Milk Allergy Cross Reactivity With Beef
Tin Fam Physician. 2008 Sep; 54(ix): 1258–1264.
Language: English | French
Approach to milk protein allergy in infants
Herbert Brill
Assistant Professor in the Division of Gastroenterology and Diet in the Section of Pediatrics at McMaster Children's Hospital in Hamilton, Ont.
Abstruse
OBJECTIVE
To provide a practical, show-based arroyo to the diagnosis and management of milk poly peptide allergy in infants.
SOURCES OF INFORMATION
MEDLINE was searched from 1950 to March 2008 using the MeSH heading milk-hypersensitivity. Additional sources were derived from reviews found with the initial search strategy. Evidence was levels I, Two, and Iii.
MAIN Bulletin
Milk protein allergy is a recognized problem in the starting time year of life; cow's milk poly peptide allergy is the virtually common such allergy. Diagnosis is suspected on history lonely, with laboratory evaluations playing a supporting role. Confirmation requires emptying and reintroduction of the suspected allergen. Management includes diet modification for nursing mothers and hydrolyzed formulas for formula-fed infants. Assessing the underlying immunopathology tin can help in determining prognosis.
Determination
The therapeutic model presented allows rapid cess of the presence of allergy, timely management, and surveillance for recurrence of symptoms. Breastfeeding can exist continued with attentive diet modification past motivated mothers.
RÉSUMÉ
OBJECTIF
Proposer une méthode pratique fondée sur des données probantes pour diagnostiquer et traiter l'allergie aux protéines du lait chez le nourrisson.
SOURCE DE L'Information
On a consulté MEDLINE entre 1950 et 2008 à l'aide de la rubrique MeSH milk-hypersensitivity. D'autres sources d'information ont été tirées des revues repérées par la stratégie initiale. Les preuves obtenues étaient de niveaux I, Two et III.
PRINCIPAL Message
Fifty'allergie aux protéines du lait est united nations problème connu chez 50'enfant de moins d'un an; l'allergie aux protéines du lait de vache est la forme la plus fréquente. 50'historique est suffisant pour suggérer ce diagnostic, les tests de laboratoire jouant un rôle de support. La confirmation exige le retrait et la réintroduction de 50'allergène présumé. Le traitement comprend une modification du régime cascade la mère allaitant et des préparations hydrolysées cascade les bébés au biberon. L'évaluation de l'immunopathologie sous-jacente peut aider à établir le pronostic.
Decision
Le modèle thérapeutique proposé permet la détection rapide de l'allergie, un traitement opportun et la surveillance d'une réapparition des symptômes. Les mères motivées peuvent continuer d'allaiter si elles modifient correctement leur alimentation.
Milk protein allergy (MPA) is a recognized problem in infancy and might touch on upwardly to 15% of infants.one Well-nigh cases of MPA tin can be managed successfully in the outpatient setting. This article summarizes the electric current testify for diagnosis and management of MPA.
Instance description
Baby M. is a full-term, 4-kg babe girl delivered vaginally of a 22-yr-old primiparous mother after an uneventful pregnancy. At the two-week follow-up visit, Baby Thou. has regained her birth weight. Her mother reports frequent episodes of regurgitation after breastfeeding, which exercise not distress her. Family history is significant for environmental allergies in both parents and a paternal uncle with eczema and astringent asthma. At the four-calendar week follow-upwards visit, the female parent reports ongoing regurgitation followed occasionally by crying. Stools have go more frequent and announced watery. The baby'southward weight is 4150 g, a gain of 10 chiliad/d since the terminal visit.
Sources of data
A MEDLINE search was conducted using the MeSH heading milk-hypersensitivity. English-language articles studying subjects younger than 1 year of age were selected. Additional manufactures were derived from review articles found with the initial search strategy, yielding a total of 36 publications. Evidence was levels I, Two, and III.
Epidemiology
Moo-cow's milk poly peptide allergy (CMPA) appears to be the about common MPA, with controlled challenge trials demonstrating an incidence of 2% to v% amidst formulafed infants (level I prove).ane The incidence in breastfed infants is 0.iv% to 0.five% according to two trials (level I evidence), 2 , three but might be as high as 2.1% (level Two evidence).4 Determining the incidence of allergy to milk proteins from other sources is complicated by the widespread employ of bovine milk. A population-based cohort study constitute the incidence of soy allergy to be 0.25% (level II evidence).5 Among loftier-take a chance infants, CMPA appears to outweigh soy milk poly peptide allergy (SMPA) by a factor of 6 to one (level I evidence).six A study past Klemola et al institute the incidence of SMPA to be 10% among children with CMPA.7 Interestingly, qualitative ascertainment solitary suggested a cross-reactivity as high as 30%, but only a x% rate was observed using rigorous quantitative measures. This underscores the importance of appropriately testing diagnostic suspicions. Cross-reactivity between milk protein from ewe, goat, or buffalo and bovine milk protein has been demonstrated in vitro.8 Unfortunately, Canadian data are lacking.
Pathophysiology
Milk protein allergy tin manifest via IgE-mediated and not–IgE-mediated pathways.ix An IgE-mediated allergy (as well known as type I hypersensitivity reaction) occurs when antigens bind to IgE antibodies bound to mast cells. Cantankerous-linking of 2 IgE antibodies by an antigen causes the mast cell to release histamine, a potent inflammatory mediator, resulting in an firsthand allergic reaction. Non–IgE-mediated MPA is likely multifactorial and includes immune complexes of IgA or IgG antibodies jump to milk antigens (type III hypersensitivity reaction) and directly stimulation of T cells by milk protein antigens (type Iv hypersensitivity reaction). The interactions upshot in cytokine release and increased production of antibodies that recognize the offending milk proteins, contributing to an inflammatory pour. These more complex immune interactions upshot in delayed onset of clinical symptoms. While in that location is overlap of clinical symptoms in the 2 groups of immune reactions,ix a non–IgE-mediated allergy is certain with isolated bloodstreaked stools (level Iii evidence). With the other symptoms, while a distinction might be suspected it cannot exist confirmed by clinical history solitary (Table i x – 12). Making the distinction is important, as IgE-mediated MPA is associated with a college hazard of multiple nutrient allergies and atopic conditions such equally asthma later in life (level I and II evidence).10 , 13
Tabular array 1
Symptoms of milk protein allergy and their differential diagnoses
| REACTION TYPE | PRESENT ATION | DIFFERENTIAL DIAGNOSES TO CONSIDER |
|---|---|---|
| igE mediated | ||
| Respiratory | Rhinoconjunctivitis Asthma (wheeze, cough) Laryngeal edema Otitis media with effusion | Master respiratory problem |
| Cutaneous | Atopic dermatitis Urticaria Angioedema | Food allergy Environmental allergy Primary atopy |
| Gastrointestinal | Oral allergy syndrome Nausea and vomiting Colic Diarrhea | Food or environmental allergy Infection, delayed gastric emptying, malrotation, celiac disease (younger than 6 mo), cystic fibrosis |
| Not–Ige mediated | ||
| Respiratory | Pulmonary hemosiderosis (Heiner syndrome) | None |
| Cutaneous | Contact rash Atopic dermatitis | Food or environmental allergy Primary atopy |
| Gastrointestinal | Gastroesophageal reflux Transient enteropathy Protein-losing enteropathy Enterocolitis syndrome Colitis Constipation Failure to thrive | Physiologic reflux, delayed gastric elimination, celiac disease (younger than 6 mo), cystic fibrosis Anal fissure Hypercalcemia, Hirschsprung affliction, hypothyroidism, functional gastrointestinal disorders |
| Other | ||
| Unclassified (rare) | Anemia (without colitis) Arthritis Henoch-Schönlein purpura Migraine | Broad |
Cross-sensitization between protein sources is well established. Amidst infants with CMPA, thirteen% to 20% have allergies to beef (level II bear witness).xiv Restani et al demonstrated that antibodies harvested from children with CMPA recognize milk proteins from ewe, goat, and buffalo species, merely non from camels (level 2 evidence).8 Completely different organisms produce soy and bovine proteins. Rozenfeld et al demonstrated that a monoclonal antibody specific to casein (a bovine milk protein) displayed affinity to a component of glycinin, an ingredient in soy-based formulas.15
Clinical presentation
Infants with MPA unremarkably present with symptoms similar to allergic reactions in older individuals. These include cutaneous symptoms such as urticaria, rash, and pruritus, every bit well equally respiratory symptoms such equally wheeze and cough (level I testify).11 These symptoms are unremarkably indicative of IgE-mediated MPA.9
Milk protein allergy tin can likewise nowadays with gastrointestinal and nutritional manifestations. These include gastroesophageal reflux, esophagitis, gastritis, delayed gastric elimination, enteropathy, colitis, constipation, and failure to thrive (level I to Two evidence).12 These symptoms might be the cause of behaviour such as crying inconsolably and refusing feeding. The symptoms are the same among breastfed and formula-fed infants. Gastrointestinal symptoms are particularly challenging owing to their nonspecificity and wide differential diagnosis, only MPA should always be suspected. 1 study administered a cow'south milk—free diet to ten infants with refractory gastroesophageal reflux that had not improved with pharmacologic therapy and reported that 2 of the infants' symptoms improved (level Two evidence).16 Jakobsson et al administered hydrolyzed formula to 15 infants with severe colic and demonstrated a 60% to 70% reduction in daily crying fourth dimension (level II evidence),17 but caution should be used in generalizing these results to all infants with colic.
Diagnosis
Confirming the diagnosis of MPA is important owing to the discrepancy between parental description of symptoms and scientific confirmation. 7 , 9 Double-blind, placebo-controlled nutrient claiming has long been regarded as the criterion standard (level I evidence),18 nonetheless, owing to the risk of substantial allergy during food challenge, an alternative examination with equal efficacy is preferred. Other investigational options include skinprick testing (SPT), serum measurement of IgE antibodies to the specific allergen, and patch testing. A contempo study suggests that a combination SPT and measuring IgE antibodies results in a positive predictive value of 95% for diagnosing IgE-mediated CMPA, obviating the need for the food challenge if an IgE-mediated CMPA is suspected (level I evidence).nineteen A similar study, however, failed to reproduce these results (level Ii show).20 Pare-prick testing and specific IgE levels are non useful for the diagnosis of non–IgE-mediated MPA,9 merely patch testing shows promise.21
Laboratory investigations are not diagnostic but tin can support a diagnosis made on clinical grounds. A decreased albumin level is suggestive of enteropathy (level III evidence). Increased platelets, erythrocyte sedimentation rate, C-reactive protein, and fecal leukocytes are all evidence of inflammation merely are nonspecific; normal values do non rule out MPA (level 3 evidence). Eosinophilic leukocytosis might be present in both types of MPA.20
Direction
The main principle in direction of MPA is to avert allergens while maintaining a balanced, nutritious diet for infants and mothers. Although it is difficult, breastfeeding can be continued if allergens are avoided. For CMPA, a breastfeeding mother must sequentially eliminate all cow'due south milk poly peptide, then all bovine protein (milk and meat), and occasionally other protein sources such as soy (level Ii evidence).22 , 23 A similar broad restriction is recommended for other MPAs given their low incidence and clan with CMPA (level Iii prove). Consultation with a dietitian is essential for a mother who continues breastfeeding; particular attention must be paid to adequate calcium intake. A list of foods containing moo-cow's milk and soy proteins is found in Table 2.24 , 25
Tabular array 2
Sources of cow's milk poly peptide and soy protein
| SOURCES OF Moo-cow'S MILK PROTEIN | SOURCES OF SOY Protein |
|---|---|
| Foods that contain cow's milk protein | Foods that incorporate soy protein |
| Milk, skim milk, buttermilk | Soya, soybean, soy protein |
| Cream, evaporated or condensed milk | Miso, edamame, okara, bean sprouts |
| Butter, margarine, milk solids, curds | Tofu, tempeh, yuba |
| Whey | Textured vegetable poly peptide |
| Lactose, caseinate, casein, lactalbumin | Monodiglyceride, lecithin |
| Cheese, yogurt, sour cream | |
| Foods that MIGHT incorporate cow'due south milk protein | Foods that MIGHT incorporate soy protein |
| Commercially prepared meats | Baked goods |
| Scalloped or creamed vegetables | Cereals |
| Canned or dehydrated soups | Breaded foods, bread crumbs |
| Candies | Chewing gum, desserts |
| Gravies | Processed meats |
| Breads, hamburger and hot dog buns | Sauces, gravies, marinades, dressings |
| Beverages | Simulated fish and meat products |
| Cakes, cookies, other desserts | Snack foods |
| Salad dressings | Soups |
| Foods sautéed or fried with butter or margarine | Thickening agents |
For formula-fed infants, electric current options include specific allergen avoidance, extensively hydrolyzed protein formulas (EHFs), and amino acid–based formulas (AAFs) (Table 3). Extensively hydrolyzed poly peptide formulas incorporate hydrolysates of casein or whey derived from cow's milk. Their efficacy among those with CMPA is approximately ninety% (level I to II prove),23 , 26 – 29 though their efficacy among those with other forms of MPA is less well demonstrated. These formulas do have potentially allergenic fabric,xxx and allergic reactions accept been reported.31 , 32 A rice-based EHF shows promise in young children,33 but is not commercially bachelor. Amino acid–based formulas are created from constituent amino acids and accept demonstrated efficacy of approximately 99% (level I evidence)28 , 34; they tin be considered as an immediate or secondary alternative to EHFs. Even so, even AAFs contain potentially allergenic cloth, such as soy lecithin, and so their employ must exist monitored. The sense of taste of the formula might be an issue for compliance; as a rule of thumb, the more than hydrolyzed a formula, the worse the taste.
Table 3
Hydrolyzed formulas available in Canada
| AGE | TYPE OF FORMULA | BRAND | COST PER half dozen OZ Bottle, $* |
|---|---|---|---|
| Infant (younger than 12 mo) | Partially hydrolyzed Extensively hydrolyzed | Good First Nutramigen Alimentum† Pregestimil | 0.72 1.48 1.99 ane.25 |
| Amino acrid based | Neocate | 2.94 | |
| Toddler (1–5 y) | Extensively hydrolyzed | Nutren Inferior† Peptamen Inferior† | 2.01 7.99 |
| Amino acrid based | Neocate Junior Vivonex Pediatric | iv.14 6.31 |
Specific allergen avoidance, such equally substituting soy-based formulas for milk-based in CMPA, is non recommended. The concomitant presence of multiple MPAs reduces the likelihood of success of milk protein substitution.seven , 8 Additionally, cross-sensitization of milk proteins correlates with increased intestinal permeability (level 2 show).35 Thus, allergy-induced enteropathy might increment the risk of cross-sensitization if specific allergen avoidance is pursued during the acute phase (level III evidence). If the expense of EHFs or AAFs is a concern, in club to avoid the take chances of cross-sensitization, accept patients avoid alternating protein sources for at least ane month to requite the intestinal mucosa time to heal, then challenge with a poly peptide alternative (level III testify).
Introduction of solid food can occur at the usual age disallowment complications such as feeding aversion. Instruction regarding diet restriction is essential and is best achieved with the help of a dietitian (level III evidence). 36 The importance of a dietitian referral is underscored by a study demonstrating a high rate of parental error in avoiding milk protein–laced foods at the grocery store (level Two show).37 Parents might also worry about lactose intolerance, and they should be reassured of the farthermost rarity of lactase deficiency in infants younger than 1 year of age.38
Prognosis
The timing of reintroducing milk protein is of great concern to parents. Traditionally, it was thought that MPA resolved by i to ii years of age (level III evidence).9 , 39 Two recent studies, nevertheless, suggest a more complex respond. Carroccio et alforty plant the proportions of Italian infants with CMPA who had milk tolerance at one, 2, and 3 years later on initiation of milk-complimentary diets were xxx%, 54%, and lxx%, respectively. Vanto et al41 demonstrated a divergence in tolerance when considering the type of CMPA among Finnish infants (level 2 evidence). At 2, 3, and 4 years of age, children with non–IgE-mediated CMPA had milk tolerance at rates of 64%, 92%, and 96%, respectively, while children with IgE-mediated allergy were milk tolerant at rates of 31%, 53%, and 63% (level II evidence). Furthermore, children with less reactive SPT results and fewer specific IgE antibodies were milk tolerant sooner than children with more dramatic findings. Taken together, these results suggest that cow's milk protein can be reintroduced in trial style at 1 year of age in children deemed to have non–IgE-mediated allergy, while children suspected of IgE-mediated allergy should not be exposed to cow'southward milk for longer time periods, with the length of fourth dimension guided by allergy testing. Data regarding resolution of other types of MPA are lacking, though children with multiple food allergies are more probable to remain allergic.
When to refer
There are no published guidelines on when to refer infants with MPA to specialist intendance. A list of potential situations in which it is prudent to refer infants for specialized care tin can be found in Table four x (level III evidence).
Table iv
When and to whom to refer infants with milk poly peptide allergy
| CONSULTANT | WHEN TO REFER |
|---|---|
| Dietitian | Counseling for lactating mothers at the time of diagnosis |
| Counseling for introduction of solid foods | |
| Allergist | Suspected anaphylactic allergy |
| Allergy testing earlier reintroducing milk (if IgE-mediated allergy is suspected) | |
| Suspected multiple food allergies (non but milk proteins) | |
| Pediatrician or pediatric gastroenterologist | Significant weight loss (> xx% of birth weight or > 10% current weight if birth weight surpassed) |
| Failure to thrive refractory to initial management | |
| Symptoms refractory to amino acrid–based formula | |
| Feeding aversion |
Summary of a practical arroyo
A diagnostic and treatment algorithm is provided in Figure 1.
Algorithm for diagnosis and handling of milk protein allergy (MPA)
*If anaphylactic allergy is suspected, do not reintroduce allergen. Consult an allergist.
-
Weight should exist followed closely (Table 5 42).
Table 5
Appropriate weight proceeds in infancy
Age (MO) Advisable WEIGHT Proceeds (G/D) 0–3 30 iii–6 15–xx 6–12 x–15 12–24 8–10 -
The timing of clinical response to poly peptide emptying depends on the symptoms observed and the manner of infant feeding.
-
- In formula-fed infants, esophagitis and behavioural symptoms should respond inside 72 hours.
-
- Other non–IgE-mediated symptoms should start to improve within 7 days.
-
- Colitis can take upward to 3 weeks to heal; ongoing bloody stools tin persist even when patients are improving generally.
-
- Advise breastfeeding mothers that a 7-24-hour interval washout of milk proteins is required when instituting a restricted diet, delaying the expected clinical response.
-
-
Milk protein allergy tin can be successfully managed in main care with the support of a dietitian; consultation with other specialists should be reserved for severe allergies, failure to respond to standard management, and specific allergy testing if indicated.
Case resolution
Baby M.'due south bloodwork results revealed the post-obit: platelet count 474 × ten9/mL; albumin 34 g/L; and no eosinophilic leukocytosis. Stool microscopy results revealed many fecal leukocytes per high-powered field. The mother was advised to remove all bovine milk products from her diet. She returned for a followup visit 2 weeks after and reported normalization of stools and resolution of crying with regurgitation. She was brash to resume consumption of moo-cow's milk products. She called the part 3 days subsequently and reported a recurrence of the looser, more frequent stools. Upon removing moo-cow's milk from the diet, the stool pattern improved. A diagnosis of CMPA was fabricated. A dietitian saw female parent and infant when Baby M. was 5 months of age and provided communication regarding introduction of solid foods. Moo-cow'southward milk was reintroduced at eleven.5 months of historic period without a relapse of symptoms, and Infant M. ate cake at her first birthday party.
Acknowledgments
I thank Dr Deanna Telner for her assistance with this manuscript.
Notes
Footnotes
This article has been peer reviewed.
Cet commodity a fait fifty'objet d'une révision par des pairs.
Competing interests
None alleged
References
i. Høst A. Frequency of cow'due south milk allergy in childhood. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):33–7. [PubMed] [Google Scholar]
2. Jakobsson O, Lindberg T. A prospective study of moo-cow'due south milk poly peptide intolerance in Swedish infants. Acta Paediatr Scand. 1979;68(vi):853–9. [PubMed] [Google Scholar]
3. Høst A, Husby S, Osterballe O. A prospective study of cow'due south milk allergy in exclusively breast-fed infants. Incidence, pathogenetic office of early inadvertent exposure to cow's milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr Scand. 1988;77(5):663–70. [PubMed] [Google Scholar]
4. Saarinen KM, Juntunen-Backman Thousand, Järvenpää AL, Klemetti P, Kuitunen P, Lope L, et al. Breast-feeding and the development of cows' milk protein allergy. Adv Exp Med Biol. 2000;478:121–xxx. [PubMed] [Google Scholar]
5. Arshad SH, Tariq SM, Matthews Southward, Hakim E. Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort report. Pediatrics. 2001;108(2):e33. [PubMed] [Google Scholar]
6. Cantani A, Lucenti P. Natural history of soy allergy and/or intolerance in children, and clinical utilise of soy-protein formulas. Pediatr Allergy Immunol. 1997;8(two):59–74. [PubMed] [Google Scholar]
7. Klemola T, Vanto T, Juntunen-Backman K, Kalimo K, Korpela R, Varjonen Due east. Allergy to soy formula and to extensively hydrolyzed whey formula in infants with moo-cow's milk allergy: a prospective, randomized study with a follow-up to the age of two years. J Pediatr. 2002;140(2):219–24. [PubMed] [Google Scholar]
eight. Restani P, Gaiaschi A, Plebani A, Beretta B, Cavagni Grand, Fiocchi A, et al. Crossreactivity between milk proteins from dissimilar animal species. Clin Exp Allergy. 1999;29(vii):997–1004. [PubMed] [Google Scholar]
ix. Baehler P, Republic of chad Z, Gurbindo C, Bonin AP, Bouthillier 50, Seidman EG. Distinct patterns of cow'south milk allergy in infancy divers past prolonged, two-stage doubleblind, placebo-controlled nutrient challenges. Clin Exp Allergy. 1996;26(3):254–61. [PubMed] [Google Scholar]
10. Høst A. Moo-cow's milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol. 1994;five(5 Suppl):1–36. [PubMed] [Google Scholar]
xi. Heine RG, Elsayed S, Hosking CS, Hill DJ. Cow'south milk allergy in infancy. Curr Opin Allergy Clin Immunol. 2002;ii(3):217–25. [PubMed] [Google Scholar]
12. Salvatore South, Vandenplas Y. Gastroesophageal reflux and moo-cow milk allergy: is in that location a link? Pediatrics. 2002;110(5):972–84. [PubMed] [Google Scholar]
xiii. Høst A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy. 1990;45(viii):587–96. [PubMed] [Google Scholar]
fourteen. Martelli A, De Chiara A, Corvo Thousand, Restani P, Fiocchi A. Beef allergy in children with cow'south milk allergy; cow's milk allergy in children with beefiness allergy. Ann Allergy Asthma Immunol. 2002;89(vi Suppl 1):38–43. [PubMed] [Google Scholar]
15. Rozenfeld P, Docena GH, Añón MC, Fossati CA. Detection and identification of a soy protein component that cantankerous-reacts with caseins from cow'southward milk. Clin Exp Immunol. 2002;130(i):49–58. [PMC gratuitous article] [PubMed] [Google Scholar]
16. McLain BI, Cameron DJ, Barnes GL. Is cow's milk protein intolerance a cause of gastro-oesophageal reflux in infancy? J Paeditr Kid Wellness. 1994;30(iv):316–eight. [PubMed] [Google Scholar]
17. Jakobsson I, Lothe L, Borschel MW. Effectiveness of casein hydrolysate feedings in infants with colic. Acta Paediatr. 2000;89(i):18–21. [PubMed] [Google Scholar]
eighteen. Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S, Sachs K, et al. Doubleblind placebo-controlled food challenge (DBPCFC) as an office process: a manual. J Allergy Clin Immunol. 1988;82(vi):986–97. [PubMed] [Google Scholar]
19. García-Ara C, Boyano-Martínez T, Díaz-Pena JM, Martín-Muñoz F, Reche-Frutos 1000, Martín-Esteban M. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the baby. J Allergy Clin Immunol. 2001;107(1):185–90. [PubMed] [Google Scholar]
20. Anveden-Hertzberg 50, Finkel Y, Sandstedt B, Karpe B. Proctocolitis in exclusively breast-fed infants. Eur J Pediatr. 1996;155(half dozen):464–7. [PubMed] [Google Scholar]
21. Canani RB, Ruotolo S, Auricchio L, Caldore M, Porcaro F, Manguso F, et al. Diagnostic accuracy of the atopy patch exam in children with nutrient allergy-related gastrointestinal symptoms. Allergy. 2007;62(7):738–43. [PubMed] [Google Scholar]
22. Järvinen KM, Mäkinen-Kiljunen S, Suomalainen H. Moo-cow'southward milk challenge through man milk evokes immune responses in infants with moo-cow's milk allergy. J Pediatr. 1999;135(iv):506–12. [PubMed] [Google Scholar]
23. Terheggen-Lagro SW, Khouw IM, Schaafsma A, Wauters EA. Safety of a new extensively hydrolysed formula in children with cow'southward milk protein allergy: a double blind crossover report. BMC Pediatr. 2002;ii:10. [PMC costless article] [PubMed] [Google Scholar]
24. McMaster Pediatric Gastroenterology Clinic Milk and dairy free diet [handout]. Hamilton, ON: McMaster Pediatric Gastroenterology Clinic; 2007 [Google Scholar]
26. Sampson HA, Bernhisel-Broadbent J, Yang Due east, Scanlon SM. Prophylactic of casein hydrolysate formula in children with cow milk allergy. J Pediatr. 1991;118(four Pt one):520–5. [PubMed] [Google Scholar]
27. Giampietro PG, Kjellman NI, Oldaeus Chiliad, Wouters-Wesseling W, Businco L. Hypoallergenicity of an extensively hydrolyzed whey formula. Pediatr Allergy Immunol. 2001;12(2):83–six. [PubMed] [Google Scholar]
28. Isolauri Due east, Sütas Y, Mäkinen-Kiljunen Southward, Oja SS, Isosomppi R, Turjanmaa K. Efficacy and prophylactic of hydrolyzed cow milk and amino acid-derived formulas in infants with cow milk allergy. J Pediatr. 1995;127(4):550–7. [PubMed] [Google Scholar]
29. Halken South, Høst A, Hansen LG, Osterballe O. Safety of a new, ultrafiltrated whey hydrolysate formula in children with cow milk allergy: a clinical investigation. Pediatr Allergy Immunol. 1993;four(2):53–9. [PubMed] [Google Scholar]
30. Rosendal A, Barkholt V. Detection of potentially allergenic material in 12 hydrolyzed milk formulas. J Dairy Sci. 2000;83(x):2200–10. [PubMed] [Google Scholar]
31. Cantani A, Micera M. Immunogenicity of hydrolysate formulas in children (part 1). Assay of 202 reactions. J Investig Allergol Clin Immunol. 2000;10(5):261–76. [PubMed] [Google Scholar]
32. Cantani A, Micera M. Immunogenicity of hydrolysate formulas in children (part two): 41 example reports. J Investig Allergol Clin Immunol. 2001;11(1):21–6. [PubMed] [Google Scholar]
33. Fiocchi A, Travaini Grand, D'Auria E, Banderali Thousand, Bernardo L, Riva East. Tolerance to a rice hydrolysate formula in children allergic to cow'south milk and soy. Clin Exp Allergy. 2003;33(11):1576–80. [PubMed] [Google Scholar]
34. Niggemann B, Binder C, Dupont C, Hadji Due south, Arvola T, Isolauri Eastward. Prospective, controlled, multi-center report on the effect of an amino-acid-based formula in infants with cow'southward milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol. 2001;12(2):78–82. [PubMed] [Google Scholar]
35. De Boissieu D, Dupont C, Badoual J. Allergy to nondairy proteins in mother's milk as assessed by abdominal permeability tests. Allergy. 1994;49(10):882–4. [PubMed] [Google Scholar]
36. Fiocchi A, Assa'ad A, Bahna S. Agin Reactions to Foods Commission, American College of Allergy, Asthma and Immunology Food allergy and the introduction of solid foods to infants: a consensus document. Ann Allergy Asthma Immunol. 2006;97(i):10–21. [PubMed] [Google Scholar]
37. Joshi P, Mofidi Southward, Sicherer SH. Interpretation of commercial nutrient ingredient labels by parents of food-allergic children. J Allergy Clin Immunol. 2002;109(6):1019–21. [PubMed] [Google Scholar]
38. Canadian Paediatric Society, Dietitians of Canada, Health Canada Nutrition for good for you term infants—statement of the Joint Working Group: Canadian Paediatric Society, Dietitians of Canada and Health Canada. Ottawa, ON: Health Canada; 2005. Bachelor from: www.hc-sc.gc.ca/fn-an/pubs/babe-nourrisson/nut_infant_nourrisson_term-eng.php Accessed 2008 Apr 21. [Google Scholar]
39. Baehler P, Seidman EG.Gastrointestinal manifestations of food-protein-induced hypersensitivity: eosinophilic gastroenteritis Rudolph CD, Rudolph AM, Hostetter MK, Lister Thousand, Siegel NJ, editors. Rudolph's pediatrics. 21st edNew York, NY: McGraw-Hill Professional; 20031444–7. [Google Scholar]
40. Carroccio A, Montalto G, Custro N, Notarbartolo A, Cavataio F, D'Amico D, et al. Evidence of very delayed clinical reactions to moo-cow'southward milk in moo-cow'south milk-intolerant patients. Allergy. 2000;55(6):574–9. [PubMed] [Google Scholar]
41. Vanto T, Helppilä S, Juntunen-Backman M, Kalimo K, Klemola T, Korpela R, et al. Prediction of the development of tolerance to milk in children with milk hypersensitivity. J Pediatr. 2004;144(2):218–22. [PubMed] [Google Scholar]
42. Overby KJ. Pediatric wellness supervision: physical growth. In: Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, translators. Rudolph'due south pediatrics. 21st ed. New York, NY: McGraw-Hill Professional person; 2003. p. 5. [Google Scholar]
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