Milk Allergic Children Research Articles

Double-Blind, Placebo-Controlled Food Challenges (DBPCFC) Demonstrating Acute IgE-Mediated Allergic Reactions to Good Start, Ultrafiltered Good Start, Alfaré, Nutramigen, and Alimentum in a Seven-Year-Old

A 7-year-old girl with IgE-mediated cows' milk allergy (immediate reactor) underwent double-blind, placebo-controlled food challenge (DBPCFC) with three whey hydrolysate formulas (Good Start, Ultrafiltered Good Start, Alfaré) and two casein hydrolysates (Nutramigen, Alimentum), using a soy protein formula (Isomil) as a control. She developed acute reactions to Good Start (3 ml; gastrointestinal, respiratory), Ultra Good Start (8 ml; respiratory, cutaneous), Alfaré (158 ml; respiratory), Nutramigen (3 ml; respiratory, cutaneous), and Alimentum (4 ml; respiratory, cutaneous, gastrointestinal) and tolerated the Isomil control (318 ml) on three separate challenges under similar conditions. The generalized urticarial reactions to Nutramigen and Alimentum began 90 minutes after receiving less than 1 teaspoonful (3 ml and 4 ml, respectively) of formula. These observations indicate that all current commercially available cows' milk protein hydrolysate formulas can cause serious allergic reactions in the highly sensitized cows' milk-allergic child. To our knowledge, this is the first report of an acute allergic reaction to Alimentum, which is currently marketed as hypoallergenic. Although many less sensitive cows' milk-allergic children can tolerate these formulas, the authors believe that the term "hypoallergenic" can create a false sense of security.

Allergen-specific IgE antibodies against antigenic components in cow milk and milk substitutes.

Crossed radioimmunoelectrophoresis (CRIE) was used to study the presence of serum IgE against antigenic components of cow milk in 21 selected milk-allergic patients. The amount of each IgE specificity was estimated by a scoring system. The milk-allergic children had mainly IgE against alpha-lactalbumin, beta-lactoglobulin, albumin and immunoglobulin, the four major proteins of bovine whey, as well as IgE against three casein components. A serum pool from 1000 normal adults had IgE against the same whey protein, but in smaller amounts, and no IgE against the casein components. Eight cow milk-based formulae, commonly used for infant feeding, and goat milk were studied by the same method. It was found that six of the milk substitutes did not differ significantly from cow milk in antibody binding, but the two hydrolysed casein products, Nutramigen and Pregestimil, consisted of such small molecules that the rabbit antisera could not precipitate the hydrolysed proteins in the gels on the CRIE plates. It was therefore not possible to study their IgE binding, if any, by this method.

Persistent nausea and food aversions in pregnancy. A possible association with cow's milk allergy in infants.

In a retrospective study the mothers of twenty-one children with well-defined cow's milk allergy and an equal number of matched controls were asked about their health and diet in pregnancy and the pattern of feeding of their children in infancy. Corroborative evidence was obtained from the medical notes. Nausea in pregnancy was found to be more persistent and atopic disease more common among the mothers of the milk allergic children; in this group food aversions during pregnancy were also more common particularly to dairy produce. The milk-allergic infants had been breast-fed for longer and had cow's milk introduced into feeds later than the control group. It is suggested that nausea in pregnancy may be a physiological response to foetal sensitization by dietary antigens such as cow's milk protein, due to impaired placental permeability in atopic pregnant women. A larger prospective study is indicated to substantiate this hypothesis.

Disaccharidase activities in milk-sensitive and celiac patients

Jejunal disaccharidase activities have been studied in normal children, children with diarrhea precipitated by cow's milk, and in two groups of celiac patients, treated and untreated. The disaccharidase activity in milk allergic children was found to fall within the normal range. Therefore, lactose intolerance does not appear to be the primary cause of the diarrhea in these patients. The disaccharidase activities in patients with celiac disease, by contrast, were markedly reduced. However, no evidence of disaccharide intolerance was detected in this small group of patients.

MILK ALLERGY

Skin testing separately and with equal concentrations of the purified milk proteins, casein, alpha-lactalbumin, beta-lactoglobulin, and BSA was done in 85 milk allergic children. For control purposes, intradermal tests with the same antigens were done in 102 normal children and 31 children allergic to non-milk substances. Six per cent of the normal children had weakly positive reactions. However, positive skin tests occurred in 68% of the children allergic, but not to milk, and in 59% of the children allergic to milk. In the milk allergic children, the incidence of positive reactions to each milk protein was similar. The incidence of positive skin tests in milk allergic children was higher than previously apprised. Positive skin tests in the milk allergic child were obtained long after the dietary elimination of milk antigens and after the disappearance of circulating milk antibodies as detected by a variety of techniques. In contrast to the control groups, strongly positive skin tests occurred only in milk allergic patients. Although no correlation was found between the results of all skin tests and the results of oral challenges with the same milk protein, a close correlation was found between the results of strongly positive skin tests and the results of oral challenge with the same milk protein. It appears that weakly positive skin tests with purified milk proteins have a little diagnostic value, but strongly positive skin tests have diagnostic significance.

MILK ALLERGY

The examination of sera from milk allergic children, children allergic to substances other than milk, and normal children, revealed no significant differences relative to coated tanned cell hemagglutinin titer or the presence of precipitating antibody as measured by gel diffusion for milk components. The passive cutaneous anaphylaxis test revealed a high percentage of positive responses with sera from milk allergic individuals only. The presence of milk hemagglutinins could not be demonstrated in the cord sera from 30 newborns. The results of this study suggest that the passive cutaneous anaphylaxis technique deserves further evaluation as a laboratory method for the confirmation of milk allergy.