Update References Cow Milk Allergy 2012

Update References Cow Milk Allergy 2012

A milk allergy is a food allergy, an adverse immune reaction to one or more of the constituents of milk from any animal (most commonly alpha S1-casein, a protein in cow’s milk). This milk-induced allergic reaction can involve anaphylaxis, a potentially life-threatening condition. It is important to note that a milk allergy is a separate and distinct condition from lactose intolerance.

Cow’s milk contains approximately 20 potentially sensitizing proteins (some recognized as major allergens), which are found in the whey and casein fractions, including α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), BSA (Bos d 6), bovine immunoglobulins (Bos d 7), and casein allergens (Bos d 8)collectively. The comparative electrophoretic profiles of other genera. The effect of industrial processing (pasteurization, ultra-high-temperature heating, or dry blending for cow’s milk formula) on the antigenic/allergenic properties of cow’s milk proteins is minimal or absent. However, according to 1 study, up to 70% of children might tolerate milk in baked products,potentially improving their quality of life.Higher temperatures and longer exposure to heat in baking might account for this. For choosing an alternative to cow’s milk, potential cross-reactivity (caused by protein sequence homology between related species) should be considered of clinical relevance. At present, cross-reactivity cannot be ruled in or out by species phylogeny, although conserved protein sequences are often cross-reactive. Alternatives from other mammals (eg, mare and camel) should be clinically evaluated for suitability from a nutritional and allergy point of view.

The immunopathogenesis

The immunological mechanism that lead to the development of Cow Milk Proteins Allergy (CMPA) is not still clarified. There are different mechanisms that contribute to its pathogenesis. The disease is caused by two main factors: IgE- and not-IgE- mechanisms. IgE-mediated reactions are based on simply immunological mechanisms that are better identified than not-IgE-mediated ones, and are based on pathways involving a humoral-immunity, with production of IgE and inflammatory processes triggered by different allergens.  Nevertheless a high percentage of children and adults does not show circulating IgE, specific for cow’s milk proteins and their skin prick test and RAST result negative. This occurs for the development of a not-IgE-mediated allergic disease. These reactions are characterized by a delayed set up, associated with the onset of symptoms after one hour or many days after the ingestion of cow’s milk proteins.  For this reason, these reactions are classified as “delayed hypersensitivity”. However it is important to explain that the two reactions above described are not mutually exclusive and both are involved in different mechanisms.  The development of both categories of CMAP is deeply linked to the ability of the host to develop a state of “mucosal tolerance”, defined as a decreased immune response towards foreign antigens. In food allergy the fine balance between mucosal tolerance and hypersensitivity is regulated by the immune system. This complex system includes molecules with regulatory properties, such as Transforming Growth Factor Beta, IL-10 (TReg) and Natural Killers. Also CD4+CD25+Foxp3+ T cells are described as important mediators for maintaining peripheral tolerance and suppressing the  T lymphocytes proliferation.

Update References Cow Milk Allergy 2012

  • Analysis of major milk whey proteins by immunoaffinity capillary electrophoresis coupled with MALDI-MS. Gasilova N, Gassner AL, Girault HH. Electrophoresis. 2012 Aug;33(15):2390-8. doi: 10.1002/elps.201200079.
  • The immunopathogenesis of cow’s milk protein allergy (CMPA). Vitaliti G, Cimino C, Coco A, Andrea Domenico P, Lionetti E. Ital J Pediatr. 2012 Jul 23;38(1):35. [Epub ahead of print]
  • MIP-1α, MCP-1, and desensitization in anaphylaxis from cow’s milk. Glez PP, Franco YB, Matheu V. N Engl J Med. 2012 Jul 19;367(3):282-4. No abstract available.
  • Diagnosed child, treated child: food challenge as the first step toward tolerance induction in cow’s milk protein allergy. Longo G, Berti I, Barbi E, Calligaris L, Matarazzo L, Radillo O, Ronfani L, Ventura A. Eur Ann Allergy Clin Immunol. 2012 Apr;44(2):54-60.
  • Characteristics of patients suffering from cow milk allergy. Liu LL, Yao H, Zhang XL, Zhang HL, Chao PL, Tong ML, Liu GL, Lin LR, Fan-Liu, Zhang ZY, Yang TC. Int Immunopharmacol. 2012 Sep;14(1):94-8. Epub 2012 Jun 18.
  • Chicken-based formula is better tolerated than extensively hydrolyzed casein formula for the management of cow milk protein allergy in infants. Jirapinyo P, Densupsoontorn N, Kangwanpornsiri C, Wongarn R. Asia Pac J Clin Nutr. 2012;21(2):209-14.
  • Oral immunotherapy for cow’s milk allergy. Passalacqua G, Landi M, Pajno GB. Curr Opin Allergy Clin Immunol. 2012 Jun;12(3):271-7.
  • Blood pressure monitoring in children undergoing food challenge: association with anaphylaxis. Caffarelli C, Ricò S, Rinaldi L, Povesi Dascola C, Terzi C, Bernasconi S. Ann Allergy Asthma Immunol. 2012 Apr;108(4):285-6. Epub 2012 Feb 24. No abstract available.
  • Esophageal eosinophilia caused by milk proteins: from suspicion to evidence based on 2 case reports. Terrados Cepeda S, Antolin-Amerigo D, Foruny JR, Gonzalez AS. J Allergy Clin Immunol. 2012 May;129(5):1416-9. Epub 2012 Mar 30. No abstract available.
  • Allergy to goat’s and sheep’s milk in a population of cow’s milk-allergic children treated with oral immunotherapy. Rodríguez del Río P, Sánchez-García S, Escudero C, Pastor-Vargas C, Sánchez Hernández JJ, Pérez-Rangel I, Ibáñez MD. Pediatr Allergy Immunol. 2012 Mar;23(2):128-32. doi: 10.1111/j.1399-3038.2012.01284.x.
  • [A neonate with acute swelling of hands and feet]. de Boer FA, Rake JP. Ned Tijdschr Geneeskd. 2012;156(11):A2782. Dutch.
  • Allergen-specific responses of CD19(+)CD5(+)Foxp3(+) regulatory B cells (Bregs) and CD4(+)Foxp3(+) regulatory T cell (Tregs) in immune tolerance of cow milk allergy of late eczematous reactions. Noh J, Noh G, Kim HS, Kim AR, Choi WS. Cell Immunol. 2012;274(1-2):109-14. Epub 2012 Feb 6.
  • Prophylactic probiotics reduce cow’s milk protein intolerance in neonates after small intestine surgery and antibiotic treatment presenting symptoms that mimics postoperative infection. Ezaki S, Itoh K, Kunikata T, Suzuki K, Sobajima H, Tamura M. Allergol Int. 2012 Mar;61(1):107-13.
  • Changes in prevalence and characteristics of IgE-mediated food allergies in children referred to a tertiary care center in 2003 and 2008. Amin AJ, Davis CM. Allergy Asthma Proc. 2012 Jan-Feb;33(1):95-101.
  • Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK. Taylor RR, Sladkevicius E, Panca M, Lack G, Guest JF. Pediatr Allergy Immunol. 2012 May;23(3):240-9.
  • Oral immunotherapy for IgE-mediated cow’s milk allergy: a systematic review and meta-analysis. Brożek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N, Fiocchi A, Schünemann HJ. Clin Exp Allergy. 2012 Mar;42(3):363-74. doi: 10.1111/j.1365-2222.2011.03948.x. Review.
  • Tolerogenic effects of interferon-gamma with induction of allergen-specific interleukin-10-producing regulatory B cell (Br1) changes in non-IgE-mediated food allergy. Noh J, Noh G, Lee SJ, Lee JH, Kim A, Kim HS, Choi WS. Cell Immunol. 2012;273(2):140-9. Epub 2012 Jan 8.
  • Epitope mapping and identification of amino acids critical for rabbits IgG-binding to linear epitopes on buffalo beta-lactoglobulin. Xin L, Hongbing C, Jinyan G, Fahui L, Xuefang W. Protein Pept Lett. 2012 Feb 7.
  • Diagnosis and management of cow’s milk protein allergy in infants. De Greef E, Hauser B, Devreker T, Veereman-Wauters G, Vandenplas Y. World J Pediatr. 2012 Feb;8(1):19-24. Epub 2012 Jan 27. Review.

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