Abstract
Cow's milk protein hydrolysate formulae have been developed to lower or eliminate the allergenicity of cow's milk proteins, and to reduce the antigenic load and the risk of sensitization. Cross-reactivity between different hydrolysate formulae and cow's milk proteins has been demonstrated. We have studied 20 children (median age 31 months, range 15–76 months) with a history of IgE-mediated cow's milk allergy. All the children had immediate allergic respiratory and/or cutaneous and/or gastro-intestinal reactions to cow's milk ingestion. In addition, the children had positive prick skin tests and positive RAST to cow's milk. Prick skin test, RAST, and double-blind placebo controlled food challenges were performed with three different hydrolysate formulae: a casein hydrolysate formula and two whey formulae, one partially and one extensively hydrolyzed. All 20 children had immediate allergic reactions after the challenge test with cow's milk. Only 2/20 children had a positive challenge test with a casein hydrolysate formula (Alimentum): one developed asthma and one urticaria. Two of the 15 children challenged with an extensively hydrolysed whey formula (Profylac) developed perioral erythema. Nine out of 20 children had a positive challenge test with a partially hydrolysed whey formula (Nidina H.A.): four developed asthma, three urticaria and two lip oedema. All children had positive prick skin tests to cow's milk proteins (casein and/or lactalbumin); 9 to Nidina H.A.; 3 to Profylac, and 3 to Alimentum. Specific IgE antibodies to cow's milk were present in all children; in 13 to Nidina H.A., in 4 to Profylac, and in 3 to Alimentum.
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Abbreviations
- CM:
-
cow's milk
- CMA:
-
cow's milk allergy
- DBPCFC:
-
double-blind placebo controlled food challenge
- HF:
-
hydrolysate formula
References
Allen PMN (1987) Antigen processing at the molecular level. Immunol Today 8:270–273
AMA-Committee on Nutrition (1989) Hypoallergenic infant formulas. Pediatrics 83:1068–1069
Businco L, Cantani A (1990) Hypoallergenic formulae. Allergy Today 3:9–11
Businco L, Cantani A, Longhi MA, Giampietro PG (1989) Anaphylactic reactions to a cow's milk whey protein hydrolysate (Alfa-Ré, Nestlé) in infants with cow's milk allergy. Ann Allergy 62:333–335
Chandra RK, Hamed A (1991) Cumulative incidence of atopic disorders in high risk infants fed whey hydrolysate, soy, and conventional cow milk formulas. Ann Allergy 67:129–132
Ellis MH, Short JA, Heiner DC (1991) Anaphylaxis after ingestion of a recently introduced hydrolysed whey protein formula. J Pediatr 118:74–77
Goldman AS, Anderson DW, Sellers WA, et al (1963) Milk allergy. I. Oral challenge with milk and isolated milk proteins in allergic children. Pediatrics 32:425–443
Guigoz Y, Solms J (1976) Bitter peptides, occurrence and structure. Chem Senses Flavor 2:71–84
Halken S, Host A, Hansen LG, et al (1992) Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. A prospective study of 159 high risk infants. Allergy 47:545–553
Heyman MB, Stoker TW, Rudolph CD, et al (1990) Hypersensitivity reaction in an infant fed hydrolysed lactalbumin contained in a semielemental formula. J Pediatr Gastroenterol Nutr 10:253–256
Kahn A, Mozin J, Rebuffat E, et al (1989) Milk intolerance in children with persistent sleeplessness: a prospective double-blind crossover evaluation. Pediatrics 84:595–603
Kleinmna RE, Bahana S, Powell GF, et al (1991) Use of infant formula in infants with cow milk allergy. A review and recommendations. Pediatr Allergy Immunol 4:146–155
Lau S, Wahn U (1989) How allergenic are “Hypoallergenic” formulas? In: Harms HK, Wahn U (eds) Food allergy in infancy and childhood. Springer-Verlag, Berlin Heidelberg New York, pp 173–176
Lorenz F, Seid M, Tangermann R, et al (1988) Detection of casein antigen in regular and hypoallergenic formula protein by ELISA: characterization of formula protein fractions according to their molecular weights. In: Reinhardt D, Schmidt (eds) Food allergy V. Nestlé Nutrition Workshop Series 17. Raven Press, New York, pp 215–220
Merritt RJ, Carter M, Haight M, et al (1990) Whey protein hydrolysate formula for infants with gastrointestinal intolerance to cow milk and soy protein in infant formulas. J Pediatr Gastroenterol Nutr 11:78–82
Oldaeus G, Bjorkstén B, Einarsson R, et al (1992) Antigenicity and allergenicity of cow milk hydrolyates intended for infant feeding. Pediatr Allergy Immunol 4:156–164
Plebani A, Albertini A, Scotta S, et al (1990) IgE antibodies to hydrolysates of cow milk proteins in children with cow milk allergy. Ann Allergy 64:279–280
Sampson HA, Bernhisel-Broadbent J, Yang E, et al (1991) Safety of casein hydrolysate formula in children with cow's milk allergy. J Pediatr 118:520–525
Saylor JD, Bahna SL (1991) Anaphylaxis to casein hydrolysate formula. J Pediatr 118:71–74
Schwartz RH, Keefe MW, Harris N, et al (1989) The spectrum of IgE-mediated acute allergic reactions to cow's milk in children as determined by skin testing with cow's milk protein hydrolysate formulas. Pediatr Asthma Allergy Immunol 3: 207–215
Strobel S, Fairclough LM (1989) Whole cow's milk versus hydrolysed infant formulac: analysis of systemic immune responses and antigenic cross-reactivities. In: Harms HK, Wahn U (eds) Food allergy in infancy and childhood. Springer Verlag, Berlin Heidelberg New York, pp 157–165
Vandenplas Y, Hauser B, Van den Borre C, et al (1992) Effect of a whey hydrolysate prophylaxis of atopic disease. Ann Allergy 68:419–424
Zeiger RS (1990) Prevention of food allergy in infancy. Ann Allergy 65:430–441
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Ragno, V., Giampietro, P.G., Bruno, G. et al. Allergenicity of milk protein hydrolysate formulae in children with cow's milk allergy. Eur J Pediatr 152, 760–762 (1993). https://doi.org/10.1007/BF01953996
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DOI: https://doi.org/10.1007/BF01953996