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Pratelli G, Tamburini B, Badami GD, Lo Pizzo M, De Blasio A, Carlisi D, Di Liberto D. Cow's Milk: A Benefit for Human Health? Omics Tools and Precision Nutrition for Lactose Intolerance Management. Nutrients 2024; 16:320. [PMID: 38276558 PMCID: PMC10819418 DOI: 10.3390/nu16020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Cow's milk (CM) is a healthy food consumed worldwide by individuals of all ages. Unfortunately, "lactase-deficient" individuals cannot digest milk's main carbohydrate, lactose, depriving themselves of highly beneficial milk proteins like casein, lactoalbumin, and lactoglobulin due to lactose intolerance (LI), while other individuals develop allergies specifically against these proteins (CMPA). The management of these conditions differs, and an inappropriate diagnosis or treatment may have significant implications for the patients, especially if they are infants or very young children, resulting in unnecessary dietary restrictions or avoidable adverse reactions. Omics technologies play a pivotal role in elucidating the intricate interactions between nutrients and the human body, spanning from genetic factors to the microbiota profile and metabolites. This comprehensive approach enables the precise delineation and identification of distinct cohorts of individuals with specific dietary requirements, so that tailored nutrition strategies can be developed. This is what is called personalized nutrition or precision nutrition (PN), the area of nutrition that focuses on the effects of nutrients on the genome, proteome, and metabolome, promoting well-being and health, preventing diseases, reducing chronic disease incidence, and increasing life expectancy. Here, we report the opinion of the scientific community proposing to replace the "one size fits all" approach with tailor-made nutrition programs, designed by integrating nutrigenomic data together with clinical parameters and microbiota profiles, taking into account the individual lactose tolerance threshold and needs in terms of specific nutrients intake. This customized approach could help LI patients to improve their quality of life, overcoming depression or anxiety often resulting from the individual perception of this condition as different from a normal state.
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Affiliation(s)
- Giovanni Pratelli
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
| | - Bartolo Tamburini
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy;
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Giusto Davide Badami
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Marianna Lo Pizzo
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Anna De Blasio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy;
| | - Daniela Carlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
| | - Diana Di Liberto
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
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Ah Heng T, Cronin C, Flores L, Meyer F, O'Sullivan M, McGinley AM, Hanley S, McKiernan A, D'Art Y, Hourihane JOB, Velasco R, Trujillo J. Safety and effectiveness of a milk ladder for managing children with IgE-mediated milk allergy. Clin Exp Allergy 2024; 54:61-63. [PMID: 37944550 DOI: 10.1111/cea.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Tessa Ah Heng
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Caoimhe Cronin
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Laura Flores
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Francois Meyer
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Meg O'Sullivan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | | | - Sarah Hanley
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Anne McKiernan
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Yvonne D'Art
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Jonathan O' B Hourihane
- Royal College of Surgeons of Ireland, Dublin, Ireland
- Cork University Hospital, Irish Centre for Maternal and Child Health Research (INFANT), HRB Clinical Research Facility Cork (CRF-C), Cork, Ireland
| | - Roberto Velasco
- Paediatric Emergency Unit, Hospital Universitari Parc Tauli, Barcelona, Spain
| | - Juan Trujillo
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
- Cork University Hospital, Irish Centre for Maternal and Child Health Research (INFANT), HRB Clinical Research Facility Cork (CRF-C), Cork, Ireland
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3
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Díaz MC, Slullitel P, Souza MV. Cow's milk allergy: Can oral food challenges be avoided? A probabilistic analysis based on clinical data. ARCH ARGENT PEDIATR 2023; 121:e202202850. [PMID: 37342978 DOI: 10.5546/aap.2022-02850.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.
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Affiliation(s)
- María C Díaz
- Unit of Allergy, Hospital General de Niños "Pedro de Elizalde", City of Buenos Aires, Argentina
| | - Pablo Slullitel
- Unit of Allergy, Hospital General de Niños "Pedro de Elizalde", City of Buenos Aires, Argentina
| | - María V Souza
- Unit of Allergy, Hospital General de Niños "Pedro de Elizalde", City of Buenos Aires, Argentina
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Olmstead M, Rathkopf M. Timing of Cow's Milk Protein Introduction and Childhood Adverse Reactions to Cow's Milk. Pediatrics 2023; 152:S32-S33. [PMID: 38038533 DOI: 10.1542/peds.2023-064344ja] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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5
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Shao MJ, Wang XY, Wang YF, Du YY, Liu CH. [Natural history and risk factors of IgE-mediated cow's milk protein allergy in infants]. Zhonghua Er Ke Za Zhi 2023; 61:917-921. [PMID: 37803859 DOI: 10.3760/cma.j.cn112140-20230423-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Objective: To investigate the natural history and risk factors for continued allergy in infants with IgE-mediated cow's milk protein allergy (CMPA). Methods: This was a prospective cohort study that included 72 infants under 24 months of age diagnosed with IgE-mediated CMPA in the allergy clinic of the Children's Hospital, Capital Institute of Pediatrics from October 2019 to November 2020. General information, clinical manifestations, serum total IgE, cow's milk specific IgE, and cow's milk protein component specific IgE were collected. Follow-ups were conducted at 24 and 36 months of age, and the patients were divided into the persistent allergy group and the tolerance group based on whether they developed cow's milk tolerance at 36 months of age. Mann-Whitney U test, chi-square test, and binary Logistic regression were used for intergroup comparison and multivariate analysis. Results: Among the 72 CMPA children, there were 42 boys and 30 girls, with an age of 10 (7, 15) months at enrollment. Cow's milk protein tolerance was observed in 32 cases (44%) and 46 cases (64%) at 24 and 36 months of age, respectively. There were 26 cases in the persistent allergy group and 46 cases in the tolerance group. The proportion of respiratory symptoms, history of wheezing, positive specific IgE for α-lactalbumin and the total IgE level in the persistent allergy group were higher than that in the tolerance group (7 cases (27%) vs. 0, 6 cases (23%) vs. 2 cases (4%), 67% (14/21) vs. 26% (10/39), 225 (151, 616) vs. 48 (21, 185) kU/L, χ2=10.82, 4.16, 9.57, Z=4.07, all P<0.05). Multivariate Logistic regression analysis showed that anaphylaxis (OR=21.14, 95%CI 2.55-175.14, P=0.005), a history of allergic rhinitis (OR=5.94, 95%CI 1.54-22.86, P=0.005), elevated milk specific IgE (OR=1.04, 95%CI 1.01-1.08, P=0.024), and positive casein specific IgE (OR=6.64, 95%CI 1.39-31.69, P=0.018) were risk factors for continuous CMPA. Conclusions: Most infants with IgE-mediated CMPA can achieve tolerance within 3 years. Anaphylaxis, a history of allergic rhinitis, elevated milk specific IgE levels, and casein sensitization are risk factors for continuous allergy.
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Affiliation(s)
- M J Shao
- Department of Allergy, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - X Y Wang
- Department of Allergy, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y F Wang
- Department of Allergy, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Y Du
- Department of Allergy, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - C H Liu
- Department of Allergy, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
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Florquin M, Eerdekens A. What is Known About Cow's Milk Protein Allergy in Preterm Infants? Breastfeed Med 2023; 18:767-778. [PMID: 37856666 DOI: 10.1089/bfm.2023.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Cow's milk protein allergy (CMPA) is well described in term infants, as opposed to preterm infants. In preterm infants, CMPA shares many gastrointestinal symptoms with necrotizing enterocolitis (NEC). Objectives: To evaluate the presentation of CMPA in preterm infants and to investigate the different diagnostic and therapeutic options. Materials and Methods: We searched for the relevant literature using the medical databases PubMed, Web of Science, and the Cochrane Library. We performed a post hoc analysis on the 25 case reports included in this study. Results: Literature was scarce and heterogeneous. The majority of preterm infants with CMPA were exposed to bovine-based milk proteins before the development of symptoms. The most common clinical manifestations were bloody stools, vomiting, and abdominal distension. Of the 25 cases, only 7 (28%) retained human milk in their diet after diagnosis. In the larger studies, no study has human milk as primary feeding choice after diagnosis. Conclusions: Preterm infants exposed to a type of cow's milk-based formula in their first days of life have a higher risk of developing CMPA. Most of the preterm infants are no longer fed with human milk after the diagnosis of CMPA is made, which is in contrast with current nutrition guidelines in preterm infants. We strongly advocate that human milk with mothers on a cow's milk-free diet is the first choice of feed after the diagnosis of CMPA. Prospective studies are necessary to obtain more information regarding clinical presentation, diagnostic tools, and therapeutic approaches.
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Affiliation(s)
- Mona Florquin
- Department of Pediatrics and University Hospital Leuven, KU Leuven, Belgium
| | - An Eerdekens
- Department of Neonatology, University Hospital Leuven, KU Leuven, Belgium
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Abramovits W, Oquendo M, Tran S, Vincent KD. A Review of the Risk of Cow's Milk Protein Allergy in Oral Medication. Skinmed 2023; 21:237-239. [PMID: 37771012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) is a common food reaction resulting from the consumption of cow's milk protein (CMP). The clinical manifestations of CMA include mild to severe urticaria, skin-manifested hypersensitivity reactions, and anaphylaxis. Food allergies may affect 8% of children and 10% of adults. The Federal Food, Drug, and Cosmetic Act (FD&C Act) requires that the label of a food must declare the presence of a "major food allergen" (MFA) contained in the food or ingredient. The Food and Drug Administration (FDA) generally regards milk protein concentrate (MPC) as safe for human consumption and use. The increasing use of MPC in formulations raises the need for its revelation in prescription and on labels of over-the-counter drugs. This review investigates oral and topical (including mucosal) preparations containing MPC for dermatologic and other uses and their therapeutic impact. Our findings suggest that for the adult population, the risk of serious cow's milk protein allergy (CMPA) from medications is minimal.
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Affiliation(s)
| | - Marcial Oquendo
- The Dallas Dermatology Treatment and Research Center, Dallas, TX
| | - Sabrina Tran
- The Dallas Dermatology Treatment and Research Center, Dallas, TX
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Rabinowitz DG, Brewster RCL, Juttukonda LJ, Bodamer OA, Palma MJ. Persistent Lactic Acidosis in an Infant With Milk Protein Allergy. Clin Pediatr (Phila) 2023; 62:951-955. [PMID: 36579865 DOI: 10.1177/00099228221148076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Danielle G Rabinowitz
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan C L Brewster
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lillian J Juttukonda
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Olaf A Bodamer
- Harvard Medical School, Boston, MA, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Melinda J Palma
- Harvard Medical School, Boston, MA, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
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Nocerino R, Coppola S, Carucci L, de Giovanni di Santa Severina AF, Oglio F, de Michele R, di Sessa I, Masino A, Bedogni G, Berni Canani R. The step-down approach in children with cow's milk allergy: Results of a randomized controlled trial. Allergy 2023; 78:2477-2486. [PMID: 37087638 DOI: 10.1111/all.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The Step-Down Approach for Cow's Milk Allergy (SDACMA) trial evaluated the tolerability and the rate of immune tolerance acquisition in CMA children starting dietary treatment with amino acid-based formula (AAF) and then switching to EHCF containing the probiotic Lacticaseibacillus rhamnosus GG (EHCF + LGG). METHODS Randomized controlled trial involving IgE-mediated CMA children receiving AAF from at least 4 weeks. EHCF + LGG tolerance was evaluated by the results of double-blind placebo-controlled food challenge (DBPCFC). Subjects tolerating EHCF + LGG were randomly allocated to remain on AAF, or to switch to EHCF + LGG. Immune tolerance acquisition to cow's milk proteins was evaluated with DBPCFC after 12 months of treatment. Allergy screening tests and body growth were also monitored. RESULTS Sixty IgE-mediated CMA children were enrolled. The proportion of children treated with AAF who resulted tolerant to the first exposure of EHCF + LGG was 0.98 (exact 95% CI 0.91-0.99). The rate of the immune tolerance acquisition to cow milk proteins after 12 months treatment was higher in the EHCF + LGG (0.48, 95% exact CI 0.29-0.67, n/N = 14/29) than in the AAF group (0.03, 95% exact CI 0.001-0.17, n/N = 1/30). There was an absolute benefit increase (ABI) of tolerance rate equal to 0.45 (95% CI 0.23-0.63, Newcombe method 10) for EHCF + LGG versus AAF, corresponding to a NNT of 2 (2-4, Bender's method). A normal body growth pattern was observed in the two study groups. CONCLUSION In IgE-mediated CMA children the step-down from AAF to EHCF + LGG is well tolerated and could facilitate the immune tolerance acquisition.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Anna Fiorenza de Giovanni di Santa Severina
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Roberta de Michele
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Ilaria di Sessa
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonio Masino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
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Switkowski KM, Oken E, Rifas-Shiman SL, Camargo CA, Gold DR, Sordillo JE, Lightdale JR. Timing of Cow's Milk Protein Introduction and Childhood Adverse Reactions to Cow's Milk. J Allergy Clin Immunol Pract 2022; 10:2713-2721.e2. [PMID: 35779778 PMCID: PMC10846592 DOI: 10.1016/j.jaip.2022.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current guidelines emphasize early introduction to potentially allergenic foods, but the optimal timing, amount, and exposure routes for foods other than peanut are not well-established. Cow's milk is often the first allergenic food introduced through infant formulas. OBJECTIVE To examine timing of cow's milk protein introduction (CMPI), including interaction with formula supplementation after delivery, in relation to reported cow's milk adverse reactions throughout childhood. METHODS Among children in the Boston, Mass-area Project Viva cohort, we assessed timing of CMPI (<2 weeks, 2 weeks-<6 months, ≥6 months) with questionnaires administered in infancy. Outcomes were (1) parent-reported cow's milk adverse reactions via annual questionnaires from age 2 to 13 years (n = 1298) and (2) milk sensitization (n = 505) and IgE-mediated milk allergy (n = 491) at age approximately 8 years. We used multivariable logistic regression models adjusted for parental atopy history, delivery mode, gestational age at delivery, child race, and census tract median household income, and investigated effect modification by ever/never breast-fed status and formula supplementation in the delivery hospital. RESULTS A total of 32% were introduced to cow's milk protein at age less than 2 weeks, 38% at age 2 weeks to less than 6 months, and 30% at age 6 months or more. Compared with children with CMPI at age less than 2 weeks, children with CMPI at age 6 months or more had a higher risk of cow's milk adverse reaction at age 2 to 5 years (odds ratio, 2.4 [1.2-4.7]). Children given formula after delivery + CMPI at age less than 2 weeks had the lowest risk overall. Among children not given formula after delivery, CMPI at age 2 weeks to 6 months appeared most protective. Results were similar among ever-breast-fed children. Timing of CMPI was not associated with milk sensitization or IgE-mediated milk allergy in mid-childhood. CONCLUSIONS Early, consistent cow's milk exposure appears protective against adverse reactions to cow's milk.
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Affiliation(s)
- Karen M Switkowski
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Carlos A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Jenifer R Lightdale
- Division of Gastroenterology/Nutrition, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass; Pediatric Gastroenterology, UMass Memorial Medical Center, Worcester, Mass
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Toca MC, Morais MB, Vázquez-Frias R, Becker-Cuevas DJ, Boggio-Marzet CG, Delgado-Carbajal L, Higuera-Carrillo MM, Ladino L, Marchisone S, Messere GC, Ortiz GJ, Ortiz-Paranza LR, Ortiz-Piedrahita C, Riveros-López JP, Sosa PC, Villalobos-Palencia NC. Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Rev Gastroenterol Mex (Engl Ed) 2022; 87:235-250. [PMID: 35623990 DOI: 10.1016/j.rgmxen.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.
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Affiliation(s)
- M C Toca
- Sección Gastroenterología, Hepatología y Nutrición, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - M B Morais
- Escuela Paulista de Medicina, Universidad Federal de Sao Paulo, Sao Paulo, Brazil
| | - R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Salud Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - D J Becker-Cuevas
- Servicio de Pediatría, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - C G Boggio-Marzet
- Gastroenterología y Nutrición Pediátrica, División Pediatría, Departamento Materno Infanto Juvenil, Hospital Gral. de Agudos «Dr. I. Pirovano», Ciudad Autónoma de Buenos Aires, Argentina
| | - L Delgado-Carbajal
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Unidad de Endoscopia Digestiva Pediátrica, Hospital Universitario «Centro Hospitalario Pereira Rossell», Montevideo, Uruguay
| | | | - L Ladino
- Instituto de Investigación en Nutrición, Genética y Metabolismo IINGM, Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | - S Marchisone
- Servicio de Gastroenterología, Hospital Infantil de Córdoba, Córboba, Argentina
| | - G C Messere
- Sección Gastroenterología, Hepatología y Nutrición, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - G J Ortiz
- Sección de Gastroenterología, Hepatología y Nutrición Infantil, Servicio de Pediatría, Hospital Nacional Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | - L R Ortiz-Paranza
- Hospital General Pediátrico «Niños de Acosta Ñu», Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - C Ortiz-Piedrahita
- Departamento de Pediatría, Servicio de Gastroenterología Infantil, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - J P Riveros-López
- Unidad de Gastroenterología Pediátrica Juan Pablo Riveros SAS, Bogotá, Colombia
| | - P C Sosa
- Sección Gastroenterología, Hepatología y Nutrición Infantil, Servicio de Pediatría, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
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12
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Grünhagen J, Zuberbier M, Worm M. [Loss of tolerance : Anaphylaxis after milk protein shake consumption in an adult sportsman]. Hautarzt 2022; 73:201-203. [PMID: 35147750 DOI: 10.1007/s00105-022-04955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
We describe the case of a man who developed an acute allergic reaction for the first time in his life directly after drinking a protein shake after a workout session. Allergy diagnostics, including skin prick testing and the determination of specific IgE antibodies revealed sensitizations to cow's milk and hen's egg. Due to the association between the onset of symptoms after ingestion of a milk protein shake, a type-1-allergic reaction to milk protein was suggested. The patient denied a provocation test, although this could have been an opportunity to elucidate the role of physical exercise in this case. We suspect in the present case a loss of tolerance of early childhood sensitization due to repetitive high protein exposure in the context of physical activity. The patient was provided information regarding dietary and emergency management.
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Affiliation(s)
- Josefine Grünhagen
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Zuberbier
- Allergologie und Immunologie, Fraunhofer-Institut für Translationale Medizin und Pharmakologie ITMP, Berlin, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - M Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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13
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Arasi S, Mastrorilli C, Pecoraro L, Giovannini M, Mori F, Barni S, Caminiti L, Castagnoli R, Liotti L, Saretta F, Marseglia GL, Novembre E. Heiner Syndrome and Milk Hypersensitivity: An Updated Overview on the Current Evidence. Nutrients 2021; 13:nu13051710. [PMID: 34070007 PMCID: PMC8157832 DOI: 10.3390/nu13051710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
Infants affected by Heiner syndrome (HS) display chronic upper or lower respiratory tract infections, including otitis media or pneumonia. Clinically, gastrointestinal signs and symptoms, anemia, recurrent fever and failure to thrive can be also present. Chest X-rays can show patchy infiltrates miming pneumonia. Clinical manifestations usually disappear after a milk-free diet. The pathogenetic mechanism underlying HS remains unexplained, but the formation of immune complexes and the cell-mediated reaction have been proposed. Patients usually outgrow this hypersensitivity within a few years. The aim of this review is to provide an updated overview on the current evidence on HS in children, with a critical approach on the still undefined points of this interesting disease. Finally, we propose the first structured diagnostic approach for HS.
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Affiliation(s)
- Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-68593570
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70126 Bari, Italy;
| | - Luca Pecoraro
- Department of Medicine, University of Verona, 37129 Verona, Italy;
- Pediatric Unit, ASST Mantua, 46100 Mantua, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98158 Messina, Italy;
| | - Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (R.C.); (G.L.M.)
| | - Lucia Liotti
- Department of Pediatrics, AOU Ospedali Riuniti Ancona, Presidio Ospedaliero di Alta Specializzazione “G. Salesi”, 60126 Ancona, Italy;
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy;
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (R.C.); (G.L.M.)
| | - Elio Novembre
- Department of Health Science, University of Florence, 70126 Florence, Italy;
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14
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Dupont C, Bocquet A, Tomé D, Bernard M, Campeotto F, Dumond P, Essex A, Frelut ML, Guénard-Bilbault L, Lack G, Linglart A, Payot F, Taieb A, Kalach N. Hydrolyzed Rice Protein-Based Formulas, a Vegetal Alternative in Cow's Milk Allergy. Nutrients 2020; 12:E2654. [PMID: 32878135 PMCID: PMC7551844 DOI: 10.3390/nu12092654] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 01/07/2023] Open
Abstract
Formulas adapted to infant feeding, although most of the time made from cow's milk proteins, can be made from hydrolyzed rice protein but they must be classified as "formulas for specific medical needs", according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow's milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow's milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.
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Affiliation(s)
- Christophe Dupont
- Pediatric Gastroenterology Department, Paris-Descartes University, 75006 Paris, France
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
- Marcel Sembat Clinic, 92100 Boulogne, France
| | - Alain Bocquet
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Medical and Pharmacy School, Franche-Comté University, 25000 Besançon, France
| | - Daniel Tomé
- UMR Nutrition Physiology and Ingestive Behavior, AgroParisTech, INRA, Paris-Saclay University, 75005 Paris, France;
| | | | - Florence Campeotto
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
| | - Pascale Dumond
- Pediatric Allergy Department, Children’s Hospital, University Hospital of Nancy, 54000 Vandoeuvre les Nancy, France;
| | - Anna Essex
- Sodilac Employee, Sodilac, 92000 Levallois, France;
| | - Marie-Laure Frelut
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Pediatric Practice, 16 Rue de Sept Fonds, 81000 Albi, France
| | | | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London WC2R ELS, UK;
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France;
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and ‘Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France
- APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | | | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospital, 33000 Bordeaux, France;
| | - Nicolas Kalach
- Department of Paediatrics, Saint Antoine Paediatric Hospital, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Catholic University of Lille, 59000 Lille, France;
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15
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Affiliation(s)
- Bodo C Melnik
- Department of Dermatology, Environmental Medicine, and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Gerd Schmitz
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
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16
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Sartorius T, Weidner A, Dharsono T, Boulier A, Wilhelm M, Schön C. Postprandial Effects of a Proprietary Milk Protein Hydrolysate Containing Bioactive Peptides in Prediabetic Subjects. Nutrients 2019; 11:E1700. [PMID: 31340611 PMCID: PMC6683050 DOI: 10.3390/nu11071700] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Milk proteins have been hypothesized to protect against type 2 diabetes (T2DM) by beneficially modulating glycemic response, predominantly in the postprandial status. This potential is, amongst others, attributed to the high content of whey proteins, which are commonly a product of cheese production. However, native whey has received substantial attention due to its higher leucine content, and its postprandial glycemic effect has not been assessed thus far in prediabetes. In the present study, the impact of a milk protein hydrolysate of native whey origin with alpha-glucosidase inhibiting properties was determined in prediabetics in a randomized, cross-over trial. Subjects received a single dose of placebo or low- or high-dosed milk protein hydrolysate prior to a challenge meal high in carbohydrates. Concentration-time curves of glucose and insulin were assessed. Incremental areas under the curve (iAUC) of glucose as the primary outcome were significantly reduced by low-dosed milk peptides compared to placebo (p = 0.0472), and a minor insulinotropic effect was seen. A longer intervention period with the low-dosed product did not strengthen glucose response but significantly reduced HbA1c values (p = 0.0244). In conclusion, the current milk protein hydrolysate of native whey origin has the potential to modulate postprandial hyperglycemia and hence may contribute in reducing the future risk of developing T2DM.
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Affiliation(s)
- Tina Sartorius
- BioTeSys GmbH, Schelztorstr. 54-56, 73728 Esslingen, Germany
| | - Andrea Weidner
- BioTeSys GmbH, Schelztorstr. 54-56, 73728 Esslingen, Germany
| | - Tanita Dharsono
- BioTeSys GmbH, Schelztorstr. 54-56, 73728 Esslingen, Germany
| | - Audrey Boulier
- Ingredia S.A., 51 Avenue F. Lobbedez CS 60946, 62033 Arras CEDEX, France
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, Ulm University of Applied Sciences, Albert-Einstein-Allee 55, 89081 Ulm, Germany
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17
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Linhart B, Freidl R, Elisyutina O, Khaitov M, Karaulov A, Valenta R. Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy. Nutrients 2019; 11:E1492. [PMID: 31261965 PMCID: PMC6683018 DOI: 10.3390/nu11071492] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open
Abstract
Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.
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Affiliation(s)
- Birgit Linhart
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria.
| | - Raphaela Freidl
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Elisyutina
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
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18
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Vandenplas Y, Al-Hussaini B, Al-Mannaei K, Al-Sunaid A, Helmi Ayesh W, El-Degeir M, El-Kabbany N, Haddad J, Hashmi A, Kreishan F, Tawfik E. Prevention of Allergic Sensitization and Treatment of Cow's Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus. Nutrients 2019; 11:nu11071444. [PMID: 31248015 PMCID: PMC6683055 DOI: 10.3390/nu11071444] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/20/2019] [Indexed: 12/23/2022] Open
Abstract
Allergy risk has become a significant public health issue with increasing prevalence. Exclusive breastfeeding is recommended for the first six months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle-East region, putting infants at risk of developing allergic sensitization and disorders. When breastfeeding is not possible or not adequate, a partially hydrolyzed whey formula (pHF-W) has shown proven benefits of preventing allergy, mainly atopic eczema, in children with a genetic risk. Therefore, besides stimulating breastfeeding, early identification of infants at risk for developing atopic disease and replacing commonly used formula based on intact cow milk protein (CMP) with a clinically proven pHF-W formula is of paramount importance for allergy prevention. If the child is affected by cow’s milk protein allergy (CMPA), expert guidelines recommend extensively hydrolyzed formula (eHF), or an amino acid formula (AAF) in case of severe symptoms. The Middle-East region has a unique practice of utilizing pHF-W as a step-down between eHF or AAF and intact CMP, which could be of benefit. The region is very heterogeneous with different levels of clinical practice, and as allergic disorders may be seen by healthcare professionals of different specialties with different levels of expertise, there is a great variability in preventive and treatment approaches within the region itself. During a consensus meeting, a new approach was discussed and unanimously approved by all participants, introducing the use of pHF-W in the therapeutic management of CMPA. This novel approach could be of worldwide benefit.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrijne Unversiteit Brussel, 1090 Brussels, Belgium.
| | - Bakr Al-Hussaini
- Department of Paediatrics, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia.
| | - Khaled Al-Mannaei
- Department of Paediatrics, Al Salam International Hospital, Dasma 35151, Kuwait.
| | - Areej Al-Sunaid
- Department of Paediatric Gastroenterology, King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia.
| | - Wafaa Helmi Ayesh
- Clinical Nutrition Department, Dubai Health Authority, PO Box 4545 Dubai, UAE.
| | - Manal El-Degeir
- Department of Paediatrics, National Guard Hospital, Dammam 31412, Saudi Arabia.
| | - Nevine El-Kabbany
- Department of Paediatrics, Mediclinic Welcare Hospital, PO Box 31500 Dubai, UAE.
| | - Joseph Haddad
- Department of Paediatrics, Saint George Hospital University Medical Center, Balamand University, PO Box 166378 Beirut, Lebanon.
| | - Aziza Hashmi
- Department of Clinical Nutrition Services, King Abdulaziz Medical City-Jeddah, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Furat Kreishan
- Department of Paediatrics, Alhakeem Furat Clinic, Amman 11942, Jordan.
| | - Eslam Tawfik
- Department of Paediatrics, Sheikh Khalifa Medical City, PO Box 51900 Abu Dhabi, UAE.
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19
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Kalach N, Bellaïche M, Elias-Billon I, Dupont C. Family history of atopy in infants with cow's milk protein allergy: A French population-based study. Arch Pediatr 2019; 26:226-231. [PMID: 30885604 DOI: 10.1016/j.arcped.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/07/2018] [Accepted: 02/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This French multicenter, cross-sectional, observational study aimed to describe the family history of atopy in infants with cow's milk protein allergy (CMPA), and the related diagnostic approaches used by specialists in a real-life ambulatory setting. PATIENTS AND METHODS In total, 1674 infants with suspected CMPA [median age 4.5 months (range: 0.1-18.0), males 54%] were enrolled in the study by 466 private physicians (pediatricians: 97%). Family history of atopy was defined as a known history of atopy in at least one first- (father, mother, and/or sibling) and/or second-degree relative (grandparents, uncles, and aunts), as reported by parents to physicians. RESULTS Atopy in a first-degree relative was more common among infants with documented or high probability of CMPA (in 84% and 80% of cases, respectively, vs. the other subgroups, P=0.005). Most infants experienced digestive (92%) and skin (61%) symptoms suggestive of CMPA. Delayed reactions were reported in 64% of infants. According to a post-classification based on the results of previous diagnostic tests and procedures, 1133 infants (68%) had highly probable (52%) or documented CMPA (16%). In these infants, a history of atopy was reported in first- and/or second-degree relative(s) in 86% of cases (81% in first-degree relatives). Whatever the family history of atopy, the characteristics of the infants were similar, except for fewer pets in the case of negative family atopy (14% vs. 25%, P<0.001). Atopy in a parent was more frequent in infants who presented with the first signs suggestive of CMPA within the first 6 months of life vs. those with later first symptoms (75% vs. 65%, P=0.063). CONCLUSION This French study confirms the high rate of family history of atopy in first-degree relatives of infants with probable or documented CMPA.
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Affiliation(s)
- N Kalach
- Clinique pédiatrique Saint-Antoine, hôpital Saint-Vincent-de-Paul, groupement des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59020 Lille cedex, France.
| | - M Bellaïche
- Service de gastroentérologie pédiatrique, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - I Elias-Billon
- Medical department, nutrition hygiène santé, 94150 Rungis, France
| | - C Dupont
- Service de gastroentérologie pédiatrique, université Paris V - René Descartes, hôpital Necker-Enfants-malades, AP-HP, 75015 Paris, France
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20
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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] [What about the content of this article? (0)] [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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21
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Comerford KB, Pasin G. Emerging Evidence for the Importance of Dietary Protein Source on Glucoregulatory Markers and Type 2 Diabetes: Different Effects of Dairy, Meat, Fish, Egg, and Plant Protein Foods. Nutrients 2016; 8:nu8080446. [PMID: 27455320 PMCID: PMC4997361 DOI: 10.3390/nu8080446] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 02/07/2023] Open
Abstract
Observational studies provide evidence that a higher intake of protein from plant-based foods and certain animal-based foods is associated with a lower risk for type 2 diabetes. However, there are few distinguishable differences between the glucoregulatory qualities of the proteins in plant-based foods, and it is likely their numerous non-protein components (e.g., fibers and phytochemicals) that drive the relationship with type 2 diabetes risk reduction. Conversely, the glucoregulatory qualities of the proteins in animal-based foods are extremely divergent, with a higher intake of certain animal-based protein foods showing negative effects, and others showing neutral or positive effects on type 2 diabetes risk. Among the various types of animal-based protein foods, a higher intake of dairy products (such as milk, yogurt, cheese and whey protein) consistently shows a beneficial relationship with glucose regulation and/or type 2 diabetes risk reduction. Intervention studies provide evidence that dairy proteins have more potent effects on insulin and incretin secretion compared to other commonly consumed animal proteins. In addition to their protein components, such as insulinogenic amino acids and bioactive peptides, dairy products also contain a food matrix rich in calcium, magnesium, potassium, trans-palmitoleic fatty acids, and low-glycemic index sugars-all of which have been shown to have beneficial effects on aspects of glucose control, insulin secretion, insulin sensitivity and/or type 2 diabetes risk. Furthermore, fermentation and fortification of dairy products with probiotics and vitamin D may improve a dairy product's glucoregulatory effects.
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Affiliation(s)
- Kevin B Comerford
- California Dairy Research Foundation (CDRF), 501 G Street, Ste. 203, Davis, CA 95616, USA.
| | - Gonca Pasin
- California Dairy Research Foundation (CDRF), 501 G Street, Ste. 203, Davis, CA 95616, USA.
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22
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Martín-Muñoz MF, Pineda F, García Parrado G, Guillén D, Rivero D, Belver T, Quirce S. Food allergy in breastfeeding babies. Hidden allergens in human milk. Eur Ann Allergy Clin Immunol 2016; 48:123-128. [PMID: 27425167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGORUND Food allergy is a rare disorder among breastfeeding babies. OBJECTIVE Our aim was to identify responsible allergens in human milk. METHODS We studied babies developing allergic symptoms at the time they were breastfeeding. Skin prick tests (SPT) were performed with breast milk and food allergens. Specific IgE was assessed and IgE Immunoblotting experiments with breast milk were carried out to identify food allergens. Clinical evolution was evaluated after a maternal free diet. RESULTS Five babies had confirmed breast milk allergy. Peanut, white egg and/or cow's milk were demonstrated as the hidden responsible allergens. No baby returned to develop symptoms once mother started a free diet. Three of these babies showed tolerance to other food allergens identified in human milk. CONCLUSION A maternal free diet should be recommended only if food allergy is confirmed in breastfed babies.
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Affiliation(s)
- M F Martín-Muñoz
- Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain. Phone: +34 62 649 3341 Fax: +34 727 7050 E-mail: ;
| | - F Pineda
- Diater Laboratories, R&D Department, Madrid, Spain
| | | | - D Guillén
- Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain
| | - D Rivero
- Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain
| | - T Belver
- Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain
| | - S Quirce
- Department of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain
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Romero B, Talesnik E, Harris PR, Cerda J. [Clinical features of Eosinophilic Colitis in infants with persistent rectal bleeding]. ACTA ACUST UNITED AC 2016; 85:666-73. [PMID: 25697612 DOI: 10.4067/s0370-41062014000600003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
UNLABELLED The most common presentation of cow's milk protein allergy (CMP) in infants is known as eosinophilic colitis (EC). The aim of this study is to evaluate EC characteristics in infants evaluated with colonoscopy due to the presence of rectorrhagia. PATIENTS AND METHODS A retrospective case-control study. Left-sided colonoscopy records of infants with persistent rectal bleeding, conducted between January 2006 and March 2011, were reviewed. The cases corresponded to infants with rectal biopsy compatible with EC and controls with negative biopsy. Telephone questionnaires to parents were conducted, evaluating personal and family history. RESULTS Complete records were obtained in 61 (79%) of the 77 procedures. 33 (54%) of them were males. Examination average age was 6.3 ± 5.9 months. 25 (41%) patients had EC on their histology. Between cases and controls, no significant difference in gestational age, birth weight and gender, only regarding age at the time of rectal bleeding, were observed. There was also no difference in personal history regarding obstructive bronchitis, allergic rhinitis, family history of asthma, allergic rhinitis or other food allergies. Those who received artificial feeding did not presented greater risk of EC. The most common symptoms in the cases did not differ significantly from the controls. CONCLUSIONS The prevalence of EC in the children studied was 40.9%. Our results show that there are groups of patients with persistent rectal bleeding in which there is no personal or family history that helps diagnosing EC. An endoscopic study could be considered in these patients to establish a correct diagnosis of this condition, avoid unnecessary diets and not to delay the detection of other diseases.
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Grimshaw KE, Beyer K, Grabenhenrich L, Keil T, Sprikkelman AB, Roberts G. Reply. Allergy 2015; 70:1680. [PMID: 27163118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K E Grimshaw
- Clinical Experimental Science Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - K Beyer
- Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany
| | - L Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany
| | - A B Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - G Roberts
- Clinical Experimental Science Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
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Cervantes-Bustamante R, Pedrero-Olivares I, Toro-Monjaraz EM, Murillo-Márquez P, Ramírez-Mayans JA, Montijo-Barrios E, Zárate-Mondragón F, Cadena-León J, Cazares-Méndez M, López-Ugalde M. Histopathologic findings in children diagnosed with cow's milk protein allergy. Rev Gastroenterol Mex 2015; 80:130-4. [PMID: 26024572 DOI: 10.1016/j.rgmx.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cow's milk protein allergy is the most common cause of food allergy. The challenge test, either open or doubled-blind with a placebo control, is regarded as the criterion standard. Endoscopy and histologic findings are considered a method that can aid in the diagnosis of this entity. AIMS The aim of this study was to describe the histopathologic findings in children suspected of cow's milk protein allergy that were seen at our hospital. MATERIAL AND METHODS A descriptive, observational study was conducted on 116 children clinically suspected of presenting with cow's milk protein allergy that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría. Upper endoscopy and rectosigmoidoscopy with biopsies were performed and the findings were described. RESULTS Of the 116 patients, 64 (55.17%) were girls and 52 (44.83%) were boys. The rectum was the site with the greatest presence of eosinophils per field in both groups, followed by the duodenum. In general, more than 15 eosinophils were found in 46% of the patients. CONCLUSIONS Between 40 and 45% of the cases had the histologic criterion of more than 15 to 20 eosinophils per field and the rectosigmoid colon was the most affected site. Therefore, panendoscopy and rectosigmoidoscopy with biopsy and eosinophil count are suggested.
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Affiliation(s)
- R Cervantes-Bustamante
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - I Pedrero-Olivares
- Servicio de Gastroenterología y Nutrición Pediátrica, Hospital de Alta Especialidad de Ixtapaluca, Secretaría de Salud,, Ixtapaluca, Estado de México, México
| | - E M Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México.
| | - P Murillo-Márquez
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - J A Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - E Montijo-Barrios
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - F Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - J Cadena-León
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - M Cazares-Méndez
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
| | - M López-Ugalde
- Departamento de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, México, D.F., México
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Mazigh S, Yahiaoui S, Ben Rabeh R, Fetni I, Sammoud A. [Diagnosis and management of cow's protein milk allergy in infant]. Tunis Med 2015; 93:205-211. [PMID: 26375735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cow's milk protein allergy (CMPA) can be responsible of a variety of symptoms and can be caused by IgE or non-IgEmediated reactions. The remaining questions concern the diagnosis (what are the most suggestive clinical manifestations, the laboratory evaluations which play a supporting role, and the management of CMPA in breast fed infants and formula-fed infants. METHODS Review of the pub med, science direct, Cochrane library, using the key words cow's milk protein allergy, guideline, and child. Evidence was levelled A, B, C. RESULTS No symptom is pathognomonic. A thorough history and careful clinical examination are necessary to suspect the disease. Skin prick tests, and serum specific IgE are only indicative of sensitivation to CMP. A double-blind placebo-controlled challenge is considered the gold standard in diagnosis, but in practice only an open challenge is performed. The patient with suspected pathology will follow a cow's milk free diet for 2-4 weeks. Formula-fed infants get an extensively hydrolyzed formula .If the allergy is present, clinical manifestations will disappear. If symptoms do not improve, an amino acid based formula should be considered. In severe Cow's milk protein allergy with life-threatening symptoms, an amino-acid formula is recommended. The infant should be maintained on an elimination diet until the infant is between 9-12 months or at least for 6 months. The overall natural evolution of the disease is favorable with most patients achieving tolerance to milk by the age of five years. CONCLUSION The importance of defined diagnostic criteria needs to be emphasized. It precludes infants from an unnecessary diet and avoids delay in diagnosis, which can lead to malnutrition.
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Turner KM, Keogh JB, Clifton PM. Dairy consumption and insulin sensitivity: a systematic review of short- and long-term intervention studies. Nutr Metab Cardiovasc Dis 2015; 25:3-8. [PMID: 25156891 DOI: 10.1016/j.numecd.2014.07.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/17/2014] [Accepted: 07/29/2014] [Indexed: 11/20/2022]
Abstract
AIM Evidence from epidemiological studies suggests that higher consumption of dairy products may be inversely associated with risk of type 2 diabetes and other components of the metabolic syndrome, although the evidence is mixed. Intervention studies that increase dairy intake often involve lifestyle changes, including weight loss, which alone will improve insulin sensitivity. The aim of this review was to examine weight stable intervention studies that assess the effect of an increased intake of dairy products or dairy derived supplements on glucose metabolism and insulin sensitivity. DATA SYNTHESIS An electronic search was conducted using MEDLINE, EMBASE, the Cochrane Database and Web of Science for randomised controlled trials altering only dairy intake in humans with no other lifestyle or dietary change, particularly no weight change, and with measurement of glucose or insulin. Healthy participants and those with features of the metabolic syndrome were included. Chronic whey protein supplementation was also included. Ten studies were included in this systematic review. CONCLUSIONS In adults, four of the dairy interventions showed a positive effect on insulin sensitivity as assessed by Homeostasis Model Assessment (HOMA); one was negative and five had no effect. As the number of weight stable intervention studies is very limited and participant numbers small, these findings need to be confirmed by larger trials in order to conclusively determine any relationship between dairy intake and insulin sensitivity.
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Affiliation(s)
- K M Turner
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - J B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - P M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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Fiedorowicz E, Kaczmarski M, Cieślińska A, Sienkiewicz-Szłapka E, Jarmołowska B, Chwała B, Kostyra E. β-casomorphin-7 alters μ-opioid receptor and dipeptidyl peptidase IV genes expression in children with atopic dermatitis. Peptides 2014; 62:144-9. [PMID: 25281794 DOI: 10.1016/j.peptides.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with heterogeneous clinical phenotypes reflecting genetic predisposition and exposure to environmental factors. Reactions to food may play a significant role especially in young children. Milk proteins are particularly strong allergens and are additional source of bioactive peptides including β-casomorphin-7 (BCM7, Tyr-Pro-Phe-Pro-Gly-Pro-Ile). BCM7 exerts its influence on nervous, digestive, and immune functions via the μ-opioid receptor (MOR). Proline dipeptidyl peptidase IV (DPPIV; EC 3.4.14.5) appears to be the primary degrading enzyme of BCM7. Moreover, DPPIV is known to restrict activity of proinflammatory peptides. BCM7 is considered to modulate an immune response by affecting MOR and DPPIV genes expression. In this study, we determined the MOR and DPPIV genes expression in children diagnosed with a severe form of AD. 40 healthy children and 62 children diagnosed with severe AD (AD score ≥60) were included in the study. Peripheral blood mononuclear cells (PBMCs) from the studied subjects were incubated with the peptide extracts of raw and hydrolysed cow milk with defined β-casein genotypes (A1A1, A2A2 and A1A2) and MOR and DPPIV genes expression was determined with real-time PCR. Incubation PBMCs with peptide extracts from cow milk caused an increase of the MOR gene expression (p<0.05; p<0.001) in AD children with a simultaneous decrease in the DPPIV gene expression (p<0.001). The obtained results supplement the knowledge on the BCM7 participation in AD etiology and provide an important diagnostic tool.
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Affiliation(s)
- Ewa Fiedorowicz
- Chair of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland
| | - Maciej Kaczmarski
- Department of Paediatrics, Gastroenterology and Allergology, Medical University of Białystok, Poland
| | - Anna Cieślińska
- Chair of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland
| | - Edyta Sienkiewicz-Szłapka
- Chair of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland
| | - Beata Jarmołowska
- Chair of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland
| | - Barbara Chwała
- The Regional Children's Specialized Hospital, Olsztyn, Poland
| | - Elżbieta Kostyra
- Chair of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury, Olsztyn, Poland.
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29
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Helm N. Promoting breastfeeding in infants with cow's milk protein allergy: a case study. Pediatr Nurs 2014; 40:253-256. [PMID: 25929118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Montijo-Barrios E, López-Ugalde MV, Ramírez-Mayans J, Anaya-Flórez MS, Arredondo-García JL, Azevedo-Tenorio I, Bacarreza-Nogales D, Bautista-Silva MG, Cáceres-Cano PA, Cáceres-Mendoza CA, Cadena-León JF, Cadranel S, Carbajal-Rodríguez L, Castillo-de-León YA, Cázares-Méndez JM, Cervantes-Bustamante R, Colindres-C E, Cossío-Ochoa EA, Chanis-Águila R, Chávez-Barrera JA, Escobar-Castro H, Fernández-Aragón M, Fernández-Carrocera LA, Flores A, Flores-Calderón J, Galaz-Pantoja ME, García-Dávila M, Heller-Rouassant S, Hernández-Bautista VM, Higuera-Benítez J, Huerta-Hernández RE, Huerta-López JG, Jovel-Banegas LE, Larrosa-Haro A, Leal-Quevedo FJ, León-Ramírez C, Limón-Rojas AE, Lozano-Sáenz JS, Mariño-Forero ÁE, Márquez-Aguirre MP, Maruy-Saito A, Méndez-Nieto CM, Menéndez-Sandoval JF, Merlos-Fernández IG, Michel-Aceves RDJ, Michel-Penichet F, Munguía-Venegas P, Murillo-Márquez P, Navarro-A DC, Noronha-Spolidoro JV, Núñez-Barrera I, Ordaz-Ortiz CR, Ortega-Martell JA, Ortiz-López-de-Wyss AC, Ovando-Fonseca JE, Oyervides-García CI, Palacios-Rosales J, Pinzón-Navarro AB, Quevedo-B R, Quito-Riera B, Ramírez-Ortiz FDM, Rivera-Medina J, Romero-Trujillo JO, Sabra A, Sáez-de-Ocariz-Gutiérrez MDM, Sánchez-Ortega A, Sánchez-Pérez MP, Sarmiento-Quintero F, Serrano-Sierra A, Suárez-Cortina L, Tormo-Carnicé R, Toro-Monjaraz E, Urquidi-Rivera ME, Vásconez F, Vera F, Worona-Dibner LB, Zablah-Córdova R, Zamora-Dávila E, Zárate-Mondragón F. [Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)]. Rev Invest Clin 2014; 66 Suppl 2:S9-S72. [PMID: 25706585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 06/04/2023]
Abstract
Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.
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Overbeck P. [Type 1 diabetes. Cow's milk acquitted]. MMW Fortschr Med 2014; 156:29. [PMID: 25318214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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32
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Hosie P. The wonders of medical science. J Fam Health Care 2014; 24:4. [PMID: 24665509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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De Koker CE, Shah N, Meyer R. The differences between lactose intolerance and cow's milk protein allergy. J Fam Health Care 2014; 24:14-20. [PMID: 24665517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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van den Braak CCM, Klebach M, Abrahamse E, Minor M, Hofman Z, Knol J, Ludwig T. A novel protein mixture containing vegetable proteins renders enteral nutrition products non-coagulating after in vitro gastric digestion. Clin Nutr 2013; 32:765-71. [PMID: 23274146 DOI: 10.1016/j.clnu.2012.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Non-coagulation of protein from enteral nutrition (EN) in the stomach is considered to improve gastric emptying and may result in reduced upper gastrointestinal complications such as reflux and aspiration pneumonia. For the development of a new EN protein mixture with reduced gastric coagulation, the coagulating properties of individual proteins, a novel blend of four proteins (P4 protein blend) and commercial EN products were investigated. METHODS A semi-dynamic, computer controlled setup was developed to mimic gastric digestion. The coagulation behaviour of 150 ml protein solutions and EN products was investigated. These were heat-treated calcium caseinate, sodium caseinate, whey, soy and pea protein, and the P4 protein blend comprising of the latter four (all solutions 6% w/v protein), four new enteral nutrition product varieties (New Nutrison® .0 or 1.5 kcal/ml, with and without MultiFibre MF6™) based on the P4 protein blend and two other commercially available casein dominant EN products (T1 and T2). RESULTS Calcium caseinate and sodium caseinate yielded a total wet coagulate of 43.5 ± 0.7 g and 52.7 ± 6.2 g, respectively. Whey, soy, pea and the P4 protein blend did not produce any measurable coagulate. T1 and T2 resulted in a total wet coagulate of 37.5 ± 0.8 g and 57.3 ± 0.8 g, respectively, while all new EN product varieties based on the P4 protein blend did not produce any measurable coagulate. CONCLUSIONS The P4 protein blend renders EN product varieties non-coagulating after in vitro gastric digestion.
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Cinotti E, Douchet C, Perrot JL, Labeille B, Allombert-Blaise C, Cambazard F. Bullous pemphigoid in an infant with milk protein allergy. Br J Dermatol 2013; 169:191-2. [PMID: 23834119 DOI: 10.1111/bjd.12228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shandilya UK, Kapila R, Haq RM, Kapila S, Kansal VK. Effect of thermal processing of cow and buffalo milk on the allergenic response to caseins and whey proteins in mice. J Sci Food Agric 2013; 93:2287-2292. [PMID: 23436735 DOI: 10.1002/jsfa.6041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 01/03/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Heat treatment is the most common method for reducing pathogen load, but it remains controversial in reducing the incidence of hyperimmune reactions. The aim of this study was to compare the allergenicity of caseins (CSN) and whey proteins (WP) of thermally processed cow and buffalo milk in a mouse model. Swiss albino mice were sensitised by intraperitoneal injections (administered in three doses at weekly intervals) of CSN or WP from cow or buffalo milk for the evaluation of humoral response and splenocyte stimulation index. RESULTS After 3 weeks of intraperitoneal stimulation of mice with milk proteins, the sterilised milk protein group displayed significantly lowered (P ≤ 0.05) serum IgG and IgE levels, while considerably increased cow milk protein-specific responses (IgE) were shown by proteins of pasteurised milk compared with those of raw milk. The stimulation index of splenocytes induced by CSN or WP of boiled and sterilised milk was also lower (P ≤ 0.05) than that of raw milk of both cow and buffalo. CONCLUSION The experiment showed that boiling and sterilisation of cow and buffalo milk clearly affect the allergenicity by decreasing the humoral and cell-mediated responses in mice. All results indicated that CSN and WP of sterilised milk are less allergenic than those of raw milk in mice.
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Affiliation(s)
- Umesh Kumar Shandilya
- Animal Biochemistry Division, National Dairy Research Institute, Karnal, 132001, Haryana, India
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Gushken AKF, Castro APM, Yonamine GH, Corradi GA, Pastorino AC, Jacob CMA. Double-blind, placebo-controlled food challenges in Brazilian children: adaptation to clinical practice. Allergol Immunopathol (Madr) 2013; 41:94-101. [PMID: 22326568 DOI: 10.1016/j.aller.2011.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND A double-blind, placebo-controlled food challenge (DBPCFC) is considered the gold standard for diagnosing food allergy, but because of methodological difficulties it is rarely conducted in clinical practice, especially in paediatric patients. The purpose of the study was to propose a DBPCFC protocol that is adapted to our conditions for the diagnosis of an IgE-mediated cow's milk allergy (CMA) in a Brazilian reference centre for paediatric allergies. METHODS This study includes the experimental phase (choice of materials, adjustments made to protocols described in the literature) and the test execution phase. DBPCFCs were performed in 58 patients aged 1-15 years who were separated into two groups: Group 1 (n=39), sex 1.6 M:F, 5.3 years median age, suggestive history of IgE-mediated CMA; and Group 2 (n=19), sex 1.4 M:F, 8.3 years median age with symptoms not associated with milk ingestion and laboratory data not compatible with IgE-mediated CMA. RESULTS The materials were standardised for testing: containers and disposable products, low-lactose cow's milk (CM) and vehicles, such as natural fruit juice, vegetable soup and soybean-based beverages. Each DBPCFC was performed in a single day with two blind, randomised phases with a 2-h interval between them. The milk doses were gradually increased and offered in regular intervals of 15-30 min. Following negative or inconclusive results, patients underwent an open oral challenge test with 200 mL of low-lactose CM. CONCLUSIONS The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision.
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Affiliation(s)
- A K F Gushken
- Allergy and Immunology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Wang B, Zhan SY. [Issues to address in developing evidence based clinical practice guidelines: experience from evidence-based recommendations for the diagnosis and treatment of cow's milk protein allergy in infants]. Zhonghua Er Ke Za Zhi 2013; 51:165-167. [PMID: 23751574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Subspecialty Group of Immunology, The Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Child Health Care, The Society of Pediatrics, Chinese Medical Association, Subspecialty Group of Digestion, The Society of Pediatrics, Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics. [Evidence based recommendations for the diagnosis and management of cow's milk allergy in Chinese infants]. Zhonghua Er Ke Za Zhi 2013; 51:183-6. [PMID: 23751578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Li HQ. [Reading and interpreting evidence based recommendations for the diagnosis and management of cow's milk allergy in Chinese infants]. Zhonghua Er Ke Za Zhi 2013; 51:187-188. [PMID: 23751579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Canani RB, Di Costanzo M. Gut microbiota as potential therapeutic target for the treatment of cow's milk allergy. Nutrients 2013; 5:651-62. [PMID: 23455693 PMCID: PMC3705311 DOI: 10.3390/nu5030651] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 12/26/2022] Open
Abstract
Cow's milk allergy (CMA) continues to be a growing health concern for infants living in Western countries. The long-term prognosis for the majority of affected infants is good, with about 80% naturally acquiring tolerance by the age of four years. However, recent studies suggest that the natural history of CMA is changing, with an increasing persistence until later ages. The pathogenesis of CMA, as well as oral tolerance, is complex and not completely known, although numerous studies implicate gut-associated immunity and enteric microflora, and it has been suggested that an altered composition of intestinal microflora results in an unbalanced local and systemic immune response to food allergens. In addition, there are qualitative and quantitative differences in the composition of gut microbiota between patients affected by CMA and healthy infants. These findings prompt the concept that specific beneficial bacteria from the human intestinal microflora, designated probiotics, could restore intestinal homeostasis and prevent or alleviate allergy, at least in part by interacting with the intestinal immune cells. The aim of this paper is to review what is currently known about the use of probiotics as dietary supplements in CMA.
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Affiliation(s)
- Roberto Berni Canani
- Food Allergy Unit, Department of Translational Medicine, Pediatric Section, University of Naples “Federico II”, Naples 80131, Italy; E-Mail:
- European Laboratory for the Investigation of Food Induced Diseases, University of Naples “Federico II”, Naples 80131, Italy
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-081-7462680; Fax: +39-081-5451278
| | - Margherita Di Costanzo
- Food Allergy Unit, Department of Translational Medicine, Pediatric Section, University of Naples “Federico II”, Naples 80131, Italy; E-Mail:
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Niggemann B. [Diagnosis is often missed or premature. How us cows' milk protein allergy recognized? (interview by Dr. Beate Schumacher)]. MMW Fortschr Med 2013; 155:24. [PMID: 23573763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Karakochuk C, van den Briel T, Stephens D, Zlotkin S. Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Am J Clin Nutr 2012; 96:911-6. [PMID: 22952175 DOI: 10.3945/ajcn.111.029744] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Moderate and severe acute malnutrition affects 13% of children <5 y of age worldwide. Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity. Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition. OBJECTIVE The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food (RUSF) and the more conventional ration of corn-soya blend (CSB) in Ethiopia. DESIGN A total of 1125 children aged 6-60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF. Children were randomly assigned to receive one or the other food. The daily rations were purposely based on the conventional treatment rations distributed at the time of the study in Ethiopia: 300 g CSB and 32 g vegetable oil in the control group (1413 kcal) and 92 g RUSF in the intervention group (500 kcal). The higher ration size of CSB was provided because of expected food sharing. RESULTS The HR for children in the CSB group was 0.85 (95% CI: 0.73, 0.99), which indicated that they had 15% lower recovery (P = 0.039). Recovery rates of children at the end of the 16-wk treatment period trended higher in the RUSF group (73%) than in the CSB group (67%) (P = 0.056). CONCLUSION In comparison with CSB, the treatment of moderate acute malnutrition with RUSF resulted in higher recovery rates in children, despite the large ration size and higher energy content of the conventional CSB ration.
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Affiliation(s)
- Crystal Karakochuk
- Department of Nutritional Sciences and the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Silverberg NB. Whey protein precipitating moderate to severe acne flares in 5 teenaged athletes. Cutis 2012; 90:70-72. [PMID: 22988649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Acne vulgaris has been linked to milk ingestion, both whole and skim milk. The milk fraction that promotes acne is unknown. Five case reports are presented of male patients aged 14 to 18 years who experienced onset of acne shortly after initiation of whey protein supplementation; 3 teenagers used the supplement for muscle building in football training and the other 2 for attempting to gain weight. All 5 patients had poor response to acne treatment regimens of oral antibiotics, topical retinoids, and benzoyl peroxide. Lesions fully cleared in 4 patients after discontinuation of whey protein supplementation, but 1 patient's acne flared after reinitiation of the whey protein supplement. Two patients did not immediately discontinue whey protein supplementation; 1 of them cleared after he discontinued whey protein during his second course of isotretinoin and 1 was lost to follow-up. Among these patients, at least 6 different brands of whey protein supplementation had been used, including whey protein shakes and reconstituted powders. Whey protein may be the fraction of dairy products that promote acne formation. Larger studies are needed to determine the mechanism of comedogenesis.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
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Venter C. A topic in 10 questions: weaning the child with cow's milk protein allergy. J Fam Health Care 2012; 22:22-23. [PMID: 22685976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Carina Venter
- University of Portsmouth Senior Allergy Dietitian, Isle of Wight
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Sakai S, Adachi R, Miyazaki T, Aso Y, Okuda H, Teshima R. [Studies on the food allergenic proteins contained in pharmaceutical excipients]. Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku 2012:58-65. [PMID: 23243989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Most drugs contain pharmaceutical excipients. These are pharmacologically inactive substances used as vehicles for the active ingredients of a medication. Some of these pharmaceutical excipients are produced from allergenic foods (e.g., milk, egg, peanut, soybean, and sesame) and removing proteins completely from such excipients is difficult. Therefore, if individuals with food allergy consume drugs containing allergenic food-derived excipients, eliminating the risk of developing specific allergic symptoms induced by them may not be possible. We determined the levels of proteins in pharmaceutical excipients and ethical drugs (inhalants and injections) by spectrophotometric analyses. The level of protein in the pharmaceutical excipient lactose in each sample was approximately 1 mg/g. In the case of oils from soybeans, peanuts, and sesame in pharmaceutical excipients, proteins were detected in the range 7-9 microg/g sample. We also determined levels of allergenic proteins in pharmaceutical excipients and ethical drugs using commercial enzyme-linked immunosorbent assay systems. The milk proteins in lactose were detected in the range 1.39-13.07 microg/g. The results of this study suggest that physicians, patients with food allergies, pharmacists, and healthcare providers must pay attention to presence of potential impurities those may cause allergic symptoms in pharmaceutical products.
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Affiliation(s)
- Shinobu Sakai
- Division of Novel Foods and Immunochemistry, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan
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Su J, Prescott S, Sinn J, Tang M, Smith P, Heine RG, Spieldenner J, Iskedjian M. Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia. J Med Econ 2012; 15:1064-77. [PMID: 22630113 DOI: 10.3111/13696998.2012.697085] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To perform an economic evaluation of a specific brand of partially hydrolyzed infant formula (PHF-W) in the prevention of atopic dermatitis (AD) among Australian infants. METHODS A cost-effectiveness analysis was undertaken from the perspectives of the Department of Health and Aging (DHA), of the family of the affected subject and of society as a whole in Australia, based on a decision-analytic model following a hypothetical representative cohort of Australian newborns who are not exclusively breastfed and who have a familial history of allergic disease (i.e., are deemed 'at risk'). Costs, consequences, and incremental cost-effectiveness ratios (ICER) were calculated for PHF-W vs standard cow's milk based infant formula (SF), and, in a secondary analysis, vs extensively hydrolyzed infant formula (EHF-Whey), when the latter was used for the prevention of AD. RESULTS From a representative starting cohort of 87,724 'at risk' newborns in Australia in 2009, the expected ICERs for PHF-W vs SF were AU$496 from the perspective of the DHA and savings of AUD1739 and AU$1243 from the family and societal perspectives, respectively. When compared to EHF-Whey, PHF-W was associated with savings for the cohort of AU$5,183,474 and AU$6,736,513 from the DHA and societal perspectives. LIMITATIONS The generalizability and transferability of results to other settings, populations, or brands of infant formula should be made with caution. Whenever possible, a conservative approach directing bias against PHF-W rather than its comparators was applied in the base case analysis. Assumptions were verified in one-way and probabilistic sensitivity analyses, which confirmed the robustness of the model. CONCLUSIONS PHF-W appears to be cost-effective when compared to SF from the DHA perspective, dominant over SF from the other perspectives, and dominant over EHF-Whey from all perspectives, in the prevention of AD in 'at risk' infants not exclusively breastfed, in Australia.
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Affiliation(s)
- John Su
- Department of Dermatology, Royal Children's Hospital, University of Melbourne, Melbourne, Australia; Monash University, Melbourne, Australia
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Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C, Wongarn R. Chicken-based formula is better tolerated than extensively hydrolyzed casein formula for the management of cow milk protein allergy in infants. Asia Pac J Clin Nutr 2012; 21:209-214. [PMID: 22507606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The effective treatment of cow milk allergy in infants consists of elimination of cow milk protein and the introduction of formulas based on an extensively hydrolyzed protein formula or an amino acid-based formula. However, about 10% of these infants are still allergic to an extensively hydrolyzed protein formula and an amino acid-based formula is very expensive. We conducted a study to verify whether the new chicken-based formula will be better tolerated than an extensively hydrolyzed protein formula for the treatment of cow milk allergy in infants. One hundred infants, diagnosed with cow milk allergy by double-blind, placebo-controlled food challenge tests, were enrolled in a double-blind, randomized, cross-over study to compare a response to an extensively hydrolyzed protein formula and the chicken-based formula. Subjects were randomly given one of the two formulas for 2 weeks. There was a 2-week washout period of taking an amino acid-based formula before being switched to the other formula for another 2 weeks. If the subjects showed allergic symptoms during the 2 weeks of test formula, they would be announced as intolerance or allergic to that formula. Sixty seven of 80 confirmed subjects agreed to enroll their infants. Fifty-eight subjects completed the study. Twenty and 33 infants were tolerant whereas and 38 and 25 infants were intolerant to an extensively hydrolyzed protein formula and the chicken-based formula, respectively. The chicken-based formula showed significantly better tolerance than an extensively hydrolyzed protein formula in the management of cow milk allergy in infants.
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Affiliation(s)
- Pipop Jirapinyo
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
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Abstract
UNLABELLED The transition from milk protein-induced enterocolitis syndrome to IgE-mediated milk allergy is uncommon. Herein, we describe three infants that suffered from recurrent vomiting and restlessness in response to cow's milk formula with negative skin prick to milk and therefore diagnosed as milk protein-induced enterocolitis syndrome. After recovering and reintroducing cow's milk formula, they developed disseminated urticaria and positive skin prick test to cow milk compatible with IgE-mediated milk allergy. CONCLUSION An infant that recovers from cow milk food-induced enterocolitis syndrome might develop afterward IgE-mediated cow milk allergy.
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Affiliation(s)
- Aharon Kessel
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Technion Faculty of Medicine, Haifa, Israel.
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