Milk Allergy In Infants Research Articles

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.

Skin care interventions in infants for preventing eczema and food allergy.

Skin care interventions in infants for preventing eczema and food allergy.

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.

Nutritional Management of Cow's Milk Allergy in Infants: A Comparison of DRACMA, ESPGHAN, and AAP Guidelines

Cow’s Milk Allergy (CMA) is one of the most common food allergies presented during infancy and childhood. The diagnosis and management of CMA is a complex task. First and foremost, CMA is manifested by a variety of symptoms classified by their type of mediation (either IgE and/or non-IgE responses), organ systems involved, and the onset of the reaction. Second, although several guidelines for the management of CMA have been published worldwide, they differ in their recommendations. To our knowledge, no global consensus exists for the management of the different symptoms associated with CMA. This review provides a table to compare three widely accepted published guidelines to enable the reader to easily navigate and compare the nutritional recommendations to be followed depending on the symptomatology. This review is intended to represent a practical tool to assess the nutritional recommendations for the management of CMA.

Skin care interventions in infants for preventing eczema and food allergy.

Skin care interventions in infants for preventing eczema and food allergy.

Cow's milk allergy in infancy and later development of type 1 diabetes-nationwide case-cohort study.

It is suggested that early intake of cow's milk could be a risk factor for type 1 diabetes (T1DM). Further, the different immunological background, gives a suggestion of an inverse relationship for the occurrence of these diseases. The aim of this study was to explore the association between cow's milk allergy (CMA) and the risk of T1DM in a register-based case-cohort study. Data were obtained from Finnish nationwide health registers. The study included all children born in Finland between January 01, 1986 and December 31, 2008 and diagnosed with T1DM before the age of 16 years (n = 7754). A 10% random sample from each birth year cohort was selected as a reference cohort (n = 137,798). T1DM, CMA, and asthma were defined based on valid special reimbursements for the costs of drugs/special formulas needed in the treatment of the diseases. Child's sex, birth decade, asthma, maternal diabetes and asthma, smoking during pregnancy, and previous deliveries were considered as confounding factors. Time-dependent, weighted Cox regression was applied for statistical analyses. Children with CMA had an increased risk of developing T1DM in fully adjusted model (HR = 1.17; 95% CI 1.02-1.34), but the association was no longer observed when including the use of special infant formulas in the definition of CMA in the sensitivity analysis (HR = 1.11; 95% CI 0.92-1.32). CMA was associated with an increased risk of T1DM in children without asthma (HR = 1.27; 95%CI 1.10-1.47), but not in children with asthma (HR = 0.80; 95% CI 0.92-1.27). Children with CMA may have an increased risk of T1DM.

Cow's Milk Protein Allergy in Term and Preterm Infants: Clinical Manifestations, Immunologic Pathophysiology, and Management Strategies.

Cow's milk allergy is a common food allergy among infants. Symptoms of cow's milk allergy are wide-ranging and depend on the mechanism involved. There are immunoglobulin E (IgE)-mediated, non-IgE-mediated, and mixed mechanisms of food allergy. Symptoms of IgE-mediated cow's milk allergy may be mild or may progress to anaphylaxis, which can be life-threatening. Non-IgE-mediated allergy includes food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome, food protein-induced enteropathy, and Heiner syndrome (pulmonary hemosiderosis). These diagnoses comprise about half of all cow's milk allergies. The most common manifestation of cow's milk allergy in infants is FPIAP. FPIAP is commonly seen in healthy, full-term infants who present with rectal bleeding and are otherwise well-appearing. This can occur in both formula-fed and exclusively breastfed infants. Food proteins secreted in maternal breast milk can contribute to the development of these symptoms. Maternal cow's milk elimination diet is often successful in helping resolve symptoms. A period of reintroduction of cow's milk resulting in re-emergence of symptoms in stable asymptomatic infants is an excellent diagnostic tool to confirm a cow's milk allergy. Preterm infants are susceptible to food allergy, as demonstrated from several case reports of necrotizing enterocolitis-like illnesses that responded clinically to cow's milk elimination. Further study is needed about food allergy in the preterm infant population.

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 …

Bifidobacterium bifidum TMC3115 ameliorates milk protein allergy in by affecting gut microbiota: A randomized double-blind control trial.

We aimed to explore the effects of Bifidobacterium bifidum TMC3115 intervention on cow's milk protein allergy (CMPA) and gut microbiota in infants. A total 256 CMPA infants were randomly and evenly assigned into an intervention group (B. bifidum) and a control group (placebo). Allergic scores, anti-inflammatory responses, and secondary outcomes were measured. Fecal specimens were collected, and the gut microbiota were analyzed by using 16S rDNA sequencing. After 6-month B. bifidum intervention, B. bifidum TMC3115 consumption reduced allergic scores, and improved anti-inflammatory responses and secondary outcomes in CMPA infants. LEfSe analysis showed Bifidobacterium, Lactobacillus, Turicibacter, Sutterella, and Parabacteroides were the most predominant phylum in the intervention group, whereas the Firmicutes (Anaerovibrio, Christensenellaceae, Oscillibacter, Bilophila, Dorea, and Roseburia) were most dominant phyla in the control group. Serum IgE or IgG2 had a strong relationship with α-diversity scores of gut microbiota. PRACTICAL APPLICATIONS: There is a high level of prevalence of milk allergy in infants, which is difficult to be treated. Bifidobacterium bifidum TMC3115 supplement reduced allergic scores, improved anti-inflammatory responses, and reduced serum level of IgE and increased the level of IgG2 in the infants. On the contrary, B. bifidum supplement increased the genus proportion of probiotics and reduced the proportion of pathogens. The improvement of gut microbiota will be beneficial in the prevention of milk allergy. B. bifidum TMC3115 reduces milk allergy in the infants by regulating gut microbiota, and should be developed a potential way in the prevention of infant milk allergy.

The impact of cow’s milk allergy in infants with failure to thrive: Experience from an Italian Referral Center

The impact of cow’s milk allergy in infants with failure to thrive: Experience from an Italian Referral Center

Skincare interventions in infants for preventing eczema and food allergy

Skincare interventions in infants for preventing eczema and food allergy

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.

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

To investigate the effect of vitamin D supplementation dose on allergic sensitization and allergic diseases in infants, and to evaluate whether vitamin D status in pregnancy and at birth are associated with infant allergy outcomes. Altogether, 975 infants participated in a randomized, controlled trial of daily vitamin D supplementation of 10μg (400 IU) or 30μg (1200 IU) from the age of 2weeks. At 12months of age, food and aeroallergen IgE antibodies were measured, and the occurrence of allergic diseases and wheezing were evaluated. We found no differences between the vitamin D supplementation groups in food (OR, 0.98; 95% CI, 0.66-1.46) or aeroallergen sensitization at 12months (OR, 0.76; 95% CI,0.34-1.71). Allergic diseases or wheezing did not differ between groups, except for milk allergy which occurred more often in infants administered 30μg vitamin D compared with the 10μg dose (OR, 2.23; 95% CI, 1.00-4.96). Infants with high cord blood 25-hydroxyvitamin D (≥100nmol/L) had a higher risk of food allergen sensitization compared with those with lower 25(OH)D concentration (75-99.9nmol/L; OR, 2.00; 95% CI, 1.19-3.39). High-dose vitamin D supplementation did not prevent allergic sensitization, allergic diseases, or wheezing during the first year of life. In contrast, we observed an increased risk of milk allergy in infants randomized to higher vitamin D supplementation, and an increased risk of allergic sensitization in infants with high cord blood vitamin D status, indicating a possible adverse effect of high concentrations of vitamin D.

Component resolved diagnostic study of cow's milk allergy in infants and young children in northern China

BackgroundIncreasing dairy consumption in China has been accompanied by rising incidence of milk allergy. Here we analyzed profiles of specific immunoglobulin E (sIgE) against cow's milk proteins, and assessed their value for milk allergy diagnosis among infants and young children from northern China. MethodsSera collected from 48 patients with milk allergy and 27 negative control subjects was analyzed by enzyme-linked immunosorbent assay to measure sIgE to α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), α-casein (Bos d 9), β-casein (Bos d 11), and κ-casein (Bos d 12). ResultsAmong milk-allergic individuals, most were sensitized to at least one milk protein; about half were sensitized to Bos d 5, Bos d 9, Bos d 11 and Bos d 12, respectively, while few had positive serum sIgE against Bos d 4. Bos d 12 sIgE had the largest area under curve (AUC) (0.878; 95% CI, 0.800–0.957) and thus showed the best diagnostic performance in discriminating between milk-allergic and non-milk allergic patients, with a sensitivity of 92.6% and specificity of 72.9% using a statistically optimal cut-off value (OD450nm, 0.191). The combinations of Bos d 5 + Bos d 12 showed an AUC of 0.926, which was larger than for any individual components. ConclusionsOur results revealed inter-individual variation in the sensitization to different milk allergen component. Bos d 12 sIgE showed best performance in diagnosing milk allergy. Milk allergy diagnostic accuracy was further improved using combinations of milk allergen components by application of ROC curves based on logistic regression.

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

IgE-Mediated Cow’s Milk Allergy in Iranian Infants and Children: Predictive Factors of Early Tolerance

Background: The majority of infants and children with cow’s milk allergy will grow out of their allergy after a few years. The aim of this study was to identify the natural course of cow’s milk allergy in infants and children during a follow-up of 18 months and also the predictive factors for its outgrowing. Methods: This prospective cross-sectional study included infants and children with IgE-mediated cow’s milk allergy. Demographic data, clinical manifestations and probable predictive factors were recorded. Skin prick tests were done with commercial extracts of cow’s milk, egg, fish, nuts and wheat on arrival. These infants and children were followed for 18 months and resolution was established by successful ingestion of cow’s milk. The collected data were analyzed using SPSS version 22.0. Descriptive statistics, student’s t-test or Mann-Whitney U-test and Chi-square test were used; a P < 0.05 was considered statistically significant. Results: Forty-nine infants and children (33 boys and 16 girls) with IgE-mediated cow’s milk allergy presentation ranged in age from 3.5 to 48 months with a mean of 17.5 ± 11.7 months enrolled in this study. Skin was the most common site of involvement, followed by gastrointestinal system and respiratory tract. Twenty-three (46) infants and children developed tolerance to cow’s milk during a follow-up of 18 months. There was a significant relationship between parental allergy and atopic dermatitis with the chance of tolerance of cow’s milk. Conclusions: Our findings showed that about one half of the infants and children with IgE-mediated cow’s milk allergy grew out of it over 18 months of follow-up (mean age 2 years). The follow-up of patients with cow’s milk allergy is important in appropriate timing of re-introduction of cow’s milk to the diet; atopic dermatitis and parental allergy can predict this outcome. © 2018, Iranian Journal of Pediatrics.

The limited utility of the double-blind food challenge in diagnosing non-IgE mediated cow’s milk allergy in infants

The limited utility of the double-blind food challenge in diagnosing non-IgE mediated cow’s milk allergy in infants

Evidence for Involvement of IL-9 and IL-22 in Cows’ Milk Allergy in Infants

Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows’ milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows’ milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows’ milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows’ milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future interventions.

Cow's Milk Allergy in Infancy and Later Development of Juvenile Idiopathic Arthritis: A Register-Based Case-Control Study.

We examined the association between cow's milk allergy (CMA) and juvenile idiopathic arthritis (JIA). The material for this case-control study was collected from national registers of all children born in Finland between 2000 and 2010 and diagnosed with JIA (n=1,298) and age-, sex-, and place-matched controls (n=5,179). We identified 235 children with CMA; 66 of these children also had JIA. A conditional logistic regression analysis was performed to evaluate the association between CMA and JIA and to test whether exposure to antibiotics would be a covariate for this association. In boys (but not in girls), a diagnosis of CMA and the use of hypoallergenic formula in infancy were associated with the later development of JIA (odds ratio=2.4, 95% confidence interval: 1.6, 3.6). The association was most evident in boys who were diagnosed with JIA before age 3 years or diagnosed with CMA with predominantly gastrointestinal symptoms. There was no statistically significant additive interaction between CMA and antibiotic exposure in the later development of JIA. These associations may reflect impaired maturation of intestinal immunity and integrity in boys with a risk of JIA. Predisposing factors related to JIA pathogenesis seem to display a sex-linked disparity.

Human milk oligosaccharides and development of cow's milk allergy in infants

Human milk oligosaccharides and development of cow's milk allergy in infants