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Cow's Milk and Allergy
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Cow's Milk and Allergy

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 May 2019) | Viewed by 109962

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. R.J. Joost van Neerven

E-Mail Website
Guest Editor
Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, The Netherlands
Interests: mucosal immunology; allergy; asthma; food allergy; nutrition; dairy
Special Issues, Collections and Topics in MDPI journals
Prof. Huub Savelkoul

E-Mail Website
Guest Editor
Wageningen University & Research, Cell Biology and Immunology Group, Wageningen, The Netherlands
Interests: the regulation of IgE antibody formation in allergy, the immunogenicity and allergenicity of dietary components, the basic immune-mediated mechanisms in food allergy, the immunomodulation by food and feed, and the development of allergy-linked immunodiagnostics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The purpose of this Special Issue “Cow’s Milk and Allergy” is to provide an overview of the association of cow’s milk with allergy. This topic has two quite different faces. On the one hand, we are all aware of the importance of cow’s milk allergy in early life. What is less known is that the consumption of raw, unprocessed milk is associated with a lower incidence of asthma and rhinitis. In this Special Issue, we want to take a closer look at all of these aspects of cow’s milk and allergy and focus on the following questions:

  • Mechanisms of cow’s milk allergy
  • Epidemiology of cow’s milk allergy
  • Prevention of cow’s milk allergy
  • Immunotherapy of cow’s milk allergy
  • Milk processing, baked milk, and cow’s milk allergy
  • The consumption of raw milk and inhalation allergies

We hope that by focusing on these topics, the Special Issue will create a broad, yet concise, overview of how cow’s milk is associated with allergy.

Prof. RJ Joost van Neerven
Prof. Huub Savelkoul
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cow’s milk allergy
  • prevention
  • hydrolysate
  • processing
  • raw milk
  • epidemiology
  • immunotherapy

Published Papers (15 papers)

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Editorial

Jump to: Research, Review, Other

6 pages, 657 KiB  
Editorial
The Two Faces of Cow’s Milk and Allergy: Induction of Cow’s Milk Allergy vs. Prevention of Asthma
by R. J. Joost van Neerven and Huub F. J. Savelkoul
Nutrients 2019, 11(8), 1945; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11081945 - 19 Aug 2019
Cited by 8 | Viewed by 5085
Abstract
Cow’s milk has been consumed by humans for over 5000 years and contributed to a drastic change in lifestyle form nomadic to settled communities. As the composition of cow’s milk is relatively comparable to breast milk, it has for a very long time [...] Read more.
Cow’s milk has been consumed by humans for over 5000 years and contributed to a drastic change in lifestyle form nomadic to settled communities. As the composition of cow’s milk is relatively comparable to breast milk, it has for a very long time been used as an alternative to breastfeeding. Today, cow’s milk is typically introduced into the diet of infants around 6 months, except when breastfeeding is not an option. In that case, most often cow’s milk based infant formulas are given. Some children will develop cow’s milk allergy (CMA) during the first year of life. However, epidemiological evidence also suggests that consumption of unprocessed, “raw” cow’s milk is associated with a lowered prevalence of other allergies. This Special Issue of Nutrients on “Cow’s Milk and Allergy” (https://0-www-mdpi-com.brum.beds.ac.uk/journal/nutrients/special_issues/milk_allergy) is dedicated to these two different sides of cow’s milk and allergy, ranging from epidemiology of CMA, clinical presentation and sensitization patterns, treatment and prevention, effects of milk processing, and current management guidelines for CMA, but also the epidemiological evidence linking cow’s milk to lower asthma prevalence as well as the tolerance-inducing effect of raw cow’s milk in food allergy models. In this editorial, we discuss these issues by highlighting the contributions in this Special Issue. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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Research

Jump to: Editorial, Review, Other

8 pages, 496 KiB  
Communication
Management of Cow’s Milk Allergy from an Immunological Perspective: What Are the Options?
by Edward F. Knol, Nicolette W. de Jong, Laurien H. Ulfman and Machteld M. Tiemessen
Nutrients 2019, 11(11), 2734; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11112734 - 11 Nov 2019
Cited by 21 | Viewed by 6489
Abstract
The immunological mechanism underlying Immunoglobuline E (IgE)-mediated cow’s milk allergy has been subject to investigations for many years. Identification of the key immune cells (mast cells, B cells) and molecules (IgE) in the allergic process has led to the understanding that avoidance of [...] Read more.
The immunological mechanism underlying Immunoglobuline E (IgE)-mediated cow’s milk allergy has been subject to investigations for many years. Identification of the key immune cells (mast cells, B cells) and molecules (IgE) in the allergic process has led to the understanding that avoidance of IgE-crosslinking epitopes is effective in the reduction of allergic symptoms but it cannot be envisioned as a treatment. For the treatment and prevention of IgE-mediated cow’s milk allergy, it is thought that the induction of a sustained state of immunological tolerance is needed. In this review, we will discuss various approaches aimed at achieving immunological tolerance and their success. Furthermore, we will speculate on the involved immunological mechanism. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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15 pages, 1535 KiB  
Article
Raw Cow’s Milk Reduces Allergic Symptoms in a Murine Model for Food Allergy—A Potential Role for Epigenetic Modifications
by Suzanne Abbring, Johanna Wolf, Veronica Ayechu-Muruzabal, Mara A.P. Diks, Bilal Alashkar Alhamwe, Fahd Alhamdan, Hani Harb, Harald Renz, Holger Garn, Johan Garssen, Daniel P. Potaczek and Betty C.A.M. van Esch
Nutrients 2019, 11(8), 1721; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11081721 - 25 Jul 2019
Cited by 38 | Viewed by 4628
Abstract
Epidemiological studies identified raw cow’s milk consumption as an important environmental exposure that prevents allergic diseases. In the present study, we investigated whether raw cow’s milk has the capacity to induce tolerance to an unrelated, non-milk, food allergen. Histone acetylation of T cell [...] Read more.
Epidemiological studies identified raw cow’s milk consumption as an important environmental exposure that prevents allergic diseases. In the present study, we investigated whether raw cow’s milk has the capacity to induce tolerance to an unrelated, non-milk, food allergen. Histone acetylation of T cell genes was investigated to assess potential epigenetic regulation. Female C3H/HeOuJ mice were sensitized and challenged to ovalbumin. Prior to sensitization, the mice were treated with raw milk, processed milk, or phosphate-buffered saline for eight days. Allergic symptoms were assessed after challenge and histone modifications in T cell-related genes of splenocyte-derived CD4+ T cells and the mesenteric lymph nodes were analyzed after milk exposure and after challenge. Unlike processed milk, raw milk decreased allergic symptoms. After raw milk exposure, histone acetylation of Th1-, Th2-, and regulatory T cell-related genes of splenocyte-derived CD4+ T cells was higher than after processed milk exposure. After allergy induction, this general immune stimulation was resolved and histone acetylation of Th2 genes was lower when compared to processed milk. Raw milk reduces allergic symptoms to an unrelated, non-milk, food allergen in a murine model for food allergy. The activation of T cell-related genes could be responsible for the observed tolerance induction, which suggested that epigenetic modifications contribute to the allergy-protective effect of raw milk. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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15 pages, 776 KiB  
Article
Modulation of Milk Allergenicity by Baking Milk in Foods: A Proteomic Investigation
by Simona L. Bavaro, Elisabetta De Angelis, Simona Barni, Rosa Pilolli, Francesca Mori, Elio. M. Novembre and Linda Monaci
Nutrients 2019, 11(7), 1536; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071536 - 06 Jul 2019
Cited by 36 | Viewed by 5345
Abstract
Cow’s milk is considered the best wholesome supplement for children since it is highly enriched with micro and macro nutrients. Although the protein fraction is composed of more than 25 proteins, only a few of them are capable of triggering allergic reactions in [...] Read more.
Cow’s milk is considered the best wholesome supplement for children since it is highly enriched with micro and macro nutrients. Although the protein fraction is composed of more than 25 proteins, only a few of them are capable of triggering allergic reactions in sensitive consumers. The balance in protein composition plays an important role in the sensitization capacity of cow’s milk, and its modification can increase the immunological response in allergic patients. In particular, the heating treatments in the presence of a food matrix have demonstrated a decrease in the milk allergenicity and this has also proved to play a pivotal role in developing tolerance towards milk. In this paper we investigated the effect of thermal treatment like baking of cow’s milk proteins that were employed as ingredients in the preparation of muffins. A proteomic workflow was applied to the analysis of the protein bands highlighted along the SDS gel followed by western blot analyses with sera of milk allergic children in order to have deeper information on the impact of the heating on the epitopes and consequent IgE recognition. Our results show that incorporating milk in muffins might promote the formation of complex milk–food components and induce a modulation of the immunoreactivity towards milk allergens compared to milk baked in the oven at 180 °C for ten minutes. The interactions between milk proteins and food components during heating proved to play a role in the potential reduction of allergenicity as assessed by in vitro tests. This would help, in perspective, in designing strategies for improving milk tolerance in young patients affected from severe milk allergies. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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Graphical abstract

18 pages, 1702 KiB  
Article
Suppression of Food Allergic Symptoms by Raw Cow’s Milk in Mice is Retained after Skimming but Abolished after Heating the Milk—A Promising Contribution of Alkaline Phosphatase
by Suzanne Abbring, Joseph Thomas Ryan, Mara A.P. Diks, Gert Hols, Johan Garssen and Betty C.A.M. van Esch
Nutrients 2019, 11(7), 1499; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071499 - 30 Jun 2019
Cited by 28 | Viewed by 4652
Abstract
Raw cow’s milk was previously shown to suppress allergic symptoms in a murine model for food allergy. In the present study, we investigated the contribution of fat content and heat-sensitive milk components to this allergy-protective effect. In addition, we determined the potency of [...] Read more.
Raw cow’s milk was previously shown to suppress allergic symptoms in a murine model for food allergy. In the present study, we investigated the contribution of fat content and heat-sensitive milk components to this allergy-protective effect. In addition, we determined the potency of alkaline phosphatase (ALP), a heat-sensitive raw milk component, to affect the allergic response. C3H/HeOuJ mice were treated with raw milk, pasteurized milk, skimmed raw milk, pasteurized milk spiked with ALP, or phosphate-buffered saline for eight days prior to sensitization and challenge with ovalbumin (OVA). Effects of these milk types on the allergic response were subsequently assessed. Similar to raw milk, skimmed raw milk suppressed food allergic symptoms, demonstrated by a reduced acute allergic skin response and low levels of OVA-specific IgE and Th2-related cytokines. This protective effect was accompanied by an induction of CD103+CD11b+ dendritic cells and TGF-β-producing regulatory T cells in the mesenteric lymph nodes. Pasteurized milk was not protective but adding ALP restored the allergy-protective effect. Not the fat content, but the heat-sensitive components are responsible for the allergy-protective effects of raw cow’s milk. Adding ALP to heat-treated milk might be an interesting alternative to raw cow’s milk consumption, as spiking pasteurized milk with ALP restored the protective effects. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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18 pages, 3133 KiB  
Article
Differential Effects of Dry vs. Wet Heating of β-Lactoglobulin on Formation of sRAGE Binding Ligands and sIgE Epitope Recognition
by Hannah E. Zenker, Arifa Ewaz, Ying Deng, Huub F. J. Savelkoul, R.J. Joost van Neerven, Nicolette W. De Jong, Harry J. Wichers, Kasper A. Hettinga and Malgorzata Teodorowicz
Nutrients 2019, 11(6), 1432; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061432 - 25 Jun 2019
Cited by 16 | Viewed by 4371
Abstract
The effect of glycation and aggregation of thermally processed β-lactoglobulin (BLG) on binding to sRAGE and specific immunoglobulin E (sIgE) from cow milk allergic (CMA) patients were investigated. BLG was heated under dry conditions (water activity < 0.7) and wet conditions (in phosphate [...] Read more.
The effect of glycation and aggregation of thermally processed β-lactoglobulin (BLG) on binding to sRAGE and specific immunoglobulin E (sIgE) from cow milk allergic (CMA) patients were investigated. BLG was heated under dry conditions (water activity < 0.7) and wet conditions (in phosphate buffer at pH 7.4) at low temperature (<73 °C) and high temperatures (>90 °C) in the presence or absence of the milk sugar lactose. Nε-(carboxymethyl)-l-lysine (CML) western blot and glycation staining were used to directly identify glycation structures on the protein fractions on SDS-PAGE. Western blot was used to specify sRAGE and sIgE binding fractions. sRAGE binding was highest under wet-heated BLG independent of the presence of the milk sugar lactose. Under wet heating, high-molecular-weight aggregates were most potent and did not require the presence of CML to generate sRAGE binding ligands. In the dry system, sRAGE binding was observed only in the presence of lactose. sIgE binding affinity showed large individual differences and revealed four binding profiles. Dependent on the individual, sIgE binding decreased or increased by wet heating independent of the presence of lactose. Dry heating required the presence of lactose to show increased binding to aggregates in most individuals. This study highlights an important role of heating condition-dependent protein aggregation and glycation in changing the immunogenicity and antigenicity of cow’s milk BLG. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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11 pages, 1513 KiB  
Article
Individual Sensitization Pattern Recognition to Cow’s Milk and Human Milk Differs for Various Clinical Manifestations of Milk Allergy
by Frauke Schocker, Skadi Kull, Christian Schwager, Jochen Behrends and Uta Jappe
Nutrients 2019, 11(6), 1331; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061331 - 14 Jun 2019
Cited by 14 | Viewed by 3937
Abstract
Cow’s milk allergy (CMA) belongs to one of the most common food allergies in early childhood affecting 2–3% of children under 3 years of age. However, approximately 1% of adults remain allergic to cow’s milk, often showing severe reactions even to traces of [...] Read more.
Cow’s milk allergy (CMA) belongs to one of the most common food allergies in early childhood affecting 2–3% of children under 3 years of age. However, approximately 1% of adults remain allergic to cow’s milk, often showing severe reactions even to traces of milk. In our study, we recruited patients with different clinical manifestations of CMA, including patients with anaphylaxis and less severe symptoms. We assessed the sensitization patterns and allergic responses of these subgroups through different immunological and cell-based methods. Sera of patients were investigated for IgE against whole cow’s milk and its single allergens by CAP- FEIA. In a newly developed in-house multiplex dot assay and a basophil activation test (BAT), cow’s milk allergens, in addition to human breast milk and single allergens from cow’s and human milk were analyzed for IgE recognition and severity of CMA in the included patients. Both the CAP-FEIA routine diagnostic and the multiplex dot test could differentiate CMA with severe from milder allergic reactions by means of the patients’ casein sensitization. The BAT, which mirrors the clinical response in vitro, confirmed that basophils from patients with severe reactions were more reactive to caseins in contrast to the basophils from more moderate CMA patients. By means of this improved component-resolved diagnosis of CMA, individual sensitization patterns could be assessed, also taking sensitization against human milk into consideration. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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18 pages, 3383 KiB  
Article
Delayed-Type Hypersensitivity Underlying Casein Allergy Is Suppressed by Extracellular Vesicles Carrying miRNA-150
by Magdalena Wąsik, Katarzyna Nazimek, Bernadeta Nowak, Philip W. Askenase and Krzysztof Bryniarski
Nutrients 2019, 11(4), 907; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11040907 - 23 Apr 2019
Cited by 23 | Viewed by 4631
Abstract
In patients with non-IgE-mediated milk allergy, a cellular mechanism of delayed-type hypersensitivity (DTH) is considered. Recent findings prove that cell-mediated reactions can be antigen-specifically inhibited by extracellular vesicles (EVs) carrying miRNA-150. We sought to establish a new mouse model of DTH to casein [...] Read more.
In patients with non-IgE-mediated milk allergy, a cellular mechanism of delayed-type hypersensitivity (DTH) is considered. Recent findings prove that cell-mediated reactions can be antigen-specifically inhibited by extracellular vesicles (EVs) carrying miRNA-150. We sought to establish a new mouse model of DTH to casein and test the possibility of antigen-specific suppression of the inflammatory reaction. To produce soluble antigenic peptides, casein was subjected to alkaline hydrolysis. DTH reaction to casein was induced in CBA, C57BL/6, and BALB/c mice by intradermal (id) injection of the antigen. Cells collected from spleens and lymph nodes were positively or negatively selected and transferred to naive recipients intravenously (iv). CBA mice were tolerized by iv injection of mouse erythrocytes conjugated with casein antigen and following id immunization with the same antigen. Suppressive EVs were harvested from cell cultures and serum of tolerized donors by means of ultrafiltration and ultracentrifugation for further therapeutic utilization. The newly established mouse model of DTH to casein was mediated by CD4+ Th1 cells and macrophages, while EVs produced by casein-tolerized animals effectively suppressed effector cell response, in an miRNA-150-dependent manner. Altogether, our observations contribute to the current understanding of non-IgE-mediated allergy to casein and of the possibilities to downregulate this reaction. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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18 pages, 2288 KiB  
Article
Comparison of the Allergenicity and Immunogenicity of Camel and Cow’s Milk—A Study in Brown Norway Rats
by Natalia Zofia Maryniak, Egon Bech Hansen, Anne-Sofie Ravn Ballegaard, Ana Isabel Sancho and Katrine Lindholm Bøgh
Nutrients 2018, 10(12), 1903; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121903 - 04 Dec 2018
Cited by 28 | Viewed by 7077
Abstract
Background: When breastfeeding is impossible or insufficient, the use of cow’s milk-based hypoallergenic infant formulas is an option for infants suffering from or at risk of developing cow’s milk allergy. As the Camelidae family has a large evolutionary distance to the Bovidae family [...] Read more.
Background: When breastfeeding is impossible or insufficient, the use of cow’s milk-based hypoallergenic infant formulas is an option for infants suffering from or at risk of developing cow’s milk allergy. As the Camelidae family has a large evolutionary distance to the Bovidae family and as camel milk differs from cow’s milk protein composition, there is a growing interest in investigating the suitability of camel milk as an alternative to cow’s milk-based hypoallergenic infant formulas. Methods: The aim of the study was to compare the allergenicity and immunogenicity of camel and cow’s milk as well as investigating their cross-reactivity using a Brown Norway rat model. Rats were immunised intraperitoneally with one of four products: camel milk, cow’s milk, cow’s milk casein or cow’s milk whey fraction. Immunogenicity, sensitising capacity, antibody avidity and cross-reactivity were evaluated by means of different ELISAs. The eliciting capacity was evaluated by an ear swelling test. Results: Camel and cow’s milk showed similarity in their inherent immunogenicity, sensitising and eliciting capacity. Results show that there was a lower cross-reactivity between caseins than between whey proteins from camel and cow’s milk. Conclusions: The study showed that camel and cow’s milk have a low cross-reactivity, indicating a low protein similarity. Results demonstrate that camel milk could be a promising alternative to cow’s milk-based hypoallergenic infant formulas. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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12 pages, 1151 KiB  
Article
Higher Polygenetic Predisposition for Asthma in Cow’s Milk Allergic Children
by Philip R. Jansen, Nicole C. M. Petrus, Andrea Venema, Danielle Posthuma, Marcel M. A. M. Mannens, Aline B. Sprikkelman and Peter Henneman
Nutrients 2018, 10(11), 1582; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10111582 - 27 Oct 2018
Cited by 15 | Viewed by 3844
Abstract
Cow’s milk allergy (CMA) is an early-onset allergy of which the underlying genetic factors remain largely undiscovered. CMA has been found to co-occur with other allergies and immunological hypersensitivity disorders, suggesting a shared genetic etiology. We aimed to (1) investigate and (2) validate [...] Read more.
Cow’s milk allergy (CMA) is an early-onset allergy of which the underlying genetic factors remain largely undiscovered. CMA has been found to co-occur with other allergies and immunological hypersensitivity disorders, suggesting a shared genetic etiology. We aimed to (1) investigate and (2) validate whether CMA children carry a higher genetic susceptibility for other immunological hypersensitivity disorders using polygenic risk score analysis (PRS) and prospective phenotypic data. Twenty-two CMA patients of the Dutch EuroPrevall birth cohort study and 307 reference subjects were genotyped using single nucleotide polymorphism (SNP) array. Differentially genetic susceptibility was estimated using PRS, based on multiple P-value thresholds for SNP inclusion of previously reported genome-wide association studies (GWAS) on asthma, autism spectrum disorder, atopic dermatitis, inflammatory bowel disease and rheumatoid arthritis. These associations were validated with prospective data outcomes during a six-year follow-up in 19 patients. We observed robust and significantly higher PRSs of asthma in CMA children compared to the reference set. Association analyses using the prospective data indicated significant higher PRSs in former CMA patients suffering from asthma and related traits. Our results suggest a shared genetic etiology between CMA and asthma and a considerable predictive sensitivity potential for subsequent onset of asthma which indicates a potential use for early clinical asthma intervention programs. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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Review

Jump to: Editorial, Research, Other

24 pages, 1237 KiB  
Review
Molecular Approaches for Diagnosis, Therapy and Prevention of Cow’s Milk Allergy
by Birgit Linhart, Raphaela Freidl, Olga Elisyutina, Musa Khaitov, Alexander Karaulov and Rudolf Valenta
Nutrients 2019, 11(7), 1492; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071492 - 29 Jun 2019
Cited by 36 | Viewed by 7112
Abstract
Cow’s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow’s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract [...] Read more.
Cow’s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow’s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow’s milk allergens. Here, we provide an overview about the allergen molecules in cow’s milk and the advantages of the molecular diagnosis of IgE sensitization to cow’s milk by serology. In addition, we review current strategies for prevention and treatment of cow’s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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21 pages, 1029 KiB  
Review
Cow’s Milk Allergy: Immunomodulation by Dietary Intervention
by Enza D’Auria, Silvia Salvatore, Elena Pozzi, Cecilia Mantegazza, Marco Ugo Andrea Sartorio, Licia Pensabene, Maria Elisabetta Baldassarre, Massimo Agosti, Yvan Vandenplas and GianVincenzo Zuccotti
Nutrients 2019, 11(6), 1399; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061399 - 21 Jun 2019
Cited by 58 | Viewed by 10767
Abstract
Cow’s milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an [...] Read more.
Cow’s milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an overview of different aspects of immune modulation by dietary intervention in cow’s milk allergy (CMA). It focuses on pathogenetic mechanisms of different CMA related disorders, e.g., gastroesophageal reflux and eosinophilic esophagitis, highlighting the role of dietary management on innate and adaptive immune systems. The traditional dietary management of CMA has greatly changed in the last years, moving from a passive approach, consisting of an elimination diet to relieve symptoms, to a “proactive” one, meaning the possibility to actively modulate the immune system. Thus, new insights into the role of hydrolysates and baked milk in immunomodulation are addressed here. Additionally, nutritional components, such as pre- and probiotics, may target the immune system via microbiota, offering a possible road map for new CMA prevention and treatment strategies. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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14 pages, 237 KiB  
Review
Epidemiology of Cow’s Milk Allergy
by Julie D. Flom and Scott H. Sicherer
Nutrients 2019, 11(5), 1051; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11051051 - 10 May 2019
Cited by 179 | Viewed by 17772
Abstract
Immunoglobulin E (IgE)-mediated cow’s milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing [...] Read more.
Immunoglobulin E (IgE)-mediated cow’s milk allergy (CMA) is one of the most common food allergies in infants and young children. CMA can result in anaphylactic reactions, and has long term implications on growth and nutrition. There are several studies in diverse populations assessing the epidemiology of CMA. However, assessment is complicated by the presence of other immune-mediated reactions to cow’s milk. These include non-IgE and mixed (IgE and non-IgE) reactions and common non-immune mediated reactions, such as lactose intolerance. Estimates of prevalence and population-level patterns are further complicated by the natural history of CMA (given its relatively high rate of resolution) and variation in phenotype (with a large proportion of patients able to tolerate baked cow’s milk). Prevalence, natural history, demographic patterns, and long-term outcomes of CMA have been explored in several disparate populations over the past 30 to 40 years, with differences seen based on the method of outcome assessment, study population, time period, and geographic region. The primary aim of this review is to describe the epidemiology of CMA. The review also briefly discusses topics related to prevalence studies and specific implications of CMA, including severity, natural course, nutritional impact, and risk factors. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
11 pages, 245 KiB  
Review
Raw Cow’s Milk and Its Protective Effect on Allergies and Asthma
by Barbara Sozańska
Nutrients 2019, 11(2), 469; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020469 - 22 Feb 2019
Cited by 44 | Viewed by 12338
Abstract
Living on a farm and having contact with rural exposures have been proposed as one of the most promising ways to be protected against allergy and asthma development. There is a significant body of epidemiological evidence that consumption of raw milk in childhood [...] Read more.
Living on a farm and having contact with rural exposures have been proposed as one of the most promising ways to be protected against allergy and asthma development. There is a significant body of epidemiological evidence that consumption of raw milk in childhood and adulthood in farm but also nonfarm populations can be one of the most effective protective factors. The observation is even more intriguing when considering the fact that milk is one of the most common food allergens in childhood. The exact mechanisms underlying this association are still not well understood, but the role of raw milk ingredients such as proteins, fat and fatty acids, and bacterial components has been recently studied and its influence on the immune function has been documented. In this review, we present the current understanding of the protective effect of raw milk on allergies and asthma. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)

Other

10 pages, 496 KiB  
Concept Paper
Prevention of Allergic Sensitization and Treatment of Cow’s Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus
by Yvan Vandenplas, Bakr Al-Hussaini, Khaled Al-Mannaei, Areej Al-Sunaid, Wafaa Helmi Ayesh, Manal El-Degeir, Nevine El-Kabbany, Joseph Haddad, Aziza Hashmi, Furat Kreishan and Eslam Tawfik
Nutrients 2019, 11(7), 1444; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071444 - 26 Jun 2019
Cited by 27 | Viewed by 10372
Abstract
Allergy risk has become a significant public health issue with increasing prevalence. Exclusive breastfeeding is recommended for the first six months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle-East region, putting infants at [...] Read more.
Allergy risk has become a significant public health issue with increasing prevalence. Exclusive breastfeeding is recommended for the first six months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle-East region, putting infants at risk of developing allergic sensitization and disorders. When breastfeeding is not possible or not adequate, a partially hydrolyzed whey formula (pHF-W) has shown proven benefits of preventing allergy, mainly atopic eczema, in children with a genetic risk. Therefore, besides stimulating breastfeeding, early identification of infants at risk for developing atopic disease and replacing commonly used formula based on intact cow milk protein (CMP) with a clinically proven pHF-W formula is of paramount importance for allergy prevention. If the child is affected by cow’s milk protein allergy (CMPA), expert guidelines recommend extensively hydrolyzed formula (eHF), or an amino acid formula (AAF) in case of severe symptoms. The Middle-East region has a unique practice of utilizing pHF-W as a step-down between eHF or AAF and intact CMP, which could be of benefit. The region is very heterogeneous with different levels of clinical practice, and as allergic disorders may be seen by healthcare professionals of different specialties with different levels of expertise, there is a great variability in preventive and treatment approaches within the region itself. During a consensus meeting, a new approach was discussed and unanimously approved by all participants, introducing the use of pHF-W in the therapeutic management of CMPA. This novel approach could be of worldwide benefit. Full article
(This article belongs to the Special Issue Cow's Milk and Allergy)
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