Avoidance Of Milk Research Articles

Milk allergy in adults and children.

Cow's milk allergy is common in children and rare in adults. The clinical features of cow's milk allergy are varied and they include anaphylaxis, gastrointestinal symptoms and atopic dermatitis. The prevalence of cow's milk allergy is difficult to ascertain, based on self-reported symptoms that are not subsequently confirmed by diagnostic testing. The gold-standard diagnostic test is the double-blind placebo-controlled food challenge. Avoidance of milk and milk products is the main therapy. Nutritional considerations are important in both children and adults, as is recognising the potential for resolution of cow's milk allergy. Providing evidence-based advice and support to individuals and their families and carers is central to managing cow's milk allergy.

Cows' milk allergy in infants

Cows' milk allergy is an immune-mediated reaction to the proteins in cows' milk, which may be IgE-mediated or non-IgE-mediated. An allergy-focused clinical history is the key to making a diagnosis. IgE-mediated allergy can be investigated by skin-prick tests or blood tests. There are no tests available for non-IgE-mediated cows' milk allergy. Avoidance of cows' milk is the most important aspect of management. Breastfed babies should continue to breastfeed with cows' milk exclusion in the mother's diet; formula-fed babies will need specialist formulas. The majority of children will eventually outgrow cows' milk allergy. This paper will focus on the identification and management of the different types of cows' milk allergy.

Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters

ObjectiveTo determine whether a 21-day milk-drinking intervention could reverse milk aversion. DesignParticipants consumed increasing amounts of cow’s milk for 21 days. Milk and dairy consumption, aversion, and likeness were assessed pre- and post-intervention and at 3 and 6 months post-intervention. SettingA large Midwestern university. ParticipantsTwenty-seven milk-averse individuals completed the intervention, 26 completed the 3-month follow-up, and 24 completed the 6-month follow-up. Main Outcomes MeasuredParticipants self-reported milk and dairy consumption, aversion, and degree to which they liked milk. AnalysisAnalysis of variance determined between-subject effects. Independent samples t test determined the effect of time. Fisher exact test determined factors affecting milk consumption. ResultsLactose digesters and maldigesters showed a significant decrease in overall symptom scores after the milk intervention, with no significant difference between groups. Independent of digestive status, subjects demonstrated a significant decrease in aversion, an increase in the amount to which they liked milk, and an increase in milk and overall calcium consumption at 3 and 6 months post-intervention. Conclusions and ImplicationsThe results suggest a reversal of milk avoidance and the possibility that milk avoiders can increase likeness and incorporate milk into their diet after exposure.

Selective IgA deficiency associated with allergy to cow's milk protein, case report

Event Abstract Back to Event Selective IgA deficiency associated with allergy to cow's milk protein, case report Catalina M. Gómez Henao1*, Cristina I. Herrera Morales1, Ana M. Celis Henao1 and Carlos F. Chinchilla Mejía1 1 Universidad de Antioquia, Colombia Background: IgA is the most abundant immunoglobulin in the human; it is found in tissues and in secretions especially from the gastrointestinal tract reflecting its role in mucosal immunity and the development of tolerance. Selective IgA deficiency (<10mg/dl) is the most common primary immunodeficiency, most patients with IgA deficiency are asymptomatic so its clinical significance is unknown, although it has been associated with increased incidence of some autoimmune and allergic diseases, being food allergy and asthma most frequently related. The protein allergy to cow's milk is one of the most prevalent and important food allergies in childhood. In patients with allergy to proteins in cow's milk have been shown a decrease in the production of TGF-β, one of the main cytokines that stimulate the production of IgA by B cells, a mechanism that could also be explaining the relationship between allergy to the protein in cow's milk with selective IgA deficiency. Objective: To report a case of protein allergy to cow's milk in the presence of IgA deficiency. Methods: Case Report Results: Patient 5 years of age, female, personal history of recurrent infections, rhinitis and Asthma, with colic pain since three years of age that is increased with cow milk intake, tolerate forms extensively cooked. Treatments: Salmeterol/Fluticasone 25-125 every 12 hours. Montelukast 4 mg daily, 100mg daily Mometasone Furoate. Paraclinical: IgA: 0.4 (20-358), IgG: 999, IgM 132.4, specific IgE for casein 4.5 IU/ml (class 3), Alpha-lactalbumin 2.98 (Class 2) Whole cow's milk 2.82 (Class 2), beta-lactoglobulin 0 (Class 0), dog dander 2.2 (Class 2). Prick test negative, albumin 4.8. Avoidance of cow's milk is recommended. During follow-up the patient gradually decreases levels of specific IgE to cow's milk protein, Tolerating lactose-free formulas to 7 years, with a slight increase in levels of IgA (13.9mg/dl). Conclusion: This case illustrates a clear association between selective IgA deficiency and food allergy which has been previously described in the literature, specifically in our patient allergic to cow's milk protein.

Role of Maternal Elimination Diets and Human Milk IgA in the Development of Cow's Milk Allergy in the Infants.

KM Jarvinen, JE Westfall, MS Seppo. Clin Exp Allergy. 2014;44(1):69–78 The goal of this study was to evaluate the association of maternal cow’s milk (CM) avoidance during breastfeeding with specific IgA levels in human milk and the development of CM allergy in infants. This prospective birth cohort study evaluated 145 mother–infant pairs who were recruited at birth and followed up prospectively at 0 to 2 weeks and at 1, 3, 6, 12, and 18 months to determine development of food allergy in the infants. Infants were all term and classified into 2 groups: high risk because of sibling(s) with food allergy and low risk, defined as having only nonatopic first-degree relatives. …

Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.

Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta. To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012). All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment. We extracted data from published reports, supplemented by additional information received from the trialists we contacted. The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity. Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.

BSACI guideline for the diagnosis and management of cow's milk allergy

This guideline advises on the management of patients with cow's milk allergy. Cow's milk allergy presents in the first year of life with estimated population prevalence between 2% and 3%. The clinical manifestations of cow's milk allergy are very variable in type and severity making it the most difficult food allergy to diagnose. A careful age- and disease-specific history with relevant allergy tests including detection of milk-specific IgE (by skin prick test or serum assay), diagnostic elimination diet, and oral challenge will aid in diagnosis in most cases. Treatment is advice on cow's milk avoidance and suitable substitute milks. Cow's milk allergy often resolves. Reintroduction can be achieved by the graded exposure, either at home or supervised in hospital depending on severity, using a milk ladder. Where cow's milk allergy persists, novel treatment options may include oral tolerance induction, although most authors do not currently recommend it for routine clinical practice. Cow's milk allergy must be distinguished from primary lactose intolerance. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for clinicians in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking the panel of experts in the committee reached consensus. Grades of recommendation are shown throughout. The document encompasses epidemiology, natural history, clinical presentations, diagnosis, and treatment.

Milk aversion can be reversed in both lactose digesters and maldigesters (631.2)

It is difficult for adults to achieve the DRI for calcium without consuming dairy products; therefore, aversion to and avoidance of milk and dairy products puts US adults in danger of calcium deficiency. We examined whether a 21 day milk drinking intervention could reverse milk aversion in people who do not habitually consume milk due to lactose intolerance (LI), perceived LI or taste aversion. 445 potential participants responded to advertisements; 82 were screened, 27 completed the milk drinking intervention, 26 completed the 3 month follow up and 24 completed the 6 month follow up. Participants who entered the milk drinking phase were instructed to consume increasing amounts of liquid cow’s milk for a period of 21 days up to 1 cup two times/day with a pre and post hydrogen breath test. The lactose digesters and maldigesters both showed a decrease in overall symptom scores, with no significant difference between groups. Independent of digestive status, subjects demonstrated a significant decrease in aversion, an increase in likeness and an increase in milk and overall calcium consumption at 3 and 6 month following the intervention. These changes in milk consumption were independent of demographics or digestive status. The data reported here suggest a reversal of food avoidance and the possibility that milk avoiders are able to increase likeness and incorporate milk into their diet after increased exposure.

Laryngeal spasm mimicking asthma and vitamin d deficiency.

We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respiratory clinic for suspect bronchial asthma. Spirometry showed mild decrease in inspiratory flows. Methacholine challenge was negative. Dyspnea was triggered by hyperventilation-induced hypocapnia, which produced marked decrease in airflow rates, particularly in inspiratory flows, consistent with laryngospasm. Nutritional assessment of the patient showed low serum level of calcium and vitamin D, attributable to avoidance of milk and dairy products for lactose intolerance and to insufficient sunlight exposure. After calcium and vitamin D supplementation episodic laryngospasm disappeared and hypocapnic hyperventilation test induced very mild change in airflow rates. Calcium and vitamin D deficiency may favour laryngeal spasm mimicking asthma, particularly in subjects with underlying myopathy.

Role of maternal elimination diets and human milk IgA in the development of cow's milk allergy in the infants

The role of maternal avoidance diets in the prevention of food allergies is currently under debate. Little is known regarding the effects of such diets on human milk (HM) composition or induction of infant humoral responses. To assess the association of maternal cow's milk (CM) avoidance during breastfeeding with specific IgA levels in HM and development of cow's milk allergy (CMA) in infants. We utilized HM and infant serum samples from a prospective birth cohort of 145 dyads. Maternal serum and HM samples were assessed for casein and beta-lactoglobulin (BLG)-specific IgA and IgG by ELISA; 21 mothers prophylactically initiated a strict maternal CM avoidance diet due to a sibling's history of food allergy and 16 due to atopic eczema or regurgitation/vomiting seen in their infants within the first 3 months of life. Infants' sera were assessed for casein and BLG-specific IgG, IgA and IgE; CMA was confirmed by an oral food challenge. The impact of HM on BLG uptake was assessed in transcytosis assays utilizing Caco-2 intestinal epithelial cell line. Mothers avoiding CM had lower casein- and BLG-specific IgA in HM than mothers with no CM restriction (P = 0.019 and P = 0.047). Their infants had lower serum casein- and BLG-specific IgG(1) (P = 0.025 and P < 0.001) and BLG-specific IgG(4) levels (P = 0.037), and their casein- and BLG-specific IgA levels were less often detectable than those with no CM elimination diet (P = 0.003 and P = 0.007). Lower CM-specific IgG4 and IgA levels in turn were associated with infant CMA. Transcytosis of BLG was impaired by HM with high, but not low levels of specific IgA. Maternal CM avoidance was associated with lower levels of mucosal-specific IgA levels and the development of CMA in infants. HM IgA may play a role in preventing excessive, uncontrolled food antigen uptake in the gut lumen and thereby in the prevention of CMA.

Cow's Milk Allergy: A New Approach Needed?

Cow's Milk Allergy: A New Approach Needed?

Lactase non-persistence as a determinant of milk avoidance and calcium intake in children and adolescents.

This study examines if lactase non-persistent (LNP) children and adolescents differ from those who are lactase persistent (LP) as regards milk avoidance and Ca intake. We also studied potential differences in anthropometric features related to obesity, and examined if milk avoidance is associated with lactase-persistence status. Additionally, we aimed to determine if heterozygous subjects showed an intermediary phenotype as regards Ca intake. Furthermore, we tested if LP and LNP influence vitamin D intake. The European Youth Heart Study is an ongoing international, multi-centre cohort study primarily designed to address CVD risk factors. Children (n 298, mean age 9·6 years) and adolescents (n 386, mean age 15·6 years) belonging to the Swedish part of the European Youth Heart Study were genotyped for the LCT-13910 C>T polymorphism. Mendelian randomisation was used. Milk avoidance was significantly more common in LNP adolescents (OR 3·2; 95% CI 1·5, 7·3). LP subjects had higher milk consumption (P<0·001). Accordingly, energy consumption derived from milk and Ca intake was lower in LNP (P<0·05 and P<0·001, respectively). Heterozygous subjects did not show an intermediary phenotype concerning milk consumption. LP or LNP status did not affect vitamin D intake or anthropometric variables. LNP in children and adolescents is associated with reduced intake of milk and some milk-product-related nutritional components, in particular Ca. This reduced intake did not affect the studied anthropometric variables, indicators of body fat or estimated vitamin D intake. However, independently of genotype, age and sex, daily vitamin D intake was below the recommended intakes. Milk avoidance among adolescents but not children was associated with LNP.

IgE-Mediated Cow’s Milk Allergy in Children

The age at which the majority of children outgrow cow's milk allergy now appears to be later than previously reported. Recent studies have attempted to elucidate factors that may help prevent cow's milk allergy, assess markers of persistence, and evaluate the usefulness of new diagnostic methods. Strict avoidance of cow's milk has been the mainstay of treatment. However, given the potential nutritional, social, and immunologic ramifications of cow's milk elimination from a child's diet, there has been a focus on reevaluating this therapeutic approach.

Assessment of nutrition status and pulse consumption patterns in adolescent girls from Huletegna Choroko Keble, Halaba Special Woreda ‐ Southern Ethiopia

In Ethiopia, adolescents have the lowest mortality, and, therefore, are of low priority for nutrition interventions. However, the prevalence of malnutrition and anemia remains high in adolescent girls. Pulse crops are important in Ethiopiaˈs small landholders’ agriculture practices offering enhanced food security. Using a cross‐sectional design, our IDRC‐CIDA community based study assessed the nutrition status, pulse consumption patterns, indigenous knowledge, and food security among adolescent girls (n=188, 15–19 y). The prevalence of stunting and underweight were 31% and 30%, respectively. The intakes of energy, calcium, vitamin C and zinc were 70%, 13%, 5% and 65% of requirements, respectively. From pulse foods, lentils (85%) haricot bean (59%), peas (51%), faba bean (36%) and chick pea (29%) were consumed once or more than once per day. The nutrient contribution of pulses for iron, protein, zinc and fiber was 10%, 20%, 80% and 18% respectively. For household food security, 13% were secure, 17% were mildly insecure, 54% were moderately insecure and the remaining 16% severely insecure. Girls were shorter than the 2007 WHO standards and the diets were grossly deficient in energy and other nutrients; yet, pulse foods offered a significant contribution to nutrient intake. The dietary practices, particularly the girls’ avoidance of milk and yogurt, contribute to the nutrient deficiencies. Programs to support adequate nutrition for adolescents would provide for a healthy transition to adulthood and be a step towards breaking the cycle of intergenerational malnutrition.

Maternal Cow's Milk Avoidance During Lactation Suppresses IgA Levels in Breast Milk and Serum IgG Levels in Infants

The effect of maternal avoidance diets during breastfeeding on development of food allergies in infants is currently under debate. We sought to assess the effect of maternal cow's milk avoidance during breastfeeding on cow's milk-specific IgA levels in breast milk and specific IgG levels in their infants.

A Case of Pulmonary Hemosiderosis that was Dissolved by an Oral Prednisolone and the Milk Avoidance

A Case of Pulmonary Hemosiderosis that was Dissolved by an Oral Prednisolone and the Milk Avoidance

Presence of functional, autoreactive human milk‐specific IgE in infants with cow's milk allergy

Occasionally, exclusively breastfed infants with cow's milk allergy (CMA) remain symptomatic despite strict maternal milk avoidance. To determine whether or not persistence of symptoms could be due to sensitization against endogenous human milk proteins with a high degree of similarity to bovine allergens. Ten peptides representing known bovine milk IgE-binding epitopes [α-lactalbumin (ALA), β- and κ-casein] and the corresponding, highly homologous human milk peptides were labelled with sera from 15 breastfed infants with CMA, aged 3weeks to 12months, and peptide (epitope)-specific IgE antibodies were assessed. Nine of the 15 breastfed infants became asymptomatic during strict maternal avoidance of milk and other major food allergens; six infants remained symptomatic until weaned. Ten older children, aged 5-15years, with CMA were also assessed. The functional capacity of specific IgE antibodies was assessed by measuring β-hexosaminidase release from rat basophilic leukaemia cells passively sensitized and stimulated with human and bovine ALA. A minimum of one human milk peptide was recognized by IgE antibodies from 9 of 15 (60%) milk-allergic infants, and the majority of older children with CMA. Genuine sensitization to human milk peptides in the absence of IgE to bovine milk was occasionally seen. There was a trend towards specific IgE being detected to more human milk peptides in those infants who did not respond to the maternal milk elimination diet than in those who did (P=0.099). Functional IgE antibody to human ALA was only detected in infants not responding to the maternal diet. Endogenous human milk epitopes are recognized by specific IgE from the majority of infants and children with CMA. Such autoreactive, human milk-specific IgE antibodies appear to have functional properties in vitro. Their role in provoking allergic symptoms in infants exclusively breastfed by mothers strictly avoiding dietary milk remains unclear.

What has changed in the diagnostic approach?

Food allergy in general, and CMA in particolar, are an unique case in which a systematic approach can be applied even to single cases. As the disease involves not only the patient, but the whole family and her social supports, these can be protagonist of the diagnosis itself. As in any field of medicine, diagnosis starts from the suspicion. In patients reports for milk allergic reactions, an accurate medical history can clarify many aspects of the diagnosis. If history does not exclude the possibility of a CMA, in particular in delayed manifestations, in primary setting there is the possibility to take a period of tentative avoidance of milk, followed by an open re-introduction. When avoidance coincides with symptom-free periods, an open reintroduction can be useful to identify the offending food (if severe symptoms are anticipated, the procedure should be done under supervision in a medical facility). This elimination - reintroduction phase does not eliminate the necessity of challenge tests, but can give some indication on the possibility of CMA. We have several methods to evaluate milk sensitization. Basically, they are: - Skin testing, including immediate skin prick test (SPT), intradermal reactions and atopy patch test (APT) - The evaluation of serum food -specific IgE using one of the several methods we have at disposition. Performance, accuracy, and the diagnostic positioning of these have been afforded in the DRACMA Guidelines. Following these analysis, the following considerations can be formulated: • Challenge is the best for diagnosing CMA • If not available, challenge is not necessary in case of: a. high pre-test probability and SPT+ (classify as CMA) b. high pre-test probability and sIgE+ (classify as CMA) c. low pre-test probability and SPT- (exclude CMA) d. low pre-test probability and sIgE- (exclude CMA). • Challenges remain necessary in all cases of uncertainity (medium pre-test probability) • If challenge is necessary out of a research setting, sensitisation tests may not be necessary. • Atopy patch test is not useful • Component-resolved diagnosis may be useful, but further data are necessary • Molecular diagnosis may be useful, but more data are needed.

Breastfeeding: More Than Just Good Nutrition

Breastfeeding: More Than Just Good Nutrition

Modelling human osteosarcoma in the mouse

Modelling human osteosarcoma in the mouse