objective was to determine the TGF-β and the anti-inflammatory activity of commercially available hypoallergenic and regular formulas. Human gingival fibroblasts were incubated with reconstituted formulas followed by detection of TGF-β target genes and activation of Smad2/3 signaling. Gingival fibroblasts and the oral squamous cell carcinoma cell line HSC-2 were also exposed to formulas before adding interleukin (IL)1β and tumor necrosis factor (TNF)α to provoke expression of pro-inflammatory cytokines. For murine bone marrow-derived macrophages, pro-inflammatory cytokine expression was stimulated with saliva. Changes in p65 nuclear translocation and phosphorylation of smad3 and p38 were analyzed by immunostaining. Our study demonstrated that regular formula, but not hypoallergenic formula, enhanced the expression of TGF-β target genes IL11, PRG4, and NOX4 in gingival fibroblasts. Hypoallergenic formulas also failed to initiate nuclear translocation of Smad2/3 and phosphorylation of Smad3. Moreover, regular formulas were more potent than hypoallergenic formulas in reducing the expression of pro-inflammatory cytokines in gingival fibroblasts, HSC-2 epithelial cells, and murine bone marrow macrophages. Hypoallergenic and regular formulas had a similar capacity to reduce p65 nuclear translocation and phosphorylation of p38 in fibroblasts. These findings suggest that hypoallergenic formulas lack in vitro TGF-β activity and have a lower anti-inflammatory activity compared with regular formulas.
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Affiliation(s)
- Layla Panahipour
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | | | - Reinhard Gruber
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland; Austrian Cluster for Tissue Regeneration, Donaueschingenstraße 13, 1200 Vienna, Austria.
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6
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Affiliation(s)
- Walter C Willett
- From the Departments of Nutrition (W.C.W., D.S.L.) and Epidemiology (W.C.W.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (W.C.W.); the Department of Pediatrics, Harvard Medical School (D.S.L.); and the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital (D.S.L.) - all in Boston
| | - David S Ludwig
- From the Departments of Nutrition (W.C.W., D.S.L.) and Epidemiology (W.C.W.), Harvard T.H. Chan School of Public Health; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (W.C.W.); the Department of Pediatrics, Harvard Medical School (D.S.L.); and the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital (D.S.L.) - all in Boston
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7
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Carvalho NCD, Pessato TB, Negrão F, Eberlin MN, Behrens JH, Zollner RDL, Netto FM. Physicochemical changes and bitterness of whey protein hydrolysates after transglutaminase cross-linking. Lebensm Wiss Technol 2019. [DOI: 10.1016/j.lwt.2019.108291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Di Francesco L, Di Girolamo F, Mennini M, Masotti A, Salvatori G, Rigon G, Signore F, Pietrantoni E, Scapaticci M, Lante I, Goffredo BM, Mazzina O, Elbousify AI, Roncada P, Dotta A, Fiocchi A, Putignani L. A MALDI-TOF MS Approach for Mammalian, Human, and Formula Milks' Profiling. Nutrients 2018; 10:nu10091238. [PMID: 30189627 PMCID: PMC6163840 DOI: 10.3390/nu10091238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
Human milk composition is dynamic, and substitute formulae are intended to mimic its protein content. The purpose of this study was to investigate the potentiality of matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS), followed by multivariate data analyses as a tool to analyze the peptide profiles of mammalian, human, and formula milks. Breast milk samples from women at different lactation stages (2 (n = 5), 30 (n = 6), 60 (n = 5), and 90 (n = 4) days postpartum), and milk from donkeys (n = 4), cows (n = 4), buffaloes (n = 7), goats (n = 4), ewes (n = 5), and camels (n = 2) were collected. Different brands (n = 4) of infant formulae were also analyzed. Protein content (<30 kDa) was analyzed by MS, and data were exported for statistical elaborations. The mass spectra for each milk closely clustered together, whereas different milk samples resulted in well-separated mass spectra. Human samples formed a cluster in which colostrum constituted a well-defined subcluster. None of the milk formulae correlated with animal or human milk, although they were specifically characterized and correlated well with each other. These findings propose MALDI-TOF MS milk profiling as an analytical tool to discriminate, in a blinded way, different milk types. As each formula has a distinct specificity, shifting a baby from one to another formula implies a specific proteomic exposure. These profiles may assist in milk proteomics for easiness of use and minimization of costs, suggesting that the MALDI-TOF MS pipelines may be useful for not only milk adulteration assessments but also for the characterization of banked milk specimens in pediatric clinical settings.
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Affiliation(s)
- Laura Di Francesco
- Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, V.le San Paolo 15, 00146 Rome, Italy.
| | - Francesco Di Girolamo
- Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, V.le San Paolo 15, 00146 Rome, Italy.
| | - Maurizio Mennini
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Andrea Masotti
- Gene Expression-Microarrays Laboratory, Bambino Gesù Children's Hospital, IRCCS, V.le San Paolo 15, 00146 Rome, Italy.
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Giuliano Rigon
- Department of Obstetrics and Gynecology, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00151 Rome, Italy.
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, Misericordia Hospital Grosseto, Usl Toscana Sud-est, 58036 Grosseto, Italy.
| | - Emanuela Pietrantoni
- Rehabilitation Hospital of High Specialization of Motta di Livenza, 31100 Treviso, Italy.
| | - Margherita Scapaticci
- Department of Laboratory Medicine, San Camillo Hospital, V.le Vittorio Veneto 18, 31100 Treviso, Italy.
| | - Isabella Lante
- Department of Laboratory Medicine, San Camillo Hospital, V.le Vittorio Veneto 18, 31100 Treviso, Italy.
| | - Bianca Maria Goffredo
- Metabolic Unit, Department of Pediatric Medicine, Bambino Gesù Children's Hospital, IRCCS, V.le San Paolo 15, 00146 Rome, Italy.
| | - Oscar Mazzina
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | | | - Paola Roncada
- Department of Health Sciences, Università degli Studi "Magna Græcia" di Catanzaro, 88100 Catanzaro, Italy.
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alessandro Fiocchi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Lorenza Putignani
- Unit of Human Microbiome, Bambino Gesù Children's Hospital, IRCCS, V.le San Paolo 15, 00146 Rome, Italy.
- Unit of Parasitology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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9
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Kiewiet MBG, Dekkers R, Ulfman LH, Groeneveld A, de Vos P, Faas MM. Immunomodulating protein aggregates in soy and whey hydrolysates and their resistance to digestion in an in vitro infant gastrointestinal model: new insights in the mechanism of immunomodulatory hydrolysates. Food Funct 2018; 9:604-613. [PMID: 29271442 DOI: 10.1039/c7fo01537b] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hydrolysates, which are used in hypoallergenic infant formulas, have been found to possess immune modulating effects. For an optimal utilization of hydrolysates, the working mechanisms and responsible proteins underlying the effects should be elucidated. In this study, the immunomodulating activity of whey and soy hydrolysates was studied by quantifying TLR activation and assessing cytokine production in hydrolysate stimulated dendritic cells. The responsible protein fraction was identified and characterized by gel electrophoresis. The immune effects under gastrointestinal conditions were studied by digesting the hydrolysates in an in vitro infant digestion model, after which the digests were analyzed. In both soy and whey hydrolysates, TLR activation and cytokine production in dendritic cells were induced by a fraction containing protein aggregates larger than 1000 kDa, which were formed by electrostatic interactions and disulfide bonds. Only soy aggregates remained intact during duodenal digestion, and maintained the TLR activating capacity. Soy and whey protein aggregates larger than 1000 kDa possess immunomodulatory properties, but only soy aggregates remain under intestinal digestion conditions. This knowledge is important for a better understanding of the effects of hydrolysates.
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Affiliation(s)
- Mensiena B G Kiewiet
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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10
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Fiocchi A, Schunemann H, Ansotegui I, Assa’ad A, Bahna S, Canani RB, Bozzola M, Dahdah L, Dupont C, Ebisawa M, Galli E, Li H, Kamenwa R, Lack G, Martelli A, Pawankar R, Said M, Sánchez-Borges M, Sampson H, Shamir R, Spergel J, Terracciano L, Vandenplas Y, Venter C, Waserman S, Wong G, Brozek J. The global impact of the DRACMA guidelines cow's milk allergy clinical practice. World Allergy Organ J 2018; 11:2. [PMID: 29308116 PMCID: PMC5753480 DOI: 10.1186/s40413-017-0179-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment. OBJECTIVES & METHODS Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and international level. We describe some economic consequences of their application. RESULTS DRACMA are the most cited CMA guidelines, and the second cited guidelines on food allergy. Many subsequent guidelines took stock of DRACMA's metanalyses adapting recommendations to the local context. Some of these chose not to consider OFC as an absolute requirement for the diagnosis of CMA. Studies on their implementation show that in this case, the treatment costs may increase and there is a risk of overdiagnosis. Interestingly, we observed a reduction in the cost of alternative formulas following the publication of the DRACMA guidelines. CONCLUSIONS DRACMA reconciled international differences in the diagnosis and management of CMA. They promoted a cultural debate, improved clinician's knowledge of CMA, improved the quality of diagnosis and care, reduced inappropriate practices, fostered the efficient use of resources, empowered patients, and influenced some public policies. The accruing evidence on diagnosis and treatment of CMA necessitates their update in the near future.
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Affiliation(s)
- Alessandro Fiocchi
- Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Piazza Sant’Onofrio, Vatican City, Rome Italy
| | - Holger Schunemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
| | - Ignacio Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Carretera Leioa-Unbe 33 bis, 48950 Erandio - Bilbao, Spain
| | - Amal Assa’ad
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Sami Bahna
- Pediatrics & Medicine, Allergy & Immunology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Roberto Berni Canani
- Department of Translational Medical Science, European Laboratory for Investigation of Food Induced Diseases and CEINGE Advanced Biotechnology, University of Naples Federico II, Naples, Italy
| | - Martin Bozzola
- Department of Pediatrics, British Hospital, Perdriel 74, CABA, Buenos Aires, Argentina
| | - Lamia Dahdah
- Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Piazza Sant’Onofrio, Vatican City, Rome Italy
| | - Christophe Dupont
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Hôpital Necker Enfants Malades, Paris, France
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Elena Galli
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - Haiqi Li
- Pediatric Division, Department of Primary Child Care, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Rose Kamenwa
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Gideon Lack
- King’s College London, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Paediatric Allergy, St Thomas’ Hospital, London, UK
| | | | - Ruby Pawankar
- Department of Otolaryngology, Nippon Medical School, 1-1-5 Sendagi, Tokyo, 113 Japan
| | - Maria Said
- Allergy & Anaphylaxis Australia (A&AA) organisation, Sydney, Australia
| | - Mario Sánchez-Borges
- Department of Allergy and Clinical Immunology Centro Médico-Docente La Trinidad Caracas, Caracas, Venezuela
| | - Hugh Sampson
- Department of Pediatrics, Jaffe Food Allergy Institute, New York, USA
- Icahn School of Medicine at Mount Sinai, Box 1089, New York, USA
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA USA
| | - Luigi Terracciano
- National Pediatric Healthcare System, Board member of the Italian Pediatric Respiratory Society, ATS, Milan, Italy
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carina Venter
- Section of Allergy & Immunology, University of Colorado Denver School of Medicine | Children’s Hospital Colorado, Aurora, CO USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - Gary Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
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11
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Kiewiet MBG, van Esch BCAM, Garssen J, Faas MM, de Vos P. Partially hydrolyzed whey proteins prevent clinical symptoms in a cow's milk allergy mouse model and enhance regulatory T and B cell frequencies. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201700340] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Mensiena B. Gea Kiewiet
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; RB Groningen The Netherlands
| | - Betty C. A. M. van Esch
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science; Utrecht University; Utrecht The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science; Utrecht University; Utrecht The Netherlands
| | - Marijke M. Faas
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; RB Groningen The Netherlands
- Department of Obstetrics and Gynecology, University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Paul de Vos
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen; University Medical Center Groningen; RB Groningen The Netherlands
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12
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Chainani-Wu N, Nayudu A. Resolution of recurrent aphthous ulcers after discontinuation of cow's milk protein intake. J Am Dent Assoc 2017; 148:614-617. [PMID: 28410620 DOI: 10.1016/j.adaj.2017.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/16/2017] [Accepted: 02/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OVERVIEW Authors of published studies have reported elevated levels of circulating antibodies to cow's milk protein (CMP) in patients with recurrent aphthous ulcers (RAUs), and authors of case reports have described resolution of RAU after dairy elimination. CASE DESCRIPTION A 10-year-old girl and an 11-year-old boy, both with 5-year histories of frequent RAU episodes, with multiple ulcerations, underwent dairy elimination trials. Both were free of oral ulcers within 2 weeks of discontinuing CMP and remained so with a CMP-free diet. In addition, the first patient had recurrence of ulcerations after occasional ingestion of CMP-containing foods. She showed elevated blood levels of immunoglobulin E in reaction to CMP and soy. Soy intake did not trigger the ulcerations. CONCLUSIONS AND PRACTICAL IMPLICATIONS The proportion of patients with RAU in whom CMP acts as a trigger is unknown. However, CMP elimination trials are safe and feasible and, therefore, should be considered, particularly before use of medications with potential side effects.
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Abstract
Food allergy is receiving increased attention in recent years. Because there is currently no known cure for food allergy, avoiding the offending food is the best defense for sensitive individuals. Type I food allergy is mediated by food proteins, and thus, theoretically, any food protein is a potential allergen. Variability of an individual's immune system further complicates attempts to understand allergen-antibody interaction. In this article, we briefly review food allergy occurrence, prevalence, mechanisms, and detection. Efforts aimed at reducing/eliminating allergens through food processing are discussed. Future research needs are addressed.
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Affiliation(s)
- Shridhar K Sathe
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
| | - Changqi Liu
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
| | - Valerie D Zaffran
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
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14
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Yanagida N, Sato S, Asaumi T, Okada Y, Ogura K, Ebisawa M. A Single-Center, Case-Control Study of Low-Dose-Induction Oral Immunotherapy with Cow's Milk. Int Arch Allergy Immunol 2015; 168:131-7. [DOI: 10.1159/000442157] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022] Open
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15
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Kiewiet MBG, Gros M, van Neerven RJJ, Faas MM, de Vos P. Immunomodulating properties of protein hydrolysates for application in cow's milk allergy. Pediatr Allergy Immunol 2015; 26:206-217. [PMID: 25692325 DOI: 10.1111/pai.12354] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 12/20/2022]
Abstract
Cow's milk proteins cause allergic symptoms in 2-3% of all infants. In these individuals, the tolerogenic state of the intestinal immune system is broken, which can lead to sensitization against antigens and eventually to allergic responses. Although a true treatment for food allergy is not available, symptoms can be avoided by providing the infants with hydrolyzed proteins. Hydrolyzed proteins are proteins that are enzymatically degraded. They lack typical allergenic IgE-binding epitopes but are also thought to play a pertinent role in other mechanisms inducing hypoallergenic effects. This review discusses the mechanisms and evidence for immunomodulating properties of cow's milk hydrolysates. Hydrolysates are found to strengthen the epithelial barrier, modulate T-cell differentiation, and decrease inflammation. Some studies suggest a role for hydrolysates in manipulating pathogen recognition receptors signaling as underlying mechanism. Peptides from hydrolysates have been shown to bind to TLR2 and TLR4 and influence cytokine production in epithelial cells and macrophages. Current insight suggests that hydrolysates may actively participate in modulating the immune responses in subjects with cow's milk allergy and those at risk to develop cow's milk allergy. However, more research is required to design effective and reproducible means to develop targeting strategies to modulate the immune response.
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Affiliation(s)
- M B G Kiewiet
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Gros
- FrieslandCampina, Amersfoort, The Netherlands
| | | | - M M Faas
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P de Vos
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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The value of mucosal allergen challenge for the diagnosis of food allergy. Curr Opin Allergy Clin Immunol 2014; 13:268-72. [PMID: 23571410 DOI: 10.1097/aci.0b013e32836093f6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The incidence of food allergy is increasing. Correct diagnosis is dependent on food challenges, which are not always performed, but more often based on history, skin prick test and specific IgE, leading to possible misdiagnoses. Mucosal provocation tests have been proposed as possible new diagnostic tools during recent decades. RECENT FINDINGS The databases EMBASE, PUBMED and Cochraine Review were used. Seven full text articles fulfilled criteria for mucosal challenge and food allergy, only one from the last 12 months. Conjunctival, nasal, buccal, gastric and coecal/rectal mucosa have been challenged. All authors find mucosal changes after challenge, but the lack of validation against double-blind placebo-controlled challenges makes evaluation difficult, with the exception of the conjunctival provocation test. SUMMARY As most mucosal surfaces are easily available, and small amounts of allergen are needed for an obvious reaction, this tool for diagnosing food allergy is promising. Further studies are however needed.
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17
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Peptide based immunotherapy: a pivotal tool for allergy treatment. Int Immunopharmacol 2014; 19:391-8. [PMID: 24530919 DOI: 10.1016/j.intimp.2014.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/25/2014] [Accepted: 01/29/2014] [Indexed: 11/20/2022]
Abstract
Immunotherapies with T-cell epitope peptides have shown a promising impact over allergic diseases as a potential therapeutic tool in in vitro and in vivo conditions. It is recognized as an effective treatment with long lasting clinical effects and subsequent reduction of the allergic inflammatory reactions. In this review, we have summarized the role of peptide based immunotherapy and emphasis has been given to the recent advancement in pollen, cat, hymenoptera venom, and food allergy.
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18
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Lee HS, Kim MN, Hong JY, Heo WI, Kim KW, Sohn MH, Kim KE, Lee KE, Park JW. The effect of heat treatment or hydrolysis on cow's milk protein distributions and antigenicities. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.4.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hee Seon Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Na Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yeon Hong
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Won Il Heo
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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19
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Turner PJ. Persistent allergy to cow's milk: of greater a clinical concern than other food allergies. Pediatr Allergy Immunol 2013; 24:624-6. [PMID: 24112423 DOI: 10.1111/pai.12148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Paul J Turner
- Section of Paediatrics (Allergy & Infectious Diseases), MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College, London, UK; Discipline of Paediatrics, University of Sydney, Sydney, NSW, Australia.
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20
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Hochwallner H, Schulmeister U, Swoboda I, Spitzauer S, Valenta R. Cow's milk allergy: from allergens to new forms of diagnosis, therapy and prevention. Methods 2013; 66:22-33. [PMID: 23954566 PMCID: PMC3969108 DOI: 10.1016/j.ymeth.2013.08.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 12/22/2022] Open
Abstract
The first adverse reactions to cow's milk were already described 2,000 years ago. However, it was only 50 years ago that several groups started with the analysis of cow's milk allergens. Meanwhile the spectrum of allergy eliciting proteins within cow's milk is identified and several cow's milk allergens have been characterized regarding their biochemical properties, fold and IgE binding epitopes. The diagnosis of cow's milk allergy is diverse ranging from fast and cheap in vitro assays to elaborate in vivo assays. Considerable effort was spent to improve the diagnosis from an extract-based into a component resolved concept. There is still no suitable therapy available against cow's milk allergy except avoidance. Therefore research needs to focus on the development of suitable and safe immunotherapies that do not elicit severe side effect.
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Affiliation(s)
- Heidrun Hochwallner
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria.
| | - Ulrike Schulmeister
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Ines Swoboda
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
| | - Susanne Spitzauer
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medical University of Vienna, Austria
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21
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Warren CM, Jhaveri S, Warrier MR, Smith B, Gupta RS. The epidemiology of milk allergy in US children. Ann Allergy Asthma Immunol 2013; 110:370-4. [PMID: 23622009 DOI: 10.1016/j.anai.2013.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/13/2013] [Accepted: 02/20/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Milk is one of the most common food allergies in US children, yet little is known about its distribution and diagnosis. OBJECTIVE To better understand current pediatric milk allergy distribution and diagnosis trends in the United States. METHODS A randomized, cross-sectional survey was administered to parents belonging to a representative sample of US households with children from June 2009 to February 2010. Data from 38,480 parents regarding demographic characteristics, allergic symptoms associated with food ingestion, and methods used to diagnose food allergy were collected and analyzed as weighted proportions. Adjusted models were estimated to examine association of these aspects with odds of milk allergy. RESULTS Of the 3,218 children identified with food allergy, 657 (19.9%) were reported to have milk allergy. Asian (odds ratio [OR], 0.5) and black (OR, 0.4) children were half as likely as white children to develop milk allergy. The highest percentage of milk-allergic children (23.8%) were aged 6 to 10 years, and the lowest percentage of milk-allergic children (15.0%) were aged 11 to 15 years. Nearly one-third (31.4%) of children with milk allergy had a history of severe reactions. Compared with children with other food allergies, children with milk allergy had a higher odds of having physician-diagnosed allergy (OR, 1.7) and were twice as likely (OR, 2.1) to outgrow their milk allergy. CONCLUSION Childhood milk allergy, which accounts for one-fifth of US food allergies, is less prevalent among Asian and black children than white children. Although less than half of children with milk allergy received confirmatory testing, it is the most commonly diagnosed food allergy.
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Affiliation(s)
- Christopher M Warren
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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22
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Abstract
The removal of aggravating factors is important to reduce the severity of infantile eczema, but there are few studies on the assessment and identification of the aggravating factors in infantile eczema. Parents of children with infantile eczema ages 1 to 10 months (N = 250) were recruited. Parents were required to complete a questionnaire. Two hundred forty-two (96.8%) children had skin dryness, 80% bathed with soap or shower gel, 82% often perspired, 84.8% wore tight-fitting clothes, 80.8% dressed in five layers of thick clothing, 85.6% were in contact with wool or feathers, and 59.2% were exposed to sunlight (>20 minutes/day). Eczema severity was greater after vaccination in 20%. Two hundred thirty-five mothers avoided eating potential food allergens (e.g., milk, egg whites, and fish), but this failed to improve the severity of symptoms in 93.6% of the children. Thirty patients had Neocate as a substitute for cow's milk, which resulted in symptom severity improvement in 10%. Thirty children were given food allergens, which exacerbated symptoms in 13.3%. One hundred twenty-eight (51.2%) of the children were treated with corticosteroid ointment; 62.5% had the ointment applied for only 2 to 3 days, and 6.2% had the corticosteroid ointment applied to weeping lesions. The vast majority of parents did not know about the aggravating factors for infantile eczema. The results demonstrated a strong need for educational programs to help parents understand and control infantile eczema.
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Affiliation(s)
- Yun-Ling Li
- Department of Dermatology, Children's Hospital, School of Medicine, University of Zhejiang, Hangzhou, China.
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23
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Guidelines change the diagnostic process of cow milk food allergy: problem-based learning. Curr Opin Allergy Clin Immunol 2013; 12:564-9. [PMID: 22951911 DOI: 10.1097/aci.0b013e328357cae6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW The accurate diagnosis of food allergy and its management has been the subject of two published guidelines, the National Institute of Health Sponsored Expert Panel Guidelines and the World Allergy Organization guidelines: Diagnosis and Rationale for Action Against Cow Milk Allergy. Both guidelines have drawn attention to the unique aspects of different food allergens. They have highlighted the possible overdiagnosis and underdiagnosis of food allergy. The purpose of this review is to demonstrate the utility and application of the two published guidelines in a real-life scenario that the pediatrician or allergy/immunology specialist may be faced with. RECENT FINDINGS This review is divided into two sections: the first section is problem-based learning, presenting a clinical scenario of a child suspected of cow milk allergy (CMA) and followed over time. At each step, the guidelines are consulted and referenced. The second section reviews recent research that demonstrates that CMA has a high prevalence, and that testing methodologies can be improved on. SUMMARY Clinicians taking the approach outlined by the guidelines will be able to confirm or refute a diagnosis of CMA, all the while minimizing unnecessary tests and procedures.
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Vandenplas Y, Gutierrez-Castrellon P, Velasco-Benitez C, Palacios J, Jaen D, Ribeiro H, Shek LPC, Shek PCL, Lee BW, Alarcon P. Practical algorithms for managing common gastrointestinal symptoms in infants. Nutrition 2012; 29:184-94. [PMID: 23137717 DOI: 10.1016/j.nut.2012.08.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In early infancy, various gastrointestinal symptoms (e.g., constipation, regurgitation, crying/fussiness, infantile colic, and excessive gas) are common problems and may result in numerous visits to pediatricians. Worldwide, this often results in switching infant formulas because parents (and sometimes doctors) believe these symptoms reflect a formula intolerance. However, in many cases, these infants are growing and developing normally. This study was performed to offer family pediatricians consensus-based algorithms on the management of the most common gastrointestinal symptoms in infants. METHODS A group of pediatric gastroenterologists and pediatric allergists from Europe, USA, Latin America, and Asia developed guidelines and practical algorithms to assist general pediatricians in addressing this challenge. RESULTS Five such practice recommendations were developed after a thorough literature review. These algorithms should not be considered as an "evidence-based guideline"; on the contrary, the authors are convinced that challenging these proposals will result in updated and improved versions. CONCLUSION To date, these algorithms, based on the published literature, are the result of a broad consensus of pediatric gastroenterologists from different continents.
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Bund T, Allelein S, Arunkumar A, Lucey JA, Etzel MR. Chromatographic purification and characterization of whey protein–dextran glycation products. J Chromatogr A 2012; 1244:98-105. [DOI: 10.1016/j.chroma.2012.04.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 11/30/2022]
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DRACMA one year after: which changes have occurred in diagnosis and treatment of CMA in Italy? Ital J Pediatr 2011; 37:53. [PMID: 22074618 PMCID: PMC3225314 DOI: 10.1186/1824-7288-37-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 11/10/2011] [Indexed: 11/19/2022] Open
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27
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:594-8. [PMID: 22027954 DOI: 10.1097/aci.0b013e32834d9a9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Restani P, Uberti F, Tarantino C, Ballabio C, Gombac F, Bastiani E, Bolognini L, Pavanello F, Danzi R. Validation by a Collaborative Interlaboratory Study of an ELISA Method for the Detection of Caseinate Used as a Fining Agent in Wine. FOOD ANAL METHOD 2011. [DOI: 10.1007/s12161-011-9270-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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