Elimination Of Cow's Milk Protein Research Articles

A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow's milk elimination diet.

Food allergy has several negative nutritional consequences and may persist beyond the first year of lives. This study aimed to assess the role of a complete oral amino acid-based supplement in the diet of children on cow's milk protein elimination diet because of food allergy. This study included two groups of children aged 1-5 years paired by age and socioeconomic status: (1) study group, on cow's milk protein elimination diet plus an oral amino acid-based supplement, and (2) control group, on cow's milk protein elimination diet. Sociodemographic, clinical, anthropometric, and dietary data were obtained through online interviews. Two 24-h dietary recalls were collected on nonconsecutive days. Both groups comprised mostly boys. The study group presented lower values of body mass index. The frequency of feeding difficulties was similar between groups. The study group had a higher intake of energy, protein, carbohydrates, calcium, iron, zinc, phosphorus, magnesium, copper, selenium, vitamins D, E, B1, B2, B6, and B12, niacin, and folic acid compared to the control group. A higher proportion of children in the study group had adequate intake according to the recommendations made for energy, carbohydrates, iron, phosphorus, selenium, vitamins A, D, E, B1, B2, and B6, and folic acid. The use of a complete oral amino acid-based supplement has a positive effect on the diet quality of preschoolers on cow's milk elimination diet because of food allergy, promoting higher intake of energy, calcium, vitamin D, and other essential nutrients.

Allarme rosso: il sanguinamento rettale

A 6-week-old, exclusively breastfed and well-appearing infant presented with blood in her stools. A diagnosis of food protein-induced allergic proctocolitis was promptly made by the presence of the high number of eosinophils in her blood and the prompt clinical response to the elimination of cow milk proteins from her mother's diet.

Allarme rosso: il sanguinamento rettale

A 6-week-old, exclusively breastfed and well-appearing infant presented with blood in her stools. A diagnosis of food protein-induced allergic proctocolitis was promptly made by the presence of the high number of eosinophils in her blood and the prompt clinical response to the elimination of cow milk proteins from her mother's diet.

Evaluation of the complementary feeding practices, dietary intake, and nutritional status of infants on a cow's milk protein elimination diet

ObjectiveTo evaluate the complementary feeding practices, food intake, and nutritional status of infants on a cow's milk protein elimination diet. MethodsA cross-sectional and observational study was conducted to compare infants aged 4–18 months who were on a cow's milk protein elimination diet with a control group of healthy infants without any dietary restrictions. General information on the child's health, demographic data, and food consumption were collected. ResultsThe study included 96 infants in the elimination diet group and 99 in the control group. In the elimination diet group, the median age (in months) of introduction of solid foods (5.0 × 4.0; p < 0.001) and water (5.5 × 4.0; p < 0.05) was later, consumption of soft drinks and industrialized cookies was less frequent (p < 0.05), and a lower index of complementary feeding inadequacies (2.75 × 3.50; p < 0.001) was observed. The elimination diet group presented lower individual values of Z scores for weight/age, weight/height, and body mass index/age, although they were fed with higher amounts of energy (117.4 × 81.3 kcal/kg of weight; p < 0.001) and macro-and micronutrients, except for vitamin A. In the elimination diet group, breast milk and its substitutes contributed to more than 67% of energy intake. Although calcium consumption was a deficit in 31.5% of the infants, none received supplementation. ConclusionInfants on an elimination diet presented more adequate complementary feeding practices and higher nutritional intake, despite lower body weight values.

Characterization of Upper Gastrointestinal Motility in Infants With Persistent Distress and Non-IgE-mediated Cow's Milk Protein Allergy.

Persistent crying in infancy is common and may be associated with gastroesophageal reflux disease (GERD) and/or non-IgE-mediated cow's milk protein allergy (CMPA). We aimed to document upper gastrointestinal motility events in infants with CMPA and compare these to findings in infants with functional GERD. Infants aged 2 to 26 weeks with persistent crying, GERD symptoms and possible CMPA were included. Symptoms were recorded by 48-hour cry-fuss chart and validated reflux questionnaire (infant GERD questionnaire [IGERDQ]). Infants underwent a blinded milk elimination-challenge sequence to diagnose CMPA. GERD parameters and mucosal integrity were assessed by 24-hour pH-impedance monitoring before and after cow's milk protein (CMP) elimination. C-octanoate breath testing for gastric emptying dynamics, dual-sugar intestinal permeability, fecal calprotectin, and serum vitamin D were also measured. Fifty infants (mean age 13 ± 7 weeks; 27 boys) were enrolled. On the basis of CMP elimination-challenge outcomes, 14 (28%) were categorized as non-IgE-mediated CMPA, and 17 (34%) were not allergic to milk; 12 infants with equivocal findings, and 7 with incomplete data were excluded. There were no baseline differences in GERD parameters between infants with and without CMPA. In the CMPA group, CMP elimination resulted in a significant reduction in reflux symptoms, esophageal acid exposure (reflux index), acid clearance time, and an increase in esophageal mucosal impedance. In infants with persistent crying, upper gastrointestinal motility parameters did not reliably differentiate between non-IgE-mediated CMPA and functional GERD. In the group with non-IgE-mediated CMPA, elimination of CMP significantly improved GERD symptoms, esophageal peristaltic function, and mucosal integrity.

The prevalence and characteristics of cow's milk protein allergy in infants and young children with iron deficiency anemia

The clinical presentation of cow's milk protein allergy (CMPA) in children varies. This retrospective study aimed to investigate the prevalence and clinical manifestations of CMPA in young children who visited for evaluation of iron deficiency anemia (IDA). Patients aged <4 years who were diagnosed as having IDA (serum ferritin <12ng/mL) at the National Cheng Kung University Hospital, Taiwan in the period 2005-2015 were reviewed. Their clinical presentations, laboratory data, endoscopy findings, and prognosis were analyzed. Seven of 51 IDA patients (13.7%) had CMPA. The pallor (100%), failure to thrive (43%), and general edema (43%) were the common features. Six (86%) had hypoalbuminemia and four (57%) had positive occult blood in the stool. Of the five patients who underwent skin prick test, four (80%) had positive results. Most of the colonoscopies revealed erosive and hemorrhagic colitis and lymphoid hyperplasia, but none of the biopsies demonstrated eosinophilia in the lamina propria. All of the patients recovered from their IDA within seven months of cow's milk protein elimination and iron supplementation. CMPA should be considered in young children with undetermined IDA. Cow's milk protein elimination and iron supplementation help in the recovery.

Can Fecal Calprotectin Level Be Used as a Markers of Inflammation in the Diagnosis and Follow-Up of Cow's Milk Protein Allergy?

PurposeCalprotectin is a cytosolic protein with immunomodulatory, antimicrobial, and antiproliferative actions. The concentration of calprotectin increases in infection, inflammation, and malignancy. We determined if calprotectin can be used as a marker for the diagnosis and follow-up of bowel inflammation in cow's milk protein allergy (CMPA).MethodsIn total, 32 patients newly diagnosed with CMPA were included (24 IgE-mediated, 8 non-IgE-mediated). In all subjects, a complete blood count, total IgE, cow's milk-specific IgE, and fecal calprotectin (FC) were assessed before and after a cow's milk protein (CMP) elimination diet was started. The results were compared with those of 39 healthy children.ResultsThe mean FC value before the CMP elimination diet was 516±311 µg/g in the 32 patients with CMPA and 296±94 µg/g in the control group (P=0.011). The mean FC value after the diet in these patients was 254±169 µg/g, which was significantly different from the mean value before the CMP elimination diet (P<0.001). When we compared FC levels before the CMP elimination diet in the IgE-mediated group with the control group, we found no significant statistical difference (P=0.142). The mean FC value before the CMP elimination diet was 886±278 µg/g in the non-IgE-mediated group and 296±94 µg/g in the control group; this difference was statistically significant (P<0.001). In the IgE-mediated and non-IgE-mediated groups, FC values after CMP elimination diet were 218±90 µg/g and 359±288 µg/g, respectively, and FC values before CMP elimination diet were 392±209 µg/g and 886±278 µg/g, respectively; these differences were statistically significant (P=0.001 and P=0.025, respectively).ConclusionsFC levels may be a useful marker for follow-up treatment and recurrence determination in CMPA.

Does cow's milk protein elimination diet have a role on induction and maintenance of remission in children with ulcerative colitis?

Aims of this study were to evaluate the efficacy of a cow's milk protein (CMP) elimination diet on induction and maintenance of remission and to define association with atopy in children with ulcerative colitis (UC). Twenty-nine consecutive patients (mean age: 11.2years; range: 4.6-17years; F/M: 15/14) with newly diagnosed UC were randomized either to receive a CMP elimination diet (n=14) or to continue a free diet (n=15) associated with concomitant steroid induction and mesalazine maintenance treatment. Children were prospectively evaluated at four time points: within 1month, 6months and 1year after diagnosis or at the time of relapse. Twenty-five of the 29 enrolled patients responded to the UC induction therapy with a complete remission (86.2%), 13 belonging to CMP elimination diet group and 12 to free diet group (p=0.59). Overall, our data showed that 7 of 13 (53.8%) patients treated with CMP elimination diet and 8 of 15 (53.3%) patients on free diet and UC therapy relapsed within 1year of follow-up (p=1). In conclusion, data of this paediatric, randomized trial suggest that CMP elimination has no role in the management of UC in non-sensitized children.

Efficien cy of Aminoacid Formula in dietotherapyof food allergy in children : clinical eviden ces

Cow's milk allergy (CM A) is the most common food allergy in young children. Babies who develop cow's milk protein (CMP ) allergy may have one or several of the following symptoms: skin rash or gastrointestinal symptoms (abdominal pain or cramps, vomiting or diarrhea). The symptoms can be controlled through a dairy-free diet. So the diagnosis and elimination of CMP is an essential element in management of children with CM A. This article provides a summary of extensive clinical research behind the Nutrilon Aminoacid, demonstrating the clinical efficacy through 25 years of experience.

Does Cow's Milk Protein Elimination Diet Have a Role on Induction and Maintenance of Remission in Children With Ulcerative Colitis?

Does Cow's Milk Protein Elimination Diet Have a Role on Induction and Maintenance of Remission in Children With Ulcerative Colitis?

Multiple food allergy: a possible diagnosis in breastfed infants.

Six infants suspected of food allergy during breastfeeding were evaluated using prick tests, total IgE, RASTs and intestinal permeability measurements during fast and provocation with mother's milk. An elimination diet was undertaken in mothers, removing first cow's milk protein (CMP), then, when inefficient, all foods suspected on the clinical history or a positive prick test in the child, followed by oral challenges in mother's diet with the corresponding food. The sole CMP-free diet in mothers always proved insufficient. In four, an additional diet excluding two to three other foods cleared the symptoms. Oral provocations in mother's diet with those foods were positive in all. In two, mothers turned down a diet excluding more than four foods, symptoms cleared while feeding the child with an extensively hydrolysed formula, whereas challenges with mother's milk induced immediate reactions. Intestinal permeability was altered during provocation tests with mother's milk sampled before maternal diet. Food allergy during breastfeeding may be due to multiple foods and the inefficacy of the sole CMP elimination in mothers does not rule out food sensitization.

Soluble Adhesion Molecules and Oral Antigen Feeding in Infants

Oral administration of foreign proteins, e.g. cow's milk (CM) proteins, stimulates the immune system and induces humoral and cellular immune response against these antigens in infants. Up-regulation of adhesion molecules is known to be associated with activation of the immune system. The purpose of the study was to examine whether orally administered CM proteins induce elevation in soluble adhesion molecules, i.e. intercellular adhesion molecule-1 (ICAM-1) and L-selectin, in infants. In a double-blind trial, 10 infants received CM-based formula and 10 infants casein hydrolysate formula until the age of 9 mo. The infants of mothers with insulin-dependent diabetes mellitus (IDDM) were recruited into a pilot study of a trial for primary prevention of IDDM by elimination of CM proteins from the diet during early infancy. A cord blood sample and peripheral blood samples were taken at the ages of 3, 6, 9, and 12 mo of age. The levels of soluble ICAM-1 and L-selectin were measured by ELISA. The levels of soluble ICAM-1 were higher at the ages of 3, 6, 9, and 12 mo in infants who received CM-based formula than in infants who received hydrolyzed formula (p = 0.05). Instead, no difference was found in the the levels of soluble L-selectin. The levels of soluble ICAM-1 and L-selectin were higher in all infants when compared with the levels reported in adults or to the levels seen in cord blood. Orally fed CM proteins induce an elevation in soluble ICAM-1 in infants. This may reflect the generation of an immune response against these proteins, because ICAM-1 has an important costimulatory role in lymphocyte activation.

DIETARY TRIGGERS OF IDDM

Higher incidence of IDDM was reported in children exposed to cow milk early in life vs. those breastfed for longer periods. Spontaneously IDDM rodents are also protected by elimination of cow milk proteins (Prot) in the diet, mainly β-lactoglobulin (LG) and bovine serum albumin (BSA), when such restriction occurs at weaning. We found that antibodies (Ab) to BSA (but not to LG) cross react with a BB-rat islet cell membrane prot. (Mr=69Kd) as demonstrated by Western blotting and by Fluorography when extracted radioactive labelled islet-cell prot. were immunoprecipitated and separated by gel-electrophoresis. The precipitate increased in cells pre-exposed to interferon-γ. Comparative aa. sequences of human, rat and bovine SA. showed clear differences in the latter vs. the others between residues 138-166, which could-serve as epitopes. Overlapping this region (aa.157-175) is a homologous area between BSA and the primary structure of β-subunits of prot. Ia, and DQ and DR (aa.50-79). Corresponding to aa-57 of DQ antigens, human albumin has an Asp. residue while BSA has an Ala. Similar substitutions occur in the Ia-β prot. of IDDM mice and rats vs. normal controls. Hypothesis: Absorption of milk BSA early in life triggers an immune response by Ab. that cross-react with MHC Class II antigens as a typical “mimicry” event.

Intestinal cow's milk allergy.

Cow's milk allergy (CMA) is multifaceted disease representing systemic, skin or gastrointestinal reactions to cow's milk (CM) protein. This article shortly reviews the intestinal form of CMA (ICMA). According us the child is allergic to CM when the immunologic reaction to CM is associated with clinical symptoms. The incidence of CMA is 1.3-1.9% in general, but the ICMA only 0.6 pro mille among the children less than six months of age. The majority of infants shows symptoms within a month of starting CM feeding. The majority of children with CMA have gastrointestinal symptoms. Manx of these infants has additionally dermatological symptoms and some respiratory symptoms. The mode of onset is often acute diarrhoea and vomiting, as in acute gastroenteritis. Laboratory findings indicate iron deficiency anemia in 20-70%. Half to two thirds of infants with chronic diarrhoea have moderate to severe steatorrhoea. The morphologic lesion in the gastrointestinal tract in ICMA is widespread, often being present from stomach to rectum. Jejunal lesion is most severe in the proximal part of the intestine and nowadays most patients have only partial villous atrophy or slight changes of the villi. Both the epithelium and the lamina propria of the jejunum are infiltrated with inflammatory cells. The morphology of the small intestine speaks for a strong immune reaction which leads increased destruction of surface epithelial cells. We recommend elimination of CM proteins to the age of 1.5 to 2 years. Most patients tolerate CM by the age of 2 years without symptoms. Prolonged breast-feeding and avoidance of early contact with CM are important in reducing the severity and frequency of CMA.

Dietary protein-induced colitis in breast-fed infants

Six infants are reported who developed an inflammatory proctocolitis in the first month of life while being breast fed exclusively. All has been born at term and had normal perinatal courses. None had growth failure or constitutional symptoms other than bloody diarrhea. No toxic, bacterial, viral, or parasitic cause was established. Rectal inflammation was suggested by the presence of fecal leukocytes and was confirmed by sigmoidoscopic observation of focal ulcerations, edema, and increased friability. Rectal biopsies demonstrated a wide spectrum of acute and chronic inflammatory changes. All infants responded clinically to initiation of feeding with either a hydrolyzed casein or a soy protein-based formula. Breast-feeding was subsequently resumed in five of the six infants; all experienced immediate recurrence of symptoms. Elimination of cow milk protein from the maternal diet led to tolerance of breast-feeding in two infants but there was no change in the other three. We believe that dietary protein-induced enterocolitis, previously reported in formula-fed infants, occurs occasionally in the exclusively breast-fed infant as well.