Microbiota and Derived Parameters in Fecal Samples of Infants with Non-IgE Cow's Milk Protein Allergy under a Restricted Diet.

María Díaz,Susana Delgado,Juan Díaz,Juan Rodríguez,Miguel Gueimonde,Carlos Bousoño,Christian Milani,David Pérez-Solis,Santiago Jiménez,Irene Espinosa-Martos,Lucía Guadamuro,Leonardo Mancabelli,Cristina Molinos-Norniella,Abelardo Margolles,Marco Ventura

doi:10.3390/nu10101481

Abstract

Cow’s milk protein allergy (CMPA) is the most common food allergy in infancy. Non-IgE mediated (NIM) forms are little studied and the responsible mechanisms of tolerance acquisition remain obscure. Our aim was to study the intestinal microbiota and related parameters in the fecal samples of infants with NIM-CMPA, to establish potential links between type of formula substitutes, microbiota, and desensitization. Seventeen infants between one and two years old, diagnosed with NIM-CMPA, were recruited. They were all on an exclusion diet for six months, consuming different therapeutic protein hydrolysates. After this period, stool samples were obtained and tolerance development was evaluated by oral challenges. A control group of 10 age-matched healthy infants on an unrestricted diet were included in the study. Microbiota composition, short-chain fatty acids, calprotectin, and transforming growth factor (TGF)-β1 levels were determined in fecal samples from both groups. Infants with NIM-CMPA that consumed vegetable protein-based formulas presented microbiota colonization patterns different from those fed with an extensively hydrolyzed formula. Differences in microbiota composition and fecal parameters between NIM-CMPA and healthy infants were observed. Non-allergic infants showed a significantly higher proportion of Bacteroides compared to infants with NIM-CMPA. The type of protein hydrolysate was found to determine gut microbiota colonization and influence food allergy resolution in NIM-CMPA cases.

Highlights

Cow’s milk protein (CMP) is the main cause of food allergy in the first year of life
Infants in the non-IgE mediated (NIM)-cow’s milk protein allergy (CMPA) group were fed with extensively hydrolyzed formula (EHF) (12 patients, 70.6%), soy protein-based formulas, and hydrolyzed rice formulas
There are only a few studies focusing on non-IgE mediated cases [10], and almost none of them consider the description of gut microbiota

Summary

Introduction

Cow’s milk protein (CMP) is the main cause of food allergy in the first year of life. Based on the involvement of IgE antibodies, CMP allergy (CMPA) is classified as classic IgE-mediated, non-IgE mediated (NIM), and mixed pathophysiology [1]. Clinical presentation is delayed, and digestive symptoms are more frequent, with NIM-CMPA than with IgE-mediated CMPA [2]. In both types, treatment involves the avoidance of cow’s milk formula and the use of a therapeutic formula as a substitute. Differences in microbial composition between infants with IgE-mediated and non-IgE mediated food allergies have been reported [11]

Objectives

Methods

Results

Conclusion