Persistent Cow's Milk Research Articles

Primary prevention of food allergy in children

Pediatricians and allergists have noted a recent increase in cases of food allergy and anaphylaxis to peanuts and nuts, affecting very young children with worrying consequences in terms of quality of life. Children suffering from persistent cow's milk protein allergies that do not heal spontaneously are at very high risk of a fatal accident. Based on the findings of these studies, recommendations for primary prevention are made.

Comprehensive Care and Education Can Improve Nutritional and Growth Outcomes in Children with Persistent Cow's Milk, Egg, or Peanut Allergies: A Five-Year Follow-Up Study of Nutritional Status.

Data suggest that food allergies greatly impact a child's health and growth due to inadequate nutrient intake. Our study aimed to establish the long-term outcome of children with food allergies compared to a control group. This study was a retrospective cohort study with longitudinal follow-up with a mean period of 4.85 years from the diagnosis to the last study visit. The patients' nutritional intake was assessed using a three-day food diary and analysed by a dietitian. Patients (61 boys and 33 girls, mean age 6.9 years) had a single food allergy including 21 patients with cow's milk, 34 with egg, and 39 with peanut allergies. The control group included 36 children (19 boys and 17 girls, mean age 8.03 years). Blood analysis was performed on all participants. Data from our study showed that patients with cow's milk, egg or peanut allergies had normal growth and achieved catch-up growth from the diagnosis until the last study visit. In the cow's milk allergy group, the allergy was shown to affect calcium intake (p < 0.05), while egg and peanut allergies did not impact the dietary intake of nutrients. None of the investigated food allergies affected blood results (p < 0.05). In the present study, we showed that single food allergies do not compromise growth in children if they are provided with appropriate support and that the affected children reach catch-up growth from the diagnosis.

L’immunothérapie orale au lait de vache : expérience d’un service de pédiatrie à Alger

Oral immunotherapy (OIT) has been recognized as a promising treatment for persistent cow's milk allergy (CMA). The objective of this study is to analyze the clinical, biological and evolutionary characteristics of patients on OIT. MethodsProspective study carried out in the pediatric ward A at the Béni Messous University Hospital in Algiers, which concerned all the children followed for CMA and in whom an OIT was practiced. ResultsOne hundred and twenty-eight patients were followed for mediated CMA IgE of which 38 needed an OIT (22.8 %), 24 boys and 14 girls, median age 4.8 years (1.5–10.5), the initial dose was between 0.6 and 100ml, baked milk was used in all patients, 52.6 % of which was baked in a wheat matrix. The mean duration of ITO was 17.5 months with an average healing age of 6.5 years. A high level of IgE specific to cow's milk and particularly to casein was correlated with a more advanced healing age. 55.2 % had associated asthma. Single organ allergic reactions have been reported without adrenaline need except in one patient. ConclusionThe results are encouraging, 63 % consumption more than 200ml/day, the others are on a personalized therapeutic escalation. The kinetics of specific IgE and ST were used to guide the OIT. Although incidents were infrequent, vigilance was required during the ITO.

Outcome of oral immunotherapy for persistent cow's milk allergy from 11years of experience in Finland.

The safety and efficacy of long-term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open-label, non-randomized study. During the 11-year study, 296 children aged 5years or older with immunoglobulin E (IgE)-mediated CMA started milk OIT. Follow-up data were collected at three time points: the post-buildup phase, 1year thereafter, and at the cross-sectional long-term follow-up between January 2016 and December 2017. Patients were divided according to baseline milk-specific IgE (sIgE) level and by the amount of milk consumption at the long-term follow-up. The high-dose group consumed ≥2dL of milk daily, while the failure group consumed <2dL of milk or were on a milk-avoidance diet. Out of the initial study group, 244/296 (83%) patients participated in the long-term follow-up. Among these patients, 136/244 (56%) consumed ≥2dL of milk daily. The median follow-up time was 6.5years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P<0.001). Respiratory symptoms in the post-buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5-8.1, P=0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8-114, P=0.01). More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long-term outcome and safety of milk OIT.

Anaphylaxis to cutaneous exposure to bovine colostrum based cream

Children who are highly sensitive to milk may also have severe allergic reactions after exposure to cow's milk proteins(CMP) through a different administration route than the oral one. We describe the case of a 16-year-old Caucasian boy with a clinical history of persistent cow's milk allergy (CMA), who developed one episode of anaphylaxis following cutaneous application of a bovine colostrum containing cream to a surgical wound. UniCAP testing showed a significant elevation in specific IgE antibodies to whey milk proteins. Until now, only three cases of anaphylaxis following cutaneous application of products containing milk proteins were available in the scientific literature.

Eosinophilic Esophagitis: Latent Disease in Patients with Anaphylactic Reaction to Cow's Milk

Food allergy and eosinophilic esophagitis are a substantial and evolving public health issue. Clinicians should know the relationship between these diseases and how one may predispose to the other. This can help minimize misdiagnosis. The objective of this study was to assess esophageal eosinophilia and eosinophilic esophagitis frequency in patients with persistent cow's milk allergy and anaphylaxis manifestations. Patients with persistent cow's milk allergy with anaphylaxis manifestations were enrolled from 2012 through 2016 at the São Paulo University Hospital, Brazil. All of them were submitted to endoscopy despite the presence or absence of gastrointestinal symptoms. Demographics data, atopic comorbidities, medication use, endoscopic findings, and esophageal eosinophilia frequency were evaluated. Eighty-nine patients were selected. The median age was 8 years. It was observed that 34 of 89 patients (38.2%; 95% confidence interval [CI]: 28.14%-49.16%) presented with esophageal eosinophilia. Five patients (7.1%) presented proton pump inhibitor-responsive esophageal eosinophilia, and 10 patients (14.2%) presented eosinophilic esophagitis. We found that 29.4% were asymptomatic patients, 23.5% had nonspecific symptoms, 23.5% had persistent typical symptoms, and 23.5% had intermittent typical symptoms. There was an association with inflammatory endoscopy findings in 21 patients (61.7%). This description demands scientific attention because it is the highest frequency of esophageal eosinophilia yet described in a group of patients with cow's milk allergy presenting with anaphylaxis. Eosinophilic esophagitis is a condition that can coexist "silently" with an IgE-mediated food allergy and is most often underestimated and underdiagnosed.

Tolerance to baked milk in Brazilian children with persistent cow's milk allergy

Methods Patients with cow s milk allergy, over 4 years-old, were submitted to oral challenge with baked milk, from January to November, 2013, at Universidade de Sao Paulo, Brazil. The tested product was a muffin that contained 2,8 g milk protein and was baked at 350° F in an oven for 30 minutes. The challenge was made under physician supervision and at the first sign of allergy reaction it was discontinued, and the patient received the proper medical assistance.

Oral cow's milk immunotherapy: clinical and serological data in long‐term follow up

Oral food inmunotherapy is a promising therapeutic aproach in patients with persistent cow's milk allergy (CMA). Although it seems that these protocols show a better outcome in patients with “milder” symptoms (i.e. non anaphylactic reactions) there are controversial results in highly sensitized subjects. We select patients with persistent CMA and severe uncontrolled anaphylactic symptoms despite a correct restrictive diet. We performed a two-day desensitization procedure at the Pediatric Critical Care Unit in our Institution. The second phase was weekly scheduled in the Outpatient clinic to reach a final cumulative dose of 250 ml of undiluted milk. Clinical and serological date were collected every six month for a five-year period. Fifteen children (2-16 y.o.) were included. All children reached the final dose of 250 ml of undiluted milk in less than ten weeks. Clinical follow-up every 6 months remained during 5 years to register all adverse reactions and possible factors involved. Serological changes were obtained every six months during the subsequent five years, including specific IgE and IgG4. Anaphylactic CMA patients may benefit from rush oral Cow's Milk immunotherapy. Clinical and serological changes have been found both at early and long-term follow-up. Several factors were involved in reactions for temporary loss of tolerance.

Cow's Milk Allergen Specific CD4+ T Cell Responses In Patients With Persistent Cow's Milk Allergy

Cow's Milk Allergen Specific CD4+ T Cell Responses In Patients With Persistent Cow's Milk Allergy

Downregulation of angiogenesis factors, VEGF and PDGF, after rapid IgE desensitization and oral immunotherapy in children with food allergy.

Background. Angiogenesis has a key role in several conditions and is regulated by several factors such as the platelet-derived growth factor (PDGF) or the vascular endothelial growth factor (VEGF). The goal of this study was to investigate the possible role of PDGF and VEGF in a group of patients with severe food allergy. Methods. We design a prospective longitudinal study (n = 30) with patients with persistent cow's milk proteins (CMP) allergy. After achieving a CMP rush desensitization protocol, a clinical followup including SPT and blood samples to determine sIgE, protein levels, PDGF, and VEGF-A and a panel of the most representative Th1, Th2, Treg, and Th17 cytokines were also monitored. Results. Baseline levels of PDGF and VEGF in the CMP allergic patients (1170 pg/mL and 253 pg/mL) were different compared to those nonallergic CMP control subjects (501 pg/mL and 108 pg/mL). Both PDGF and VEGF were significantly downregulated (P < 0.05) 6 months after completion of the CMP desensitization process and remained significantly decreased 12 months later. Conclusion. The present study shows a significant increase of PDGF and VEGF in anaphylaxis suffering children compared to a control group. Interestingly, both VEGF and PDGF were significantly downregulated after completing a full CMP rush IgE desensitization.

THE VALUE OF CLINICAL AND LABORATORY PHENOTYPE IN PREDICTING THE COURSE OF COW’S MILK ALLERGY

The prognosis of allergy to cow's milk protein allows to determine the length of elimination diet, and the timing of repeated prick screening for its expansion. Aim : to identify clinical and laboratory phenotype of patients with persistent cow's milk allergy. Patients and methods : the study included 52 children with allergy to cow's milk protein aged from 3 months to 5 years. The criterion for the development of tolerance to cow's milk was negative result of open oral provocation test with cow's milk. Results : tolerance to cow's milk occurred in 15 of 52 (28,8%) patients. Tolerance was achieved in 12 months in 10 children (19%), in 24 months — in 3 children (5,8%), in 36 months — in 1 patient (1,9%) and in 60 months — in 1 child (1,9%). In patients with persistent cow’s milk allergy the concentration of specific IgE to cow's milk protein was increased (p = 0,006) compared to a group of children who develop tolerance. Also in this group clinical course of AD (p = 0,01), sensitization to allergens of grasses (p = 0,006), sensitization to inhalant allergens (p = 0,04) and the presence of asthma (p = 0,037) were significantly more severe. Conclusions: in assessing the likelihood of development of tolerance to cow's milk protein it is necessary to consider not only the degree of sensitization to cow's milk protein, but also the severity of atopic dermatitis, the presence of asthma, sensitization to other allergens such as alimentary and inhalant ones. In patients with persistent allergy to the cow's milk protein development of asthma can be expected with high probability, which causes necessity of the providing of asthma prophylaxis in this group of patients.

Interleukin 10 (IL10) and transforming growth factor β1 (TGFβ1) gene polymorphisms in persistent IgE-mediated cow's milk allergy

OBJECTIVES:The aim of this cross-sectional study was to evaluate whether interleukin 10 (IL10) and transforming growth factor β1 (TGFβ1) gene polymorphisms were associated with persistent IgE-mediated cow's milk allergy in 50 Brazilian children. The diagnostic criteria were anaphylaxis triggered by cow's milk or a positive double-blind, placebo-controlled food challenge. Tolerance was defined as the absence of a clinical response to a double-blind, placebo-controlled food challenge or cow's milk exposure.METHOD:The genomic DNA of the 50 patients and 224 healthy controls (HCs) was used to investigate five IL10 gene polymorphisms (-3575A/T, -2849A/G, -2763A/C, -1082G/A, -592C/A) and one TGFβ1 polymorphism (-509C/T).RESULTS:Among the five IL10 polymorphisms analyzed, homozygosis for the G allele at the -1082 position was significantly higher in the patients compared with the healthy controls (p = 0.027) and in the persistent cow's milk allergy group compared with the healthy controls (p = 0.001).CONCLUSIONS:Homozygosis for the G allele at the IL10 -1082G/A polymorphism is associated with the persistent form of cow's milk allergy.

The natural history of cow's milk allergy in north-eastern Poland

The rate of cow's milk allergy diminishes with age. There is not enough information concerning geographical trends in persistent cow's milk allergy in children. The objective of the study was to evaluate the prevalence of persistent cow's milk allergy in children previously diagnosed with IgE-mediated cow's milk allergy (CMA). Diagnosis of cow's milk allergy was established by a medical history of symptoms associated with exposure to cow's milk, positive skin prick tests with cow's milk, the presence of milk-specific IgE, and by a positive double- or single-blind placebo-controlled food challenge with milk confirmed by a positive open-controlled milk challenge. A second oral challenge was performed after at least one year of a milk-free diet and children with a positive oral milk rechallenge were diagnosed as having a persistent CMA. Two hundred ninety-one children, 2-14 years of age (mean 5.30±3.16 years, 95% CI, 5.02-5.62 years) completed the study. Persistent CMA was diagnosed in 79 patients (27.1%). Two hundred twelve children (72.9%) outgrew their allergy to cow's milk at a mean age of 5 years after an average time of 16.4±0.8 months on an elimination diet. Eighty percent of children below 3 years of age became milk tolerant. Milk-specific IgE (p=0.018) and history of paternal bronchial asthma and/or rhinitis (p=0.020) were associated with persistence of cow's milk allergy in regression analysis. An age above 3 years, as well as features of atopy, individual and familial, may be associated with a risk of delayed tolerance to milk in children.

Allergie sévère aux protéines de lait de vache : intérêt d’une immunothérapie sublinguale complétée par la voie orale. À propos d’un cas

An 18-month-old girl presented with a history of persistent cow's milk allergy following a severe anaphylactic reaction at two and a half months of age. She was found to be significantly sensitized to α-lactalbumin, β-lactoglobulin, casein and bovine serum albumin. Sublingual immunotherapy for 3 months followed by oral immunotherapy over a period of three years resulted in a reduction of specific IgE from greater than 100kU/L to 20kU/L, a significant increase in specific IgG4 and full tolerance to 90mL of milk as well as to various other dairy products. The authors emphasize the effectiveness of a short course of sublingual immunotherapy followed by a longer course of oral immunotherapy in such cases.

Sesame Seed Food Allergy

The number of reports regarding sesame seed food allergy (SFA) has increased significantly worldwide over the past two decades, either due to a genuine increase in SFA or merely an increase in its awareness. Its prevalence is difficult to estimate due to the lack of well designed prospective population-based studies. Based on the available data, we estimate that SFA affects 0.1-0.2 % of the population, in areas where the food is available. Albeit this prevalence appears to be relatively low, it is approximately one-half of that of persistent cow's milk allergy. While only one fatality has been reported, the significant number of SFA patients presenting as anaphylaxis indicates the potential risk. Many reports based the diagnosis of SFA on sensitization criteria alone, particularly amongst atopic dermatitis patients. Elimination of sesame from the diet of these children utilizing such criteria is not justified, and may even increase the risk for developing SFA.

Allergy to goat’s and sheep’s milk in a population of cow’s milk–allergic children treated with oral immunotherapy*

Cow's milk oral immunotherapy (CMOIT) is a recognized treatment for persistent cow's milk (CM) allergy. However, further data are necessary on tolerance to milk from other mammals. To describe the clinical and immunologic features of goat's and sheep's milk (GSM) allergy in patients who tolerated CM after CMOIT. Fifty-eight CM-allergic patients who successfully underwent CMOIT in our department were evaluated using skin prick test (SPT), specific immunoglobulin (Ig) E determination, enzyme-linked immunoassay (ELISA), and controlled oral challenge to assess allergy to GSM. Statistical analysis was carried out to identify markers of allergy to GSM. Fifteen of 58 (25.9%) patients were allergic to either goat's or sheep's milk or to both, as confirmed by a controlled positive oral challenge. Forty-seven percent of all positive oral challenges were classified as anaphylactic reactions. Specific IgE to CM casein, goat's whole milk, and sheep's whole milk was 13.2, 18.0, and 21.4 kU(A)/l in the group of GSM-allergic patients and 6.6, 6.5, and 6.5 kU(A) /l in the GSM-non-allergic patients (p < 0.05). Decision-making cut-off points based on sIgE for diagnosing symptomatic GSM allergy could not be determined. ELISA inhibition assays showed limited cross-reactivity (up to 77.2%) between CM casein and GSM casein in the group of GSM-allergic patients in contrast with almost 100% in GSM-not-allergic patients. We found a high prevalence (26%) of allergy to GSM in our population of CM-allergic children treated with oral immunotherapy. Therefore, tolerance to GSM should be assessed in order to provide accurate nutritional advice and minimize life-threatening accidental intake. Specific IgE to CM casein, goat's and sheep's whole milk is a good marker of this allergy. Although CM oral immunotherapy is a specific treatment for CM allergy, it may not be effective against allergy to the milk of other mammals.

Skin Testing With Water Buffalo's Milk in Children With Cow's Milk Allergy

BACKGROUND: Cow's milk allergy is the most common food allergy in young children. In areas outside the United States, milk from other mammals has been studied as a possible and desirable alternative for children with cow's milk allergy. OBJECTIVES: We chose to further investigate water buffalo's milk as an alternative for cow's milk allergic children in the United States. METHODS: Children with cow's milk allergy were skin prick tested with water buffalo's milk. Additionally, subjects were followed clinically for 1 year after the test to determine how many of the subjects had persistent cow's milk allergy. RESULTS: In total, 30 children, age 8 months to 8 years, were skin prick tested to water buffalo's milk with 73% (22/30) having a positive test. All children with a negative water buffalo's milk skin test also had a negative cow's milk skin test. In follow-up, most (7 of 8) of the children with a negative skin prick test (SPT) to water buffalo's milk were found to have outgrown their cow's milk allergy. In comparison, all of the subjects with a positive skin test to water buffalo's milk had persistent cow's milk allergy. After adjusting for this, we determined that 96% (22/23) of the children with persistent cow's milk allergy were positive on skin testing to water buffalo's milk. CONCLUSIONS: In this population, the vast majority of children with persistent cow's milk allergy were positive on skin prick testing to water buffalo's milk. These results indicate that water buffalo's milk is unlikely to be a successful alternative for children with cow's milk allergy.

Specific Oral Tolerance Induction in 39 Children with IgE Mediated Persistent Cow's Milk Allergy

Specific Oral Tolerance Induction in 39 Children with IgE Mediated Persistent Cow's Milk Allergy

Is it Possible to Establish a Clinical and Laboratorial Profile in Persistent Cow's Milk Allergic Patients?

Is it Possible to Establish a Clinical and Laboratorial Profile in Persistent Cow's Milk Allergic Patients?

Cesarean delivery and cow milk allergy/intolerance

The present study provides support for a positive association between cesarean delivery and persistent cow milk allergy/cow's milk intolerance. Correspondingly, a negative association was seen between cesarean delivery and early outgrown cow milk allergy/intolerance. A possible explanation is that cesarean delivery, rather than increasing the overall risk of food allergy, increases the risk of persistency of disease among food allergic children.