Milk Allergy Research Articles

Relationship between the diagnosis of food protein-induced enterocolitis syndrome and postemetic procalcitonin levels.

There are no reports on the relationship between food protein-induced enterocolitis syndrome (FPIES) diagnosis and procalcitonin levels. Our study sought to demonstrate a correlation between the presence or absence and severity of FPIES symptoms and postemetic procalcitonin levels. The subjects were 53 patients with FPIES (44 with hen's egg allergy, 4 with milk allergy, 4 with wheat allergy, and 3 with soy allergy), who collectively underwent a total of 75 oral food challenges (OFCs). Procalcitonin levels at 5 hours after antigen ingestion were compared between patients with a positive OFC result and those with a negative OFC result and between patients who experienced mild or moderate events and those who experienced severe events. At 5 hours after ingestion of the causative food, the median procalcitonin levels in patients with a negative OFC result, patients who experienced a mild or moderate event, and patients who experienced a severe event were 0.02, 0.03, and 0.16 ng/mL, respectively. The procalcitonin level was significantly higher in the groups with a positive OFC result than in the groups with a negative OFC result (P< .001), and it was significantly higher in those who experienced severe events than in those who experienced mild or moderate events (P= .012). Measurement of procalcitonin levels has the potential to provide a quantitative and objective assessment of FPIES diagnosis and severity.

A personalized approach to the management of breastfed infants with functional gastrointestinal disorders and cow’s milk allergy. The role of nutritional recommendations for a nursing mother

Introduction. Functional gastrointestinal disorders (FGID) in infants are a complex of symptoms from the gastrointestinal tract that cannot be explained by structural or biochemical disorders. To alleviate the symptoms of functional disorders, a set of measures is required, first of all, psychological support for the mother and, of course, rational feeding, which includes maintaining breastfeeding, optimizing the nutrition of the nursing mother. Despite the abundance of professional information on this issue, previous studies demonstrate a low level of women’s awareness of nutrition during breastfeeding. The aim of the work is to determine the effectiveness of recommendations on nursing mother’s nutrition in the complex treatment of breastfed children with FGID and allergy to cow’s milk proteins.&#x0D; Materials and methods. Seventy five mother–child pairs were included in the study. 1–4 months infants exclusively breastfed during the study were divided into two groups: 1 — FGID infants (n = 51) and 2 — infants with suspected cow’s milk allergy (CMA) n = 24. In addition to the comprehensive treatment of the child, mothers of both groups were given recommendations on the nursing woman’s nutrition. Mothers of children from group 2 were assigned a diagnostic dairy-free diet for a period of 1 month. &#x0D; Results. On the 2nd visit, when analyzing the symptoms of the FGID in group 1, the number of children with symptoms of regurgitation of more than 2 episodes per day decreased by 28% (p &lt; 0.001), crying for more than 3 hours per day — by 52% (p &lt; 0.001). Children of group 2 with a clear positive effect from the diagnostic dairy-free diet therapy of the mother (n = 20) were diagnosed with Allergic and alimentary gastroenteritis and colitis (K52.2 — 10th revision of ICD-10), the continuation of the dairy-free diet for the mother and the supervision of an allergist were prescribed. The survey of women showed that all nursing women were interested in nutrition issues during lactation, 92% of the surveyed mothers searched for this information on the Internet. At the same time, only 12% of women considered this information to be sufficient. Evaluating the presented materials on nutrition, the overwhelming majority of respondents replied that they helped them to adjust their diet and expand nutrition, as well as to maintain breastfeeding.&#x0D; Conclusion. Thus, an integrated approach in the management of FGID infants and gastrointestinal manifestations of food allergies, including the use of nutrition recommendations developed in the National Medical Research Center of Children’s Health for nursing women, allows achieving a positive effect on the side of symptoms both in FGID and CMA patients, and also contributes to the improvement of the psycho-emotional state of a woman and prolonged breastfeeding.

Food allergy to cow’s milk proteins and meat

Introduction. Cow’s milk and dairy products are important sources of high-quality animal proteins, calcium, vitamins, and minerals. They are widely used in the diet of preschool and school-age children and contribute to the normal development and resilience of children against the effects of adverse external factors. However, cow’s milk can cause serious allergic reactions in children, even leading to anaphylaxis. Allergy to cow’s milk proteins is one of the common allergic reactions among preschool-age children. Through conducted research, patterns of the natural course of milk allergy over time have been established. In most cases, by the age of 5 years, children develop tolerance to cow’s milk proteins. However, some school-age children may retain heightened sensitivity to them. Sustaining such prolonged milk allergy in a school-age child requires identifying the cause and conducting in-depth examinations for each specific patient. In such cases, valuable information about elevated sensitivity to whole cow’s milk protein and its components is provided by molecular (component-based) diagnostics. This enables the identification of causally significant components (α-lactalbumin, β-lactoglobulin, bovine serum albumin) of milk protein for the purpose of rational diet therapy, considering cross-reactions with beef meat. The presented article summarizes and systematizes literary and proprietary data on allergy to cow’s milk proteins and its components, as well as to beef meat. Understanding the characteristics of allergy to cow’s milk proteins and its components, cross-reacting with beef, will help avoid serious consequences of irrational elimination diets.

An Unusual Cause of Vomiting in Childhood: A Case Report

In infants and young children, vomiting is a common symptom that may indicate a digestive or other health problem. This case report presents a rare incidence in which an intracranial tumour was the root cause of an infant's vomiting and failure to thrive. An intracranial tumour was found during the evaluation, which also evaluated acute gastroenteritis, reflux illness, and milk protein intolerance. Considering unusual etiologies, such as metabolic, endocrine, and neurological disorders, is crucial for determining the cause of symptoms like chronic vomiting and stunted development in infants, as shown by this instance. The best possible results for patients depend on their ability to benefit from early diagnosis and treatment.

Особенности процесса ферментации молочно-соевой смеси

The plant milk market is actively developing at the moment, as many consumers suffer from lactose and casein intolerance, while vegetarianism is being popularized. The use of soy milk is becoming popular in the technology of fermented dairy plant products, as it is a lactose-free analog of cow milk and source of native protein, polyunsaturated fatty acids, vitamins, minerals, and other micronutrients. However, the fermentation of dairy and plant compositions is quite complex and has not been fully understood yet, and therefore the goal of this study was to conduct a comparative analysis of the fermentation of milk and soy mixtures with different compositions (cow milk: soy milk in the ratios of 55:45; 70:30; 85:15). The tests were conducted at the Laboratory of Agricultural Product Processing. To obtain milk and soy mixtures, a plant protein drink – soy milk – was prepared from soybeans of the Sentyabrinka variety selected by the Federal State Budgetary Scientific Institution Federal Research Center All-Russian Research Institute of Soybean. The fermentation of milk and soy mixtures was performed using the acid-rennet method with bacterial starter cultures No. 1 (Lactobacillus lactis, Lactococcus diacetylactis, Lactococcus cremoris, Streptococcus thermophilus) and No. 2 (Lactococcus lactis ssp. lactis, Lac. lactis subsp. diacetilactis, Leuconostoc lactis and/or mesenteroides subsp. cremoris, Lactobacillus plantarum, Lactobacillus helveticus, Streptococcus thermophilus). The acid formation of fermented milk and soy clots was studied in time at intervals of 1 hour, and their active and titratable acidity levels were analyzed in the course of work. Fermentation completion was determined based on the organoleptic indicators of fermented clots and their acidity levels. The following was established as the result of the tests: composition of the milk-soy mixture – 70:30; technological fermentation process parameters and modes – 328–346 minutes at a temperature of 34 °C, with the production of a fermented milk and soy clot having the best organoleptic quality indicators – well-formed, with a stable texture, pleasant, sour-milk taste, light soy aftertaste and smell. The analytical dependences of the titratable and active acidity indicators on the duration of fermentation process were calculated based on an analysis of acid formation in experimental clot samples.

Milk coagulation and gastric emptying in women experiencing gastrointestinal symptoms after ingestion of cow's milk.

Gastrointestinal symptoms after drinking milk are often attributed to lactose intolerance or cow's milk allergy. However, some individuals without either condition still report gastrointestinal symptoms after drinking milk. This may be caused by gastric emptying (GE) rate or gastric protein coagulation. This study aimed to compare GE rate and protein coagulation after milk consumption between individuals reporting gastrointestinal symptoms and those without symptoms using a novel gastric MRI approach. Thirty women were included in this case-control study, of whom 15 reported gastrointestinal symptoms after drinking milk and 15 were controls. Participants underwent gastric MRI before and up to 90 min after consumption of 250 mL cow's milk. Gastric content volume and image texture of the stomach contents were used to determine GE and changes in the degree of coagulation. GE half-time did not differ between the groups (gastrointestinal symptom group 66 ± 18 min; control group 61 ± 14 min, p = 0.845). The gastrointestinal symptom group reported symptoms from 30 min onwards and rated pain highest at 90 min. The control group reported no symptoms. Image texture analyses showed a significantly higher percentage of coagulum and lower percentage of liquid in the group in the GI symptom group (MD 11%, 95% CI [3.9, 17], p = 0.003). Invitro data suggests that pH and proteolytic enzyme activity influence the coagulum structure. Gastric milk coagulation and emptied fraction of stomach content may differ between individuals experiencing symptoms after milk consumption, possibly due to differences in pH and proteolytic enzyme activity.

Early Introduction of Novel and Less-Studied Food Allergens in the Plant-Based Era: Considerations for US and EU Infant Formula Regulations

Early life feeding practices may affect the long-term health of individuals, particularly in terms of the development of non-communicable diseases, such as metabolic and allergic diseases. Accumulating evidence suggests that the interplay of breastfeeding and/or formula feeding followed by the introduction of solids plays a role in the occurrence of non-communicable diseases both in the short and long term. International food allergy guidelines recommend that breastfeeding women do not need to avoid food allergens and do not recommend any infant formula for allergy prevention. Guidelines regarding solid food introduction for food allergy prevention recommend the introduction of well-cooked eggs and peanuts around 4–6 months of age, and not to delay the introduction of other food allergens. There is also an increasing trend to feed infants a plant-based or plant-forward diet and have access to infant formulas based on plant-based ingredients. The use of novel plant-based infant formulas raises a few questions reviewed in this paper: (1) Do fortified, plant-based infant formulas, compliant with US Food and Drug Administration (FDA) regulations and European Food Safety Authority (EFSA) (European) guidelines, support adequate infant growth? (2) Are plant-based infant formulas suitable for the management of cow’s milk allergy? (3) Does feeding with novel, plant-based infant formulas increase the risk of food allergies to the food allergens they contain? (4) Does feeding infants plant-based food allergens in early life increase the risk of allergic and severe allergic reactions? The review of the literature indicated that (1) plant-based formulas supplemented with amino acids and micronutrients to comply with FDA regulations and EFSA guidelines, evaluated in sufficiently powered growth studies, can support adequate growth in infants; (2) currently available plant-based infant formulas are suitable for the management of CMA; (3) an early introduction and continuous intake of food allergens are more likely to prevent food allergies than to increase their risk; and (4) an early introduction of food allergens in young infants is safe.

Malpractice in Cow's Milk Protein Allergy Management-Suez Canal Area

Malpractice in Cow's Milk Protein Allergy Management-Suez Canal Area

Cow's Milk Protein Allergy.

Cow's milk allergy refers to an immunological reaction to milk protein. It is one of the commonest food protein allergies with an estimated prevalence of 0.5% to 3% at 1 y of life. The disease may be IgE or non-IgE mediated or mixed with a wide range of symptoms often involving multiple organ systems. Gastrointestinal manifestations are common in non-IgE disease and may consist of enteropathy, proctocolitis, colic, reflux-like symptoms, constipation, enterocolitis syndrome and eosinophilic esophagitis. The gold standard for diagnosis remains a double-blind placebo-controlled oral challenge. Specific IgE and skin prick tests may predict severe and persistent disease, and aid in deciding on reintroduction or oral immunotherapy; however, they do not contribute to a definitive diagnosis as they indicate only sensitization. In practice, an elimination diet followed by open challenge under medical supervision is often used for diagnosis except when symptoms are severe such as anaphylaxis. Management consists of the elimination of the allergen with resolution of symptoms between 1-4 wk later depending on the type of allergy. Extensively hydrolyzed and Amino acid formulas are used to substitute milk in infants. Soy-based formulas are often utilized in resource-limited settings. Tolerance to the protein develops over time and periodic reintroduction should be attempted every six months after the initial one year of elimination diet. Oral immunotherapy is a newer treatment technique for IgE-mediated disease. There is no firm evidence on prevention apart from recommending breast feeding in early life along with initiating complementary feeding between 4-6 mo age.

Eosinophilic gastroenteritis and colitis related to cow’s milk allergy: A case report

Objective: To provide evidence on clinical, laboratory, histopathological features, diagnostic and treatment of primary eosinophilic gastroenteritis in children. Case presentation: A 7-year-old boy admitted to the 108 Military Central Hospital with symptoms of abdominal pain, nausea and vomiting, recurrent diarrhea related to cow's milk intakes. The child was diagnosed with eosinophilic gastroenteritis, combined with increased serum IgE. The disease was stabilized with corticosteroids, oral proton pump inhibitors (PPIs) combined with the elimination of cow's milk from the daily diet. Conclusion: Primary eosinophilic gastroenteritis in children was definitively diagnosed based on exclusion of other causes of eosinophilia and 3 features: Gastrointestinal symptoms, endoscopy showed gastrointestinal eosinophilic infiltration, peripheral eosinophilia. Corticosteroids are the most effective and useful symptom control drugs in most cases in combination with a diet, eliminating the allergic component.

Efficacy of an extensively hydrolyzed formula with the addition of synbiotics in infants with cow's milk protein allergy: a real-world evidence study.

Cow's milk protein allergy (CMPA) is the most frequent food allergy in early childhood. For those infants requiring breastmilk substitutes, formulas with extensively hydrolyzed proteins (EHF), should be the treatment of choice. As there are limited data showing the progression of initial symptoms in infants newly diagnosed with CMPA who are treated with EHF with added synbiotics, the main objective of this study was to evaluate the resolution of symptoms in said infants after 4 weeks of treatment. As a secondary objective this study aimed to assess the impact of the treatment on the family's quality of life. observational, longitudinal, prospective, and multicentric real-world evidence study. The intervention phase (EHF with synbiotics) lasted 28 days and was completed by 65 patients. Treating physicians registered child´s anthropometry, Infant Gastrointestinal Symptoms Questionnaire (IGSQ-13) and CoMiSS (Cow´s Milk Allergy Symptoms Score) both at baseline and after 28 days of treatment. During treatment, caregivers reported child´s regurgitation and stools, PO-SCORAD (Patient Oriented Scoring of Atopic Dermatitis) and FAQL-PB (Family Quality of Life-Parental Burden). Data were collected using Google Forms and analyzed through the STATA program. 95.4% of the patients showed an improvement or disappearance of the overall initial symptoms after 4 weeks of treatment. Gastrointestinal symptoms improved or disappeared in 92% of patients (p < 0.05) while dermatological symptoms improved or disappeared in 87.5% of patients (p < 0.05). The median CoMiSS at baseline was 9, with 21 patients exceeding the cut-off point of 12. After 4 weeks of treatment, the median dropped to 3, and no patient exceeded the 12-cut-off point (p = 0.000). At baseline, patients had a PO-SCORAD of 11.5 (interquartile range 1-23) that went to 1.0 (interquartile range 1-6) at day 28 (p = 0.000). The treatment diminished stool frequency (p < 0.05), improved stool consistency (p = 0.004) and decreased the frequency of regurgitation in infants with CMPA (p = 0.01). The percentage of patients who no longer had any episode of regurgitation increased from 11% to 31% on day 28 (p = 0.003). At baseline, 13% of patients cried more than 3 h per day, while at day 28 that percentage dropped to 3% (p = 0.03). An improvement in the infants' sleep pattern was also appreciated with the treatment. At study onset, 56% of the families reported feeling very overwhelmed, a percentage that dropped to 17% after 28 days of treatment (p < 0.05). The small percentage of families who did not feel overwhelmed at study onset (17%), grew to 43% on day 28 (p < 0.05). The use of an EHF with synbiotics for the management of infants diagnosed with or suspected to have CMPA suggested a good safety profile, an adequate infant growth, and improvement of overall, gastrointestinal, and dermatological symptoms. It also suggested a lower daily frequency of regurgitations and stools, and an improvement in stool consistency, sleeping pattern, and quality of life of the infant and his family.

Allergenicity evaluation of fermented milk prepared by co-fermentation of Lactobacillus plantarum 7-2 and commercial starters after in vitro digestive

Milk allergy is one of the most common food allergies, in which αS-casein is the major milk allergen. Under optimized conditions, mixed starter (containing Lactobacillus plantarum 7-2 and commercial starter) effectively degraded αS-casein of skimmed milk and reduced the pressure of stomach digestion. The fermented milk prepared by mixed starter was determined by ELISA, the antigenicity of αS-casein was reduced by 77.53%. Compared with the fermented milk prepared by commercial starter, label-free quantitative proteomics demonstrated that the mixed starter more efficiently degraded the epitopes of major milk allergens and influenced the digestion pattern of the fermented milk. Therefore, L. plantarum 7-2 shows positive potential in reducing the antigenicity of αS-casein and others. In addition, this study predicted that the new epitopes produced in the fermentation process could induce immunity using molecular simulation.

Natural history and risk factors of IgE-mediated cow's milk protein allergy in infants

Objective: To investigate the natural history and risk factors for continued allergy in infants with IgE-mediated cow's milk protein allergy (CMPA). Methods: This was a prospective cohort study that included 72 infants under 24 months of age diagnosed with IgE-mediated CMPA in the allergy clinic of the Children's Hospital, Capital Institute of Pediatrics from October 2019 to November 2020. General information, clinical manifestations, serum total IgE, cow's milk specific IgE, and cow's milk protein component specific IgE were collected. Follow-ups were conducted at 24 and 36 months of age, and the patients were divided into the persistent allergy group and the tolerance group based on whether they developed cow's milk tolerance at 36 months of age. Mann-Whitney U test, chi-square test, and binary Logistic regression were used for intergroup comparison and multivariate analysis. Results: Among the 72 CMPA children, there were 42 boys and 30 girls, with an age of 10 (7, 15) months at enrollment. Cow's milk protein tolerance was observed in 32 cases (44%) and 46 cases (64%) at 24 and 36 months of age, respectively. There were 26 cases in the persistent allergy group and 46 cases in the tolerance group. The proportion of respiratory symptoms, history of wheezing, positive specific IgE for α-lactalbumin and the total IgE level in the persistent allergy group were higher than that in the tolerance group (7 cases (27%) vs. 0, 6 cases (23%) vs. 2 cases (4%), 67% (14/21) vs. 26% (10/39), 225 (151, 616) vs. 48 (21, 185) kU/L, χ2=10.82, 4.16, 9.57, Z=4.07, all P<0.05). Multivariate Logistic regression analysis showed that anaphylaxis (OR=21.14, 95%CI 2.55-175.14, P=0.005), a history of allergic rhinitis (OR=5.94, 95%CI 1.54-22.86, P=0.005), elevated milk specific IgE (OR=1.04, 95%CI 1.01-1.08, P=0.024), and positive casein specific IgE (OR=6.64, 95%CI 1.39-31.69, P=0.018) were risk factors for continuous CMPA. Conclusions: Most infants with IgE-mediated CMPA can achieve tolerance within 3 years. Anaphylaxis, a history of allergic rhinitis, elevated milk specific IgE levels, and casein sensitization are risk factors for continuous allergy.

What is Known About Cow's Milk Protein Allergy in Preterm Infants?

Background: Cow's milk protein allergy (CMPA) is well described in term infants, as opposed to preterm infants. In preterm infants, CMPA shares many gastrointestinal symptoms with necrotizing enterocolitis (NEC). Objectives: To evaluate the presentation of CMPA in preterm infants and to investigate the different diagnostic and therapeutic options. Materials and Methods: We searched for the relevant literature using the medical databases PubMed, Web of Science, and the Cochrane Library. We performed a post hoc analysis on the 25 case reports included in this study. Results: Literature was scarce and heterogeneous. The majority of preterm infants with CMPA were exposed to bovine-based milk proteins before the development of symptoms. The most common clinical manifestations were bloody stools, vomiting, and abdominal distension. Of the 25 cases, only 7 (28%) retained human milk in their diet after diagnosis. In the larger studies, no study has human milk as primary feeding choice after diagnosis. Conclusions: Preterm infants exposed to a type of cow's milk-based formula in their first days of life have a higher risk of developing CMPA. Most of the preterm infants are no longer fed with human milk after the diagnosis of CMPA is made, which is in contrast with current nutrition guidelines in preterm infants. We strongly advocate that human milk with mothers on a cow's milk-free diet is the first choice of feed after the diagnosis of CMPA. Prospective studies are necessary to obtain more information regarding clinical presentation, diagnostic tools, and therapeutic approaches.

Exercise-Induced Allergic Reactions in Children Desensitized to Hen's Eggs and Cow's Milk by Oral Immunotherapy.

Exercise-induced allergic reactions on desensitization (EIARDs) after successful in-hospital rush oral immunotherapy (OIT) for wheat allergy have been reported. However, the incidence rates of EIARDs after rush OIT for egg allergy and milk allergy have not been determined. To determine the frequency of EIARDs and risk factors associated with rush OIT for egg and milk allergy. This retrospective chart review, conducted in January 2020, enrolled 64 and 43 patients who underwent rush OIT for egg and milk allergy, respectively (in 2010 to 2014). In particular, 48 and 32 desensitized patients underwent exercise-provocation tests (Ex-P) after allergen administration (4,400 mg boiled egg white and 6,600 mg cow's milk protein, respectively). The EIARDs were determined by Ex-P or a suspicious event even after passing the Ex-P. Specific IgE levels to egg white, cow's milk, ovomucoid, casein, α-lactalbumin, and β-lactoglobulin were analyzed using ImmunoCAP. At least one episode of EIARD was observed in 10 and 17 patients with egg and milk allergy (21% and 53%), respectively, which persisted for more than 5 years in one patient with egg allergy (2.1%) and 11 patients with milk allergy (34.4%) as of January 2020. We could not find background differences between the EIARD-positive and EIARD-negative groups, except that the egg white-specific IgE/total IgE ratio before rush OIT was significantly higher in patients with egg allergy with EIARD than in those without it. Exercise-induced allergic reactions on desensitization were more frequent and common in patients with milk allergy. Moreover, EIARDs to milk allergy were more likely to persist than those to egg allergy.

Analysis of brazilian pediatricians’ knowledge of cow's milk protein allergy

To analyze the knowledge of Brazilian pediatricians about cow's milk protein allergy (CMPA) using a validated questionnaire. Quantitative study with a cross-sectional design in which an online questionnaire on CMPA knowledge was applied. The sample calculation indicated 1024 participants. The online form was divided into two blocks, the first comprising questions on the identification of pediatricians, and the second comprising the validated questionnaire, built from the Brazilian Consensus on Food Allergy (2018). The general evaluation of the questionnaire showed a percentage of agreement of 91% and a Content Validity Index of 0.95. The results of the applied questionnaires were presented in absolute and relative frequencies, mean, median, standard deviation, and percentiles. The level of significance was set at 5% (p

The Importance Factors in Selecting Extensively Hydrolyzed Formulas for Cow’s Milk Allergy Management

Current guidelines recommend extensively hydrolyzed formulas (eHF) as the first choice for infants with mild to moderate cow’s milk allergy (CMA) symptoms. Different eHF producers may apply different technical processes that can influence the end characteristics of the products, the efficacy and effectiveness in CMA management. Thi s review aims to summarizes references and reports to indicate the importance factors that should be considered in selecting eHF available in the market for CMA treatment. The most important factor is the clinical evidence on tolerance level of the eHF formula above 90% among allergic children or the efficacy and effectiveness in CMA management. Other factors are the composition of protein molecular size in the end product and the long history of usage of the product in the population with positive feedback from more than 90% healthcare professionals that could indicate as the real-world evidence.

Soy Formula as An Alternative for Infants with Cow’s Milk Allergy: Perspective from Pediatricians and Midwives in Indonesia

The prevalence of food allergy in children is increasing globally, with cow's milk allergy beingthe most common in infants and increasing from 2% to 3% in developed countries. However, data oncow's milk allergy in infants is limited in Indonesia. This study used a mixed methods approach using anonline survey and in-depth interviews. The survey was conducted from September 2021 to March 2022.Qualitative analysis, all interviews were recorded and transcribed. Data were analyzed using simplethematic analysis. The results showed that a total of 93 pediatricians and 104 midwives participated inthe survey. However, among the 93 pediatricians, only 56 (60.2%) completed the survey. Meanwhile, 11midwives (10.6%) were excluded because they had no experience in handling CMA cases. The majorityof CMA cases occurred in children under two years old, and most were treated by pediatricians. In termsof diagnostic tests, 51.8% of pediatricians recommended all specific IgE tests, prick tests, and provocationtests to diagnose allergies. More than 80% (46/56) of pediatricians chose to avoid all types of cow's milkproducts in the mother and child's diet as the main treatment. Meanwhile, only 22.1% of midwives didthe same. Milk choice will differ depending on the severity of CMA. Soy milk formula is preferred bymidwives for patients with low-level and moderate to severe allergies. Meanwhile, pediatriciansrecommend extensive hydrolysate formula for low severity patients and amino acid-based formula formoderate to severe.

Effectiveness and safety of low-dose oral immunotherapy protocols in paediatric milk and egg allergy.

Effectiveness and safety of low-dose oral immunotherapy protocols in paediatric milk and egg allergy.

Assessing the probiotic potential, antioxidant, and antibacterial activities of oat and soy milk fermented with Lactiplantibacillus plantarum strains isolated from Tibetan Kefir.

Sufficient intake of probiotics has been shown to help in the digestion, protect the body against pathogenic microorganisms and boost the immune system. Recently, due to high prevalence of milk allergies and lactose intolerance in population, the non-dairy based probiotic alternative are becoming increasing popular. In this context, the oat milk and soya milk-based fermented products can be an ideal alternative for the development of Lactic acid bacteria bacteria based probiotics. These bacteria can not only improve the product's flavor and bioavailability but also increases its antibacterial and antioxidant capabilities due to fermentation process. The purpose of the resent work was to assess the antioxidant and probiotic properties of oat and soy milk that had been fermented with three different strains of Lactiplantibacillus plantarum (L. plantarum) including L. plantarum 12-3, L. plantarum K25, and L. plantarum YW11 isolated from Tibetan Kefir. Different validated assays were used to evaluate the probiotic properties, adhesion and survival in the digestive system (stomach, acid and bile salts resistance), antioxidant and antimicrobial activities and safety (ABTS and DPPH scavenging assays) of these strains. Results of the study showed that soya milk and oat milk fermented with L. plantarum strains possess promising probiotic, antibacterial and antioxidant properties. These results can be helpful to produce dairy-free probiotic replacements, which are beneficial for those who are unable to consume dairy products due to dietary or allergic restrictions.