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Lijing X, Mengyao Z, Jing L, Yang L, Xiaoli X. Analysis of the characteristics of intestinal microbiota after oral tolerance in infants with food protein-induced proctocolitis. Front Pediatr 2024; 12:1338294. [PMID: 38737636 PMCID: PMC11082304 DOI: 10.3389/fped.2024.1338294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Objective To understand the characteristics of the intestinal microbiota after oral tolerance in infants with food protein-induced proctocolitis (FPIAP) treated with amino acid formula and their differences from healthy children, aiming to provide a scientific basis for guiding the application of probiotics during treatment. Methods FPIAP infants were prospectively enrolled, fecal specimens were obtained, and DNA was extracted for PCR amplification of the bacterial 16S rRNA gene V4 region. Library construction and sequencing were performed, and bioinformatic analysis was performed after obtaining valid data. Results There were 36 patients in the FPIAP group: 20 males and 16 females, age 21.944 ± 13.277 months. Diarrhea with blood in the stool were the main symptom, with an average course of 14.83 ± 9.33 days. Thirty infants (83.33%) had mucus stool, 11.11% (4/36) of them experiencing vomiting, and 55.56% (20/36) of the infants displaying poor intake and weight gain, 28 (77.78%) patients with moderate eczema, 2 (5.6%) patients with chronic respiratory symptoms. The treatment time with amino acid formula was 5.51 ± 2.88 months. A control group comprising of 25 healthy infants who were full-term, natural delivery, bottle fed, and matched in terms of age (24.840 ± 12.680 months) and gender (15 males and 10 females) was selected. Anaerobic bacteria were less abundant in FPIAP infants than healthy infants (P = 4.811 × 10-5), but potentially pathogenic bacteria were more abundant (P = 0.000). The abundance of Actinobacteria was low in FPIAP infants, the abundance of Proteobacteria was high, and the abundance of Firmicutes was reduced. Bifidobacterium could be used as a bacterial genus to differentiate healthy and FPIAP infants. Both α-and β-diversity indicators of intestinal microbiota were lower in FPIAP infants. In FPIAP infants, glucose and energy metabolism and amino acid anabolism were decreased, and inflammation-related lipopolysaccharide synthesis pathways were increased. Conclusion Compared with healthy infants, FPIAP infants with oral tolerance after amino acid formula treatment had differences in the structure and diversity of intestinal microbiota, among which Bifidobacterium was significantly reduced. Trial Registration This trial was registered on https://register.clinicaltrials.gov/.
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Affiliation(s)
| | | | | | | | - Xie Xiaoli
- Department of Pediatric Gastroenterology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Chatchatee P, Nowak-Wegrzyn A, Lange L, Benjaponpitak S, Chong KW, Sangsupawanich P, Eussen SRBM, van Ampting MTJ, Oude Nijhuis MM, Langford JE, Trendelenburg V, Pesek R, Davis CM, Muraro A, Erlewyn-Lajeunesse M, Fox AT, Michaelis LJ, Beyer K. Tolerance development in cow's milk-allergic children receiving amino acid-based formula with synbiotics: 36-Months follow-up of a randomized controlled trial (PRESTO Study). J Pediatr Gastroenterol Nutr 2024; 78:699-703. [PMID: 38504410 DOI: 10.1002/jpn3.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 03/21/2024]
Abstract
The objective of the present study is to assess the rates of acquired tolerance to cow's milk (CM) after 36 months in subjects who consumed amino acid-based formula with synbiotics (AAF-S) or amino acid-based formula without synbiotics (AAF) during a 1-year intervention period in early life as part of the PRESTO study (Netherlands Trial Register number NTR3725). Differences in CM tolerance development between groups were analysed using a logistic regression model. Results show that the proportion of subjects (mean [±SD] age, 3.8 ± 0.27 years) who developed CM tolerance after 36 months was similar in the group receiving AAF-S (47/60 [78%]) and in the group receiving AAF (49/66 [74%]) (p = 0.253), that is, figures comparable to natural outgrowth of CM allergy. Our data suggest that the consumption of AAF and absence of exposure to CM peptides do not slow down CM tolerance acquisition.
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Affiliation(s)
- Pantipa Chatchatee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University Langone Health, New York, USA
| | | | - Suwat Benjaponpitak
- Pediatric Allergy and Immunology Division, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Kok W Chong
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla Hospital, Hat Yai, Thailand
| | | | | | | | | | - Valerie Trendelenburg
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Carla M Davis
- Baylor College of Medicine, Texas Children's Hospital, Houston, USA
| | - Antonella Muraro
- Food Allergy Centre, Padua General University Hospital, Padua, Italy
| | | | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise J Michaelis
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Cela L, Brindisi G, Gravina A, Pastore F, Semeraro A, Bringheli I, Marchetti L, Morelli R, Cinicola B, Capponi M, Gori A, Pignataro E, Piccioni MG, Zicari AM, Anania C. Molecular Mechanism and Clinical Effects of Probiotics in the Management of Cow's Milk Protein Allergy. Int J Mol Sci 2023; 24:9781. [PMID: 37372929 DOI: 10.3390/ijms24129781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Cow's milk protein allergy (CMPA) is the most common food allergy (FA) in infancy, affecting approximately 2% of children under 4 years of age. According to recent studies, the increasing prevalence of FAs can be associated with changes in composition and function of gut microbiota or "dysbiosis". Gut microbiota regulation, mediated by probiotics, may modulate the systemic inflammatory and immune responses, influencing the development of allergies, with possible clinical benefits. This narrative review collects the actual evidence of probiotics' efficacy in the management of pediatric CMPA, with a specific focus on the molecular mechanisms of action. Most studies included in this review have shown a beneficial effect of probiotics in CMPA patients, especially in terms of achieving tolerance and improving symptoms.
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Affiliation(s)
- Ludovica Cela
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia Brindisi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandro Gravina
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesca Pastore
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Semeraro
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Ivana Bringheli
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Lavinia Marchetti
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Rebecca Morelli
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Bianca Cinicola
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Capponi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra Gori
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Elia Pignataro
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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New Insights in Cow's Milk and Allergy: Is the Gut Microbiota the Missing Link? Nutrients 2022; 14:nu14081631. [PMID: 35458195 PMCID: PMC9028706 DOI: 10.3390/nu14081631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
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Sorensen K, Meyer R, Grimshaw KE, Cawood AL, Acosta-Mena D, Stratton RJ. The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study. Immun Inflamm Dis 2022; 10:e572. [PMID: 34873874 PMCID: PMC8926503 DOI: 10.1002/iid3.572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Cow's milk allergy (CMA) is common in infants and children. Clinical presentations may vary, with a range of symptoms affecting the gastrointestinal (GI), skin and respiratory systems. Whilst the primary focus of research to date has been on the management of these symptoms, studies investigating the broader clinical burden of CMA are limited. Methods We performed a retrospective matched cohort study examining clinical data, including allergic symptoms and infections, extracted from case records within The Health Improvement Network database. A total of 6998 children (54% male) were included in the study, including 3499 with CMA (mean age at diagnosis 4.04 months) and 3499 matched controls without CMA, observed for a mean period of 4.2 years. Results GI, skin and respiratory symptoms affected significantly more children with CMA (p < .001), which recurred more often (p < .001), compared with children without CMA. More children with CMA had symptoms affecting multiple systems (p < .001). CMA was associated with a greater probability of these symptoms requiring hypoallergenic formula (HAF) prescription persisting over time (log‐rank test p < .0001, unadjusted hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.76–0.85, p < .001), with a longer median duration of symptoms and HAF prescription compared with the duration of symptoms in those without CMA (3.48 vs. 2.96 years). GI, skin, respiratory and ear infections affected significantly more children with CMA than those without, increasing by 74% (p < .001), 20% (p < .001), 9% (p < .001), and 30% (p < .001) respectively. These infections also recurred more often among children with CMA, increasing by 62% for GI infections, 37% for skin and respiratory infections, and 44% for ear infections (p < .001). Conclusions This real‐world study provides evidence to suggest that CMA presents a significant clinical burden to children, which has implications for the healthcare system. Further research is warranted to understand the health economic impact of this, and the phenotypes, factors and management approaches which may affect clinical outcomes.
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Affiliation(s)
| | - Rosan Meyer
- Department of Paediatrics, St. Mary's Hospital, London, UK
| | - Kate E Grimshaw
- Dietetic Department, Salford Care Organisation, Salford Royal NHS Foundation Trust, Salford, UK.,Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Abbie L Cawood
- Medical Affairs, Nutricia Ltd., Trowbridge, UK.,Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Rebecca J Stratton
- Medical Affairs, Nutricia Ltd., Trowbridge, UK.,Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
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