Cow's Milk Allergy In Infants Research Articles

Evaluation of Cow's Milk Related Symptom Score [CoMiSS] accuracy in cow's milk allergy diagnosis.

Cow's Milk-related Symptom Score (CoMiSS) is an awareness tool to recognize cow's milk allergy (CMA) symptoms in infants. We aimed to assess the best cut-off point of CoMiSS in our country and investigate other parameters suggested to raise the strength of CoMiSS in CMA diagnosis. We enrolled 100 infants with CMA-suggestive symptoms with documentation of CoMiSS initially and 4 weeks after cow milk-free diet (CMFD) followed by an open food challenge (OFC) test. Infants with symptom recurrence upon challenge were diagnosed with confirmed CMA. Initial mean CoMiSS was 15.76 ± 5.29, being higher in the confirmed CMA group (84% of infants). Following CMFD, median CoMiSS significantly reduced to 1.5 in the confirmed CMA group compared to 6.5 in the negative group. Receiver operation characteristic (ROC) curve identified a CoMiSS score of ≥12 as the best cut-off value with 76.19% sensitivity, 62.50% specificity and overall accuracy of 74.00%. Mucoid stool, bloody stool and faltering growth were reported in 80, 41 and 52% of confirmed CMA infants, respectively, with considerable improvement following CMFD. Our study revealed a CoMiSS score of ≥12 to be the best cut-off point. However, CoMiSS cannot be used alone for accurate diagnosis of CMA. CoMiSS ≥12 can predict a positive response to CMFD; nevertheless, CoMiSS is a good awareness tool and cannot be regarded as a stand-alone CMA diagnostic test. CoMiSS reduction following CMFD was predictive of a reaction to OFC to diagnose CMA as well as for monitoring symptom improvement. Symptoms commonly associated with CMA as mucoid stool, bloody stool, marked abdominal distention not responding to medical treatment and faltering growth, in addition to their improvements in response to CMA are suggested parameters to be added to CoMiSS to improve its accuracy.

Screening for Cow Milk Allergy in Infants and Preschool Children

Abstract Background Cow milk allergy (CMA) is the third most common food allergy that triggers anaphylactic reactions. Lactose intolerence, infantile colic and gastroesophageal reflux are the most common conditions which overlap with CMA causing both over and underdiagnosis. There are no wide population based epidemiological studies for the prevalence of CMA among Egyptian children. We sought to evaluate the prevalence of CMA among infants and preschool children and to correlate the parental reporting of CMA to the available diagnostic tools. Methods We conducted a cross sectional study that included 800 Egyptian children aged 3 months -5 years, who were enrolled consecutively from the primary care units and outpatient clinics of Children’s Hospital, Ain Shams University. Detailed history taking and clinical examination were done and those with suggestive history of CMA were subjected to further evaluation including skin prick test (SPT) and oral challenge test (OCT). Results The study comprised 390 girls (48.8%) and 410 boys (51.2%). Their weight centiles ranged between 5th and 97th percentiles, with median (IQR)=25(5-50) percentiles and mean(SD)=36.1(31.9). CM was introduced at age of 1-12 months, mean (SD): 9 (6) months with median (IQR): 12 (9-12) months. Forty (5%) subjects had suggestive history of CMA, 32 of whom completed their evaluation. The diagnosis of cow milk allergy was confirmed in 8/40 children (20%), comprising 1 % of the whole study sample. CMA was probably excluded at the time of the study in 21 subjects (52.5%), while diagnosis remained undetermined in 11/40 cases (27.5%) (8 refused to undergo SPT & OCT while 3 were lost to follow up). Conclusion The prevalence of CMA in Egyptian infants and preschool children is estimated to be around 1 % with possible overestimation of cow milk allergy diagnosis according to parental reports.

Growth Patterns of Indonesian Infants with Cow's Milk Allergy and Fed with Soy-Based Infant Formula.

PurposeThe use of soy-based infant formula has increased widely in infants with cow's milk allergy (CMA). This study aimed to provide evidence on the growth pattern of CMA infants fed with soy-based infant formula in an Indonesian setting.MethodsA multi-site, intervention study was conducted among full-term and normal birth weight CMA infants. Within six months, the subjects were provided with a soy-based infant formula. Weight, height, and head circumference were measured at baseline, weeks 4, 8, 12, 16, 20, and 24. Adverse events were recorded by scoring atopic dermatitis and symptom-based clinical scores.ResultsBased on the World Health Organization growth chart, we found that most of subjects had normal nutritional status for weight-for-age, length-for-age, weight-for-length, and head-circumference-for-age. There were statistically significant differences between baseline and end-line for weight-for-age, length-for-age, weight-for-length, and head circumference-for-age nutritional status. No allergic symptoms or intolerance toward soy formula were observed at the end of the intervention period.ConclusionThese results show that infants fed with soy-based infant formula have a normal pattern of growth.

High-Dose Vitamin D Supplementation Does Not Prevent Allergic Sensitization of Infants

J Rosendahl, AS Pelkonen, O Helve. J Pediatr. 2019;209:139–145.e1 To examine the effect of post-natal vitamin D supplementation on the development of allergic disease in the first year of life. The study included 987 infants born to mothers of Northern European descent in Finland. Inclusion criteria included term birth with an appropriate weight for gestational age and newborns not requiring higher levels of care. The study population was followed from birth until 12 months of age. The study was a double-blinded randomized control trial. The study population was randomly divided into two vitamin D supplementation groups: one group received …

Hypoallergenic and Low-Protein Ready-to-Feed (RTF) Infant Formula by High Pressure Pasteurization: A Novel Product.

Infant milk formula (IMF) is designed to mimic the composition of human milk (9–11 g protein/L); however, the standard protein content of IMF (15 g/L) is still a matter of controversy. In contrast to breastfed infants, excessive protein in IMF is associated with overweight and symptoms of metabolic syndrome in formula-fed infants. Moreover, the beta-lactoglobulin (β-Lg) content in cow milk is 3–4 g/L, whereas it is not present in human milk. It is considered to be a major reason for cow milk allergy in infants. In this respect, to modify protein composition, increasing the ratio of alpha-lactalbumin (α-Lac) to β-Lg would be a pragmatic approach to develop a hypoallergenic IMF with low protein content. Such a formula would ensure the necessary balance of essential amino acids, as 123 and 162 amino acid residues are available in α-Lac and β-Lg, respectively. Hence, in this study, a pasteurized form of hypoallergenic and low-protein ready-to-feed (RTF) formula, a new product, is developed to retain heat-sensitive bioactives and other components. Therefore, the effects of high pressure processing (HPP) under 300–600 MPa at approximately 20–40 °C and HTST pasteurization (72 °C for 15 and 30 s) were investigated and compared. The highest ratio of α-Lac to β-Lg was achieved after HPP (600 MPa for 5 min applied at 40.4 °C), which potentially explains the synergistic effect of HPP and heat on substantial denaturation of β-Lg, with significant retention of α-Lac in reconstituted IMF. Industrial relevance: This investigation showed the potential production of a pasteurized RTF formula, a niche product, with a reduced amount of allergenic β-Lg.

Association of blood eosinophilia and vitamin D insufficiency in young infants with cow milk allergy.

Cow milk allergy is the most common food allergic disease in young infants and vitamin D has a critical role in regulating intestinal inflammation. To determine roles of vitamin D in cow milk allergy, fifty-six young infants with cow milk allergy were enrolled. The serum 25-hydroxyvitamin D (25OHD), total and specific IgE, circulating regulatory T lymphocytes, and blood eosino-phil counts were determined. The serum 25OHD in cow milk allergy and age-matched infants were sim-ilar (68.3±38.9 nmol/L versus 72.9±33.1 nmol/L, p>0.05), 71% Cow milk allergy infants (40/56) had serum 25OHD lower than 75 nmol/L compared to 66% (37/56) in the controls. The cow milk allergy infants with 25OHD lower than 75 nmol/L had persistent blood eosinophilia and delayed resolution of symptoms after cow milk elimination compared to those with 25OHD above 75 nmol/L (odd ratio 3.7, 95% CI 1.1-12.6, p<0.05). The serum 25OHD inversely correlated with blood eosinophil counts after cow milk elimination (r=-0.37, p<0.01). Cow milk allergy infants with 25OHD lower than 50 nmol/L (vitamin D deficiency, n = 22) were in general at younger age (1.6±0.6 months) compared to infants with insufficient (50-75 nmol/L) or normal (>=75 nmol/L) group (4.3±1.2 and 4.6±0.9 months, respectively, p<0.001). Low serum vitamin D associates with persistent blood eosinophilia and symptoms in young cow milk allergy infants.

ASUHAN KEBIDANAN PADA BAYI DENGANALERGI SUSU SAPI DI KLINIK ABRAR MEDICAL CENTRE PALOPO

The incidence of allergic disease in children has been increasing in the last 2 decades worldwide, including Indonesia. The increase in the incidence rate is estimated due to lifestyle changes and pollution. Allergic diseases can have a long-term negative impact, thus disrupting the quality of a child's life and disrupting the growth process. In various regions of Indonesia, the incidence of allergies varies from 30% to 60%.This research uses quantitative research explanation with case study method approach.The results of this case study where all action plans have been implemented ie in this case encourage the mother to continue breastfeeding to her child and stop giving formula milk. Cow milk allergy in infants can bertatasai by collaborating with dr. Children in terms of drug delivery and care provided. Keywords : Baby, Cow's milk allergy

Early-life gut microbiome and cow’s milk allergy- a prospective case - control 6-month follow-up study

Increasing evidence suggests that perturbations in the intestinal microbiota in early infancy are implicated in the pathogenesis of food allergy (FA); existing evidence on the structure and composition of the intestinal microbiota in human beings with FA is limited and conflicting. The main object of the study was to compare the faecal microbiota between healthy and cow’s milk allergy (CMA) infants at the baseline immediately after the diagnosis, and to evaluate the changes in the faecal microbiota after 6 months of treatment of CMA infants with hypoallergenic formula (HF), compared with healthy children fed on standard milk formulae. Sixty infants younger than 4 months of age with challenge-proven CMA and 60 healthy age-matched children were investigated in this prospective case - control follow-up study. Faecal samples were collected at baseline and at 6 months of follow-up, microbial diversity and composition were characterized by high-throughput 16S rRNA sequencing. The average age (±SD) of the infants at inclusion was 2.9 ± 1.0 months. Children with CMA have lower gut microbiota diversity and an elevated Enterobacteriaceae to Bacteroidaceae (E/B ratio) in early infancy compared with healthy children (115.8 vs. 0.8, P = 0.0002). After 6 months of treatment with HF, CMA infants had a higher Lactobacillaceae (6.3% vs. 0.5%, P = 0.04) and lower Bifidobacteriaceae (0.3% vs. 8.2%, P = 0.03) and Ruminococcaceae (1.5% vs. 10.5%, P = 0.03) abundance compared with control children. Conclusion: Low gut microbiota diversity and an elevated E/B ratio in early infancy may contribute to the development of FA, including CMA. A strict elimination diet may weaken FA by reducing E/B ratio and promoting a gut microbiota that would benefit the acquisition of oral tolerance.

Synbiotics‐supplemented amino acid‐based formula supports adequate growth in cow's milk allergic infants

Children with cow's milk allergy (CMA) are at risk for inadequate nutritional intake and growth. Dietary management of CMA, therefore, requires diets that are not only hypoallergenic but also support adequate growth in this population. This study assessed growth of CMA infants when using a new amino acid-based formula (AAF) with prebiotics and probiotics (synbiotics) and evaluated its safety in the intended population. In a prospective, randomized, double-blind controlled study, full-term infants with diagnosed CMA received either an AAF (control; n = 56) or AAF with synbiotics (oligofructose, long-chain inulin, acidic oligosaccharides, Bifidobacterium breve M-16V) (test; n = 54) for 16 wk. Primary outcome was growth, measured as weight, length and head circumference. Secondary outcomes included allergic symptoms and stool characteristics. Average age (±SD) of infants at inclusion was 4.5 ± 2.4 months. Both formulas equally supported growth according to WHO 2006 growth charts and resulted in similar increases of weight, length and head circumference. At week 16, differences (90% CI) in Z-scores (test-control) were as follows: weight 0.147 (-0.10; 0.39, p = 0.32), length -0.299 (-0.69; 0.09, p = 0.21) and head circumference 0.152 (-0.15; 0.45, p = 0.40). Weight-for-age and length-for-age Z-scores were not significantly different between the test and control groups. Both formulas were well tolerated and reduced allergic symptoms; the number of adverse events was not different between the groups. This is the first study that shows that an AAF with a specific synbiotic blend, suitable for CMA infants, supports normal growth and growth similar to the AAF without synbiotics. This clinical trial is registered as NCT00664768.

A Comprehensive Review of Sensitization and Allergy to Soy-Based Products

Since 1943, cases of sensitization or allergy to soy-based formulas (SBFs) have been described without any consensus on their real prevalence. We identified the adjusted prevalence of IgE-mediated soy allergies in children and performed a secondary analysis of the impact of age (less than and more than 6months). We performed a systematic review with meta-analysis of studies published from 1909 to 2013 in PubMed, Embase, LILACS, ARTEMISA, Cochrane, Bandolier, DARE and the GRADE system for grading quality. Results are presented in tables and graphs using a forest plot. The 40 studies identified established weighted prevalence of soy allergies of 0 to 0.5% (0.27) for the general population, 0.4 to 3.1% (1.9) for the referred population, and 0 to 12.9% (2.7) for allergic children. Prevalence of sensitization after the use of SBFs is 8.7 and 8.8%, depending on the method used. The prevalence of allergies to soy and IgE sensitization to the use of SBFs is less than reported. Not enough evidence exists to show a higher risk of allergy in infants younger than 6months. The concern about soy allergy is no reason to postpone the use of SBFs in IgE-mediated cow's milk allergy infants until the age of 6months.

Cow's Milk Allergy, Asthma, and Pediatric IBD

We identified a total of 595 Finnish children born in 1994-2008 and diagnosed as having inflammatory bowel disease (IBD) by October 2010 from the National Reimbursement Register (based on certificates including the diagnostic criteria) to determine whether the presence of cow's milk allergy (CMA) or asthma is associated with the risk of contracting IBD (altogether 2380 matched controls). A diagnosis of CMA in infancy was associated with Crohn disease (odds ratio [OR] 1.92, confidence interval [CI] 1.09-3.36, P < 0.05) and ulcerative colitis (OR 1.71, CI 1.04-2.83, P < 0.05), but childhood asthma only with Crohn disease (OR 2.33, CI 1.41-3.86, P = 0.001). Thus, CMA in infants is a risk factor for contracting pediatric IBD and accordingly, asthma for Crohn disease.

Gray-Scale and Color Doppler Ultrasound Findings in Children With Cow's Milk Allergy

The objective of our study was to evaluate whether gray-scale and color Doppler ultrasound can reveal intestinal inflammation in infants with cow's milk allergy (CMA). This study evaluated the clinical findings and grayscale and color Doppler sonograms of 34 infants. Seventeen 0- to 6-month-old infants with suspected CMA and 17 nonsymptomatic age-matched infants were evaluated by a blinded investigator who determined the percentage of vessel density and the thickness of different parts of the bowel. Clinical and sonographic variables were evaluated in the same regions of bowel considering three time points: presentation, after 4 weeks of feeding only amino acid-based formula, and after challenge test. Likelihood ratios and receiver operating characteristic (ROC) curves were used to define a cutoff point for vascular density percentage. The difference in the percentage of vessel density between patients with CMA (mean, 28.1%) and control infants (mean, 7.77%) was statistically significant. ROC analysis showed that a cutoff point of 18.7% could differentiate between patients with CMA and control infants with 81.8% sensitivity and 94.1% specificity. The area under the curve was 0.941. We found statistical differences in bowel wall thickness between control patients and patients with CMA. There was a significant increase in vessel density in infants younger than 6 months with CMA compared with healthy age-matched infants. The most appropriate cutoff point for vessel density was 18.7%. The results of this study suggest that Doppler ultrasound could be used as a screening tool to diagnose CMA.

Is the Skin Prick Test (SPT) for milk useful for diagnosis of Cow's Milk Allergy (CMA) in infants?

RATIONALE: There is a concept that infants present lower cutaneous reactivity to SPT for food allergy diagnosis. The aim of this study is to describe the results of SPT to cow's milk in infants with suspicion of CMA.METHODS: It was included 39 infants (17F: 22 M) under 2 years old among 170 CMA pediatric patients. Two groups were defined: Group I: patients ≤ 6 months (n = 8) and Group II: from 6 months to 2 years (n = 31). The criteria of CMA diagnosis were: clinical history, presence of specific IgE for milk (SPT ≥ 3 mm or RAST ≥ 3.5 KU/L) and positive oral challenge test for milk (open or double blind placebo controlled). The SPT was done with milk in commercial extract (IPI ASAC) and “in natura”. Histamine was used as positive control. Anaphylatic patients were submitted to SPT after one year of follow up without anaphylaxis episodes.RESULTS: Cutaneous symptoms were present in 31 (79.4%), gastrointestinal in 22 (56.4%), respiratory in 9 (23.0%) and anaphylaxis in 14 (35.8%). SPT was positive in 7 patients (87.5%) from group I and 23 (74.1%) in group II. The wheal ≥ 6 mm was found in 1 patient from group I and 20 from Group II. The comparison between the extracts was favorable to commercial ones (25x17).CONCLUSIONS: In this series the SPT was a useful diagnostic method for IgE-mediated CMA in infants, being the commercial extract more positive than “in natura CM”. The SPT ≥ 6 mm was more frequent in children with age ≥ 6 months. RATIONALE: There is a concept that infants present lower cutaneous reactivity to SPT for food allergy diagnosis. The aim of this study is to describe the results of SPT to cow's milk in infants with suspicion of CMA. METHODS: It was included 39 infants (17F: 22 M) under 2 years old among 170 CMA pediatric patients. Two groups were defined: Group I: patients ≤ 6 months (n = 8) and Group II: from 6 months to 2 years (n = 31). The criteria of CMA diagnosis were: clinical history, presence of specific IgE for milk (SPT ≥ 3 mm or RAST ≥ 3.5 KU/L) and positive oral challenge test for milk (open or double blind placebo controlled). The SPT was done with milk in commercial extract (IPI ASAC) and “in natura”. Histamine was used as positive control. Anaphylatic patients were submitted to SPT after one year of follow up without anaphylaxis episodes. RESULTS: Cutaneous symptoms were present in 31 (79.4%), gastrointestinal in 22 (56.4%), respiratory in 9 (23.0%) and anaphylaxis in 14 (35.8%). SPT was positive in 7 patients (87.5%) from group I and 23 (74.1%) in group II. The wheal ≥ 6 mm was found in 1 patient from group I and 20 from Group II. The comparison between the extracts was favorable to commercial ones (25x17). CONCLUSIONS: In this series the SPT was a useful diagnostic method for IgE-mediated CMA in infants, being the commercial extract more positive than “in natura CM”. The SPT ≥ 6 mm was more frequent in children with age ≥ 6 months.

Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals: the Milan Cow's Milk Allergy Cohort study

The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally. To prospectively determine prognostic predictors of tolerance in a random cohort of referrals using CMA workup outcomes as covariates and tolerance as the status variable in a duration model of CMA. The 2001-2006 Milan Cow's Milk Allergy Cohort (MiCMAC) enrolled children referrals using double-blind, placebo-controlled food challenges (DBPCFCs) as study end points (confirmation of CMA; onset of tolerance). The Cox regression model was used to analyze all clinical factors that contributed to tolerance. Covariates analyzed were skin, gastrointestinal, and respiratory symptoms; history and demographics at presentation; age at diagnosis and DBPCFC outcomes; sensitization (skin and serum) by cow's milk protein fractions; sensitization to other food and inhalant allergens; total IgE levels; specific IgE concentrations for cow's milk protein fractions, other ingestants, and aeroallergens; and threshold doses at DBPCFC. Sensitization and DBPCFC were performed at 6-month intervals. A total of 112 infants were enrolled (mean [SD] age, 13.85 [9.84] months), and 59 achieved tolerance (mean [SD] age when tolerance was achieved, 27.58 [11.81] months). On univariate analysis, asthma and/or rhinitis at presentation was an independent predictor of persistence (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.26-3.82). On multivariate analysis, predictors of persistence were a fresh milk wheal diameter increment of 1 mm (HR, 1.18; 95% CI, 1.07-1.31) and a positive skin prick test result with soy (HR, 6.99; 95% CI, 1.56-31.25). This is the first study, to our knowledge, to identify incremental biological predictors of delayed tolerance to cow's milk in children that should be integrated into DBPCFC schedules for CMA in infants.

Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants

Probiotic bacteria are proposed to alleviate intestinal inflammation in infants with atopic eczema/dermatitis syndrome (AEDS) and food allergy. In such infants we investigated effects of probiotic bacteria on faecal IgA, and on the intestinal inflammation markers tumour necrosis factor-alpha (TNF-alpha), alpha1-antitrypsin (AT), and eosinophil cationic protein (ECP). A total of 230 infants with AEDS and suspected cow's milk allergy (CMA) received in a randomized double-blinded manner, concomitant with elimination diet, Lactobacillus GG (LGG), a mixture of four probiotic strains (MIX), or placebo for 4 wk. Four weeks after treatment, CMA was diagnosed with a double-blind placebo-controlled milk challenge. Faecal samples of 102 infants, randomly chosen for analysis, were collected before treatment, after 4-wk treatment, and on the first day of milk challenge. After treatment, IgA levels tended to be higher in probiotic groups than in the placebo group (LGG vs. placebo, p=0.064; MIX vs. placebo, p=0.064), and AT decreased in the LGG group, but not in other treatment groups. After challenge in IgE-associated CMA infants, faecal IgA was higher for LGG than for placebo (p=0.014), and TNF-alpha was lower for LGG than for placebo, but non-significantly (p=0.111). In conclusion, 4-wk treatment with LGG may alleviate intestinal inflammation in infants with AEDS and CMA.

Cow's milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow's milk allergy infants.

IgE-mediated cow's milk proteins (CMPs) allergy shows a tendency to disappear with age. The sooner tolerance is detected, the earlier the substitute diets can be suspended and the quicker family emotional hardship is alleviated. To analyse the specific IgE levels to cow's milk and its proteins, which help to separate tolerant from no tolerant children in the follow-up of infants with allergy to cow's milk. Sixty-six infants diagnosed with IgE-mediated allergy to CMPs were included in this prospective follow-up study. Periodic reassessments were carried out every 6 months until they were 2-years old and then, annually, until tolerance arose or until the last reassessment in which tolerance had not been achieved. Non-tolerant infants were followed, at least, for a period of 3 years. In each visit, the same skin tests and determination of specific IgE (CAP System FEIA) for milk and its proteins were carried out. The open challenge test was repeated unless a clear transgression to milk, which came to be positive, had taken place within the previous 3 months in each of the follow-up visits. Specific IgE levels to milk and its proteins, in different moments of the follow-up were analysed by means of the receiver-operating characteristic curve to predict clinical reactivity. Throughout the follow-up 45 (68%) infants became tolerant. The follow-up mean for tolerant infants was 21.2 months whereas for non-tolerant infants it was 58 months. The specific IgE levels which were predictors of the clinical reactivity (positive predictive value (PPV)> or =90%), grew as the age of the infants increased: 1.5, 6 and 14 kU(A)/L for milk in the age range 13-18 and 19-24 months and in the third year, respectively. Specific IgE levels to casein: 0.6, 3 and 5 kU(A)/L, respectively, predicted clinical reactivity (PPV> or =90%) in the different analysed moments of the follow-up. The cut-off points: 2.7, 9 and 24 kU(A)/L for milk and 2, 4.2 and 9 kU(A)/L for casein, respectively, predicted clinical reactivity with an accuracy > or =95% corresponding to a specificity of 90%. Monitorization of specific IgE concentration for milk and casein by means of the CAP system in allergic children to CMPs allows us to predict, to a high degree of probability, clinical reactivity. Age factor must be taken into account to evaluate the specific IgE levels which are predictors of tolerance or clinical reactivity.

Phyto-œstrogènes du soja : problèmes posés chez le nourrisson allergique au lait de vache et consommant des formules à base de soja

This work presents isoflavones levels in soy-based infant formulas commercialised in France. These compounds are known to be both estrogenic and anti-gonadotrophic compounds. A comparison is made with soy based food supplements for estrogen deprived menopausal women. This work gives the latest scientific data on the effects of isoflavones in humans and presents the actual controversy on the effect of soy based infant formulas on human health. It gives the actual data on cow milk allergy in infants and explains what to do when cow milk allergy is suspected in infants. This paper warns paediatrics and advises them to avoid soy based infant formulas for infant below 6 months or to prefer formula with low isoflavone content if they are commercially available.

Expression of intercellular adhesion molecules on circulating lymphocytes in relation to different manifestations of cow's milk allergy.

The complex interactions between immune cells are partly mediated by different adhesion molecules, but little is known about their role in the systemic immunoinflammatory process following sensitization to food antigens in early infancy. The aim of this study was to investigate the expression of intercellular adhesion molecule-1 (ICAM-1or CD54) and the alpha subunits of its ligands' lymphocyte function-associated antigen-1 (LFA-1) (alphaL subunit or CD11a) and Mac-1 (alphaM subunit or CD11b) on peripheral blood leucocytes in infants with cow's milk allergy (CMA) and in healthy controls. Thirty-nine breastfed infants, aged from 0.6 to 8.3 months, and their lactating mothers were included in the study from delivery onwards. During follow-up, 25 infants developed CMA and 14 remained healthy. Expressions of CD54 and CD11b on peripheral blood leucocytes were evaluated by flow cytometry. In addition, the expression of CD11a on peripheral blood leucocytes was analysed by immunocytochemistry. Mothers' milk samples were collected and their leucocyte content was evaluated using a light microscope. The frequency of ICAM-1 expressing peripheral blood lymphocytes was significantly higher in patients with CMA than in healthy infants (P=0.03, Mann-Whitney U-test). Furthermore, the high proportion of ICAM-1-expressing cells was associated with gastrointestinal and multiorgan symptoms in the CMA infants. There was no significant difference in the expression of Mac-1 alphaM on lymphocytes in our study groups, but the LFA-1 alphaL expression seemed to be higher in the IgE-mediated CMA. We suggest that the high expression of ICAM-1 on peripheral blood lymphocytes may reflect enhanced stimulation of T cells in vivo and their migration to the effector tissues in an early-phase of developing CMA. Furthermore, high ICAM-1 expression may be associated with the presence of multiorgan manifestations of CMA, whereas high LFA-1 expression may reflect the IgE-mediated disease.

Residual Intestinal Disease After Milk Allergy in Infancy

ABSTRACTBackgroundThe subsidence of cow's milk allergy (CMA) has been a subject of controversy. In this study the authors examined whether children with this condition in infancy developed full tolerance or whether they continue to have vague gastrointestinal (GI) symptoms relating to the consumption of milk or dairy products and/or signs of mucosal lesion in the GI tract.MethodsThe authors reexamined 56 10‐year‐old subjects who manifested CMA before 1 year of age, and compared the results with a group of 204 randomly selected age‐matched school children. Fifty‐three and 90 subjects respectively attended a reexamination and were evaluated for growth, lactose tolerance, and immunoglobulin A (IgA)‐ and IgG‐class antibodies to whole cow's milk. The subjects reporting milk‐related GI symptoms were encouraged to do a 4‐week blind elimination‐challenge test with 1 week of low‐lactose milk flour. Sixteen of the 25 children were able to complete the trial.ResultsApproximately half the study subjects (45%) reported milk‐related GI symptoms, whereas the respective figure among the control subjects was 10%. Three of six study subjects and seven of 10 control subjects, although completing the challenge, responded with intestinal symptoms. The growth of the former CMA subjects was retarded compared with the control subjects, and the difference in height was most striking in those subjects still reporting milk‐related GI symptoms. However, all subjects had normal hemoglobin and whole‐blood folic acid levels. The CMA subjects had significantly (P = 0.014) lower concentrations of milk antibodies compared with the control subjects. Lactose malabsorption, defined as high counts in a hydrogen breath test and related clinical symptoms, was found in eight CMA subjects (14%) and six control subjects (3%).ConclusionsIn a certain proportion of subjects with CMA in infancy, GI intolerance seems to persist even after small‐dose tolerance has been achieved. The intestinal symptoms and the increased prevalence of lactose intolerance may be caused by a disturbance of the surface epithelial cells—a state to which the authors refer as residual intestinal disease.

Residual intestinal disease after milk allergy in infancy.

The subsidence of cow's milk allergy (CMA) has been a subject of controversy. In this study the authors examined whether children with this condition in infancy developed full tolerance or whether they continue to have vague gastrointestinal (GI) symptoms relating to the consumption of milk or dairy products and/or signs of mucosal lesion in the GI tract. The authors reexamined 56 10-year-old subjects who manifested CMA before 1 year of age, and compared the results with a group of 204 randomly selected age-matched school children. Fifty-three and 90 subjects respectively attended a reexamination and were evaluated for growth, lactose tolerance, and immunoglobulin A (IgA)- and IgG-class antibodies to whole cow's milk. The subjects reporting milk-related GI symptoms were encouraged to do a 4-week blind elimination-challenge test with 1 week of low-lactose milk flour. Sixteen of the 25 children were able to complete the trial. Approximately half the study subjects (45%) reported milk-related GI symptoms, whereas the respective figure among the control subjects was 10%. Three of six study subjects and seven of 10 control subjects, although completing the challenge, responded with intestinal symptoms. The growth of the former CMA subjects was retarded compared with the control subjects, and the difference in height was most striking in those subjects still reporting milk-related GI symptoms. However, all subjects had normal hemoglobin and whole-blood folic acid levels. The CMA subjects had significantly (P = 0.014) lower concentrations of milk antibodies compared with the control subjects. Lactose malabsorption, defined as high counts in a hydrogen breath test and related clinical symptoms, was found in eight CMA subjects (14%) and six control subjects (3%). In a certain proportion of subjects with CMA in infancy, GI intolerance seems to persist even after small-dose tolerance has been achieved. The intestinal symptoms and the increased prevalence of lactose intolerance may be caused by a disturbance of the surface epithelial cells--a state to which the authors refer as residual intestinal disease.