Non-IgE-mediated cow's milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)

Jaime, Beatriz Espín; Martín, Juan José Díaz; Baviera, Luis Carlos Blesa; Monzón, Ángela Claver; Hernández, Anselmo Hernández; Burriel, Jose Ignacio García; Mérida, María José García; Fernández, Carlos Sánchez; Rodríguez, Cristóbal Coronel; Riechmann, Enriqueta Román; Köninckx, Carmen Ribes

doi:10.1016/j.anpede.2018.11.009

Cited by 23 publications

(28 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the precise molecular interactions leading to tolerance are poorly characterized and not yet fully elucidated. Since no useful laboratory tests to address this allergy resolution are available, repeated oral challenges are usually performed every 6–12 months, in order to evaluate tolerance development, and to avoid continuing a restrictive diet for an unnecessarily long time (5). Current literature in this field indicates that several immunological mechanisms may be responsible for non-IgE reactions.…”

Section: Introductionmentioning

confidence: 99%

Fecal Changes Following Introduction of Milk in Infants With Outgrowing Non-IgE Cow's Milk Protein Allergy Are Influenced by Previous Consumption of the Probiotic LGG

et al. 2019

View full text Add to dashboard Cite

Cow's milk protein allergy (CMPA) is the most common allergy in the first year of life. Non-IgE mediated CMPA is characterized by digestive symptoms and tolerance development before the age of three. Gut microbiota composition in early life has been associated with food allergy. The ingestion of different foods/nutrients may mark different shifts in the microbial colonization of the infant intestine as well as the consumption of probiotics. Aim: To analyze changes in microbiota composition and metabolic and cytokine profiles in fecal samples from infants with non-IgE mediated CMPA after successful milk challenges, tolerance acquisition, and increasing dairy introduction in their diet. Methods: Twelve children with CMPA, aged between 1 and 2 years old, were recruited for the study. Participants were initially consuming hypoallergenic hydrolyzed formulas (four of them supplemented with the probiotic Lactobacillus rhamnosus GG), before being exposed to a standardized oral challenge (SOC) with cow's milk. Fecal samples were collected before, 1 week, and 1 month after performing the SOC. Changes in gut microbiota were determined by high-throughput amplicon sequencing of the 16S rRNA gene. Levels of lactobacilli were also determined by quantitative PCR (qPCR). Microbial metabolites were analyzed by chromatographic methods and fecal cytokines related to the Th1/Th2 balance were determined by immunoassay. Results: Lactic acid bacteria significantly increased in infants who outgrew non-IgE CMPA, after the introduction of milk. Microbial metabolites derived from the fermentation of proteins, such as branched chain fatty acids, and p -cresol, diminished. After the SOC, some cytokines related to inflammation (TNF-α, IFN-γ) increased. Accompanying the introduction of an unrestricted diet, we found significant differences in fecal microbial composition, metabolites, and cytokines between infants who did not consume the probiotic L. rhamnosus GG and those that did. Conclusions: These findings indicate that the introduction of intact milk proteins is followed by modifications in the infant gut environment through changes in immune mediators, microbiota, and its metabolic end-products. Consumption of probiotics during CMPA may contribute to gut homeostasis by fine-tuning these profiles.

show abstract

Section: Introductionmentioning

confidence: 99%

Fecal Changes Following Introduction of Milk in Infants With Outgrowing Non-IgE Cow's Milk Protein Allergy Are Influenced by Previous Consumption of the Probiotic LGG

et al. 2019

View full text Add to dashboard Cite

show abstract

“…It is important to note that non-IgE-mediated CMPA should be considered in the diagnosis of any patient presenting the following symptoms: Prolonged diarrhea, abnormal growth, recurrent vomiting, flatulence, blood in the stools, IDA, or other mild gastrointestinal disorders not responding to standard treatment [ 29 , 30 ]. This diagnosis is strengthened by the presence of skin lesions and/or respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Although the clinical picture of the patients described in this publication can resemble that of non-IgE-mediated CMPA, there are significant differences: In the case of allergies, it is impossible to obtain remission of symptoms without the elimination of the allergen, i.e., cow’s milk, and additionally, confirmation of non-IgE-mediated CMPA requires an oral provocation test, in which symptoms reappear after the reintroduction of milk [ 30 ]. In PLE and IDA related to excessive consumption of cow’s milk, it is sufficient to introduce iron supplementation and reduce the amount of milk consumed; there is no need to introduce an elimination diet.…”

Section: Discussionmentioning

confidence: 99%

The Consequence of Excessive Consumption of Cow’s Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia—Case Reports and a Literature Review

et al. 2021

View full text Add to dashboard Cite

Cow’s milk is a key component of a child’s diet. While the consumption of even trace amounts can result in allergy to its proteins and/or hypolactasia, excessive cow’s milk consumption can result in numerous health complications, including iron deficiency, due to the diet being improperly balanced. Although the incidence of iron deficiency has declined, it remains the most widespread nutritional deficiency globally and the most common cause of anemia. One rare consequence of anemia caused by iron deficiency is protein-losing enteropathy; however, the mechanisms of its development are unclear. The following manuscript, based on a literature review, presents two rare cases of children, a 16-month-old boy and a 2.5-year-old girl, who developed severe microcytic anemia, enteropathy with hypoalbuminemia, and anasarca as a result of excessive cow’s milk consumption. It highlights the possible relationship between excessive consumption of cow’s milk in children and severe iron deficiency anemia with accompanying hypoalbuminemia; it may also result in serious clinical conditions, even in children that do not demonstrate food hypersensitivity.

show abstract

“…All three infants were mixed-fed and none Age at which CMA can be reintroduced (mean, range months) 13.4 (12)(13)(14)(15)(16)(17) of their mothers had to follow a dairy elimination diet for improvement of symptoms. Several guidelines (10,11,24,37,38), suggest an AAF as the 1st choice for the management of FPIES. However, in a recent Spanish study (36), only 20% of infants with FPIES needed to switch to an AAF for their symptoms to resolve.…”

Section: Discussionmentioning

confidence: 99%

“…Breastfeeding should always be encouraged, and CMP avoidance in maternal diet may not be necessary (8,9). Most mixed-fed/formulafed infants would tolerate an extensively hydrolysed cow's milk formula (eHF) with proven efficacy as milk substitute and an Amino Acid Formula (AAF) could be used in severe cases (9)(10)(11) as per several international guidelines (Appendix 2).…”

Section: Introductionmentioning

confidence: 99%

Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Sekkidou¹,

Muhardi²,

Constantinou

et al. 2021

Front. Allergy

View full text Add to dashboard Cite

Background: The majority of mixed-fed infants with non-IgE-mediated cow's milk protein allergy (CMPA) enteropathies are managed with an extensively hydrolysed cow's milk based infant formula (eHF). Given the high variability in peptide distribution of available eHFs, it is important to understand the suitability of a specific product in the management of distinct phenotypes.Objective: To assess the symptom resolution of various phenotypes of clinical manifestations of CMPA enteropathies and constipation managed by a casein-based eHF.Methods: The data of 20 full-term infants (n = 15 with non-IgE-mediated CMPA and n = 5 with constipation) attending a paediatric allergy clinic in Cyprus and managed with a casein-based eHF were retrospectively analysed.Results: Based on the clinical symptoms and history, infants were classified into the following phenotypes: (a) 11/15 (73.3%) FPIAP, (b) 3/15 (20%) FPIES, and (c) 1/15 (6.7%) severe diarrhoea. Overall, 14 (93.3%) patients were successfully managed with the casein-based eHF and 1 (6.7%) required an AAF. This formula was effective in 91% of patients with FPIAP, in 100% with FPIES and with diarrhoea. Three (60%) patients with constipation responded to the eHF.Conclusion: This case-series report supports the efficacy of a particular casein-based eHF for the nutritional management of non-IgE mediated CMPA enteropathies.

show abstract

Cited by 23 publications

References 39 publications

Fecal Changes Following Introduction of Milk in Infants With Outgrowing Non-IgE Cow's Milk Protein Allergy Are Influenced by Previous Consumption of the Probiotic LGG

Fecal Changes Following Introduction of Milk in Infants With Outgrowing Non-IgE Cow's Milk Protein Allergy Are Influenced by Previous Consumption of the Probiotic LGG

The Consequence of Excessive Consumption of Cow’s Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia—Case Reports and a Literature Review

Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

Contact Info

Product

Resources

About