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New Insights into Cow's Milk and Allergy

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 41500

Special Issue Editors


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Guest Editor
Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Via Roma 67, 56126 Pisa, Italy
Interests: allergy; atopy; sensitization; child; cow's milk allergy; mechanisms; asthma; diagnosis
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Guest Editor
1. Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
2. Department of Pediatrics, Buzzi Children’s Hospital, 20157 Milano, Italy
Interests: pediatric infectious diseases; pediatric nutrition; children; malnutrition; obesity; global health; telemedicine; digital health; preventive medicine; translational research
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
1. Department of Health Sciences, Università di Milano, 20122 Milan, Italy
2. Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
Interests: enteral and parenteral nutrition; neurologically impaired children; childhood obesity; metabolic syndrome; gut microbiota
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Allergic diseases, such as food allergies, are heterogeneous inflammatory immune-mediated disorders that have shown a significantly increased prevalence in Western countries in recent decades. Cow’s milk allergy (CMA) represents a model for evaluating the natural history of food allergies; in this Special Issue, data and revisions on the prevalence, age of onset and duration of food allergies will be provided. Information regarding prevention measures, follow-up recommendations and the use of alternative formulas and for how long will make up part of the Special Issue. Different mechanisms are involved in CMA with different clinical signs and symptoms: IgE-mediated and non-IgE-mediated manifestations will be elucidated, considering the very recent literature. Furthermore, CMA is present during childhood, adolescence and even adulthood. Thus, the management of patients with CMA is of interest not only for the pediatrician but also for the adult allergist, which will be discussed in this Special Issue.

Prof. Dr. Diego Peroni
Prof. Dr. Gian Vincenzo Zuccotti
Prof. Dr. Elvira Verduci 
Guest Editors

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Keywords

  • cow's milk allergy
  • sensitization
  • mechanisms
  • diagnosis
  • natural history
  • follow-up
  • tolerance
  • alternative formulae
  • allergy
  • supplementation

Published Papers (7 papers)

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Editorial

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3 pages, 178 KiB  
Editorial
New Insights in Cow’s Milk and Allergy: Is the Gut Microbiota the Missing Link?
by Elvira Verduci, Gian Vincenzo Zuccotti and Diego G. Peroni
Nutrients 2022, 14(8), 1631; https://doi.org/10.3390/nu14081631 - 14 Apr 2022
Cited by 1 | Viewed by 1577
Abstract
The present Editorial derives from the Special Issue “New Insights into Cow’s Milk and Allergy” recently published in Nutrients [...] Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)

Research

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15 pages, 673 KiB  
Article
The Use of an Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy—Effect on Clinical Outcomes
by Katy Sorensen, Abbie L. Cawood, Lisa H. Cooke, Dionisio Acosta-Mena and Rebecca J. Stratton
Nutrients 2021, 13(7), 2205; https://doi.org/10.3390/nu13072205 - 27 Jun 2021
Cited by 5 | Viewed by 4724
Abstract
Cow’s milk protein allergy (CMPA) is common and costly. Clinical trials of infants with CMPA have shown that the use of an amino acid formula containing pre- and probiotics (synbiotics) (AAF-Syn) may lead to significant reductions in infections, medication prescriptions and hospital admissions, [...] Read more.
Cow’s milk protein allergy (CMPA) is common and costly. Clinical trials of infants with CMPA have shown that the use of an amino acid formula containing pre- and probiotics (synbiotics) (AAF-Syn) may lead to significant reductions in infections, medication prescriptions and hospital admissions, compared to AAF without synbiotics. These effects have not yet been confirmed in real-world practice. This retrospective matched cohort study examined clinical and healthcare data from The Health Improvement Network database, from 148 infants with CMPA (54% male, mean age at diagnosis 4.69 months), prescribed either AAF-Syn (probiotic Bifidobacterium breve M16-V and prebiotics, including chicory-derived oligo-fructose and long-chain inulin) or AAF. AAF-Syn was associated with fewer symptoms (−37%, p < 0.001), infections (−35%, p < 0.001), medication prescriptions (−19%, p < 0.001) and healthcare contacts (−18%, p = 0.15) vs. AAF. Infants prescribed AAF-Syn had a significantly higher probability of achieving asymptomatic management without hypoallergenic formula (HAF) (adjusted HR 3.70, 95% CI 1.97–6.95, p < 0.001), with a shorter clinical course of symptoms (median time to asymptomatic management without HAF 1.35 years vs. 1.95 years). AAF-Syn was associated with potential cost-savings of £452.18 per infant over the clinical course of symptoms. These findings may be attributable to the effect of the specific synbiotic on the gut microbiome. Further research is warranted to explore this. This real-world study provides evidence consistent with clinical trials that AAF-Syn may produce clinical and healthcare benefits with potential economic impact. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
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Review

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21 pages, 359 KiB  
Review
Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips
by Enza D’Auria, Silvia Salvatore, Miriam Acunzo, Diego Peroni, Erica Pendezza, Elisabetta Di Profio, Giulia Fiore, Gian Vincenzo Zuccotti and Elvira Verduci
Nutrients 2021, 13(8), 2762; https://doi.org/10.3390/nu13082762 - 12 Aug 2021
Cited by 23 | Viewed by 6899
Abstract
An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of [...] Read more.
An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
13 pages, 536 KiB  
Review
COVID-19 Vaccines in Children with Cow’s Milk and Food Allergies
by Lucia Liotti, Annamaria Bianchi, Paolo Bottau, Silvia Caimmi, Giuseppe Crisafulli, Fabrizio Franceschini, Francesca Mori, Claudia Paglialunga, Francesca Saretta and Carlo Caffarelli
Nutrients 2021, 13(8), 2637; https://doi.org/10.3390/nu13082637 - 30 Jul 2021
Cited by 9 | Viewed by 6598
Abstract
The COVID-19 pandemic is the most challenging global health crisis of our times. Vaccination against COVID-19 plays a key role to control the current pandemic situation. The risk of allergic reactions to new COVID-19 vaccines is low. However, there is a debate on [...] Read more.
The COVID-19 pandemic is the most challenging global health crisis of our times. Vaccination against COVID-19 plays a key role to control the current pandemic situation. The risk of allergic reactions to new COVID-19 vaccines is low. However, there is a debate on the safety in allergic patients following post marketing findings by different agencies. Our aim is to understand from current experiences whether children with cow’s milk or food allergy are at higher risk than a general population for allergic reactions to COVID-19 vaccines. Current data indicate that patients with a history of allergy to cow’s milk or other foods, even if severe, should receive COVID-19 vaccine in a setting with availability of treatments for anaphylactic reactions and under medical supervision. Recipients should be discharged after a protracted observation period of 30 min if no reaction developed. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
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16 pages, 1273 KiB  
Review
Nutraceuticals in Viral Infections: An Overview of the Immunomodulating Properties
by Giorgio Costagliola, Giulia Nuzzi, Erika Spada, Pasquale Comberiati, Elvira Verduci and Diego G. Peroni
Nutrients 2021, 13(7), 2410; https://doi.org/10.3390/nu13072410 - 14 Jul 2021
Cited by 16 | Viewed by 4132
Abstract
Nutraceuticals, including vitamin D, vitamin A, zinc, lactoferrin, polyphenols coenzyme Q, magnesium, and selenium, are implicated in the modulation of the complex molecular pathways involved in the immune response against viral pathogens. A common element of the activity of nutraceuticals is their ability [...] Read more.
Nutraceuticals, including vitamin D, vitamin A, zinc, lactoferrin, polyphenols coenzyme Q, magnesium, and selenium, are implicated in the modulation of the complex molecular pathways involved in the immune response against viral pathogens. A common element of the activity of nutraceuticals is their ability to enhance the innate immune response against pathogens by acting on the major cellular subsets and inducing the release of pro-inflammatory cytokines and antimicrobial peptides. In some cases, this action is accompanied by a direct antimicrobial effect, as evidenced in the specific case of lactoferrin. Furthermore, nutraceuticals act through complex molecular mechanisms to minimize the damage caused by the activation of the immune system against pathogens, reducing the oxidative damage, influencing the antigen presentation, enhancing the differentiation and proliferation of regulatory T cells, driving the differentiation of lymphocyte subsets, and modulating the production of pro-inflammatory cytokines. In this paper, we review the main molecular mechanisms responsible for the immunomodulatory function of nutraceuticals, focusing on the most relevant aspects for the prevention and treatment of viral infections. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
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21 pages, 792 KiB  
Review
Cow’s Milk Protein Allergy as a Model of Food Allergies
by Arianna Giannetti, Gaia Toschi Vespasiani, Giampaolo Ricci, Angela Miniaci, Emanuela di Palmo and Andrea Pession
Nutrients 2021, 13(5), 1525; https://doi.org/10.3390/nu13051525 - 30 Apr 2021
Cited by 29 | Viewed by 8295
Abstract
Cow’s milk allergy (CMA) is one of the most common food allergies in infants, and its prevalence has increased over recent years. In the present paper, we focus on CMA as a model of food allergies in children. Understanding the diagnostic features of [...] Read more.
Cow’s milk allergy (CMA) is one of the most common food allergies in infants, and its prevalence has increased over recent years. In the present paper, we focus on CMA as a model of food allergies in children. Understanding the diagnostic features of CMA is essential in order to manage patients with this disorder, guide the use of an elimination diet, and find the best moment to start an oral food challenge (OFC) and liberalize the diet. To date, no shared tolerance markers for the diagnosis of food allergy have been identified, and OFC remains the gold standard. Recently, oral immunotherapy (OIT) has emerged as a new therapeutic strategy and has changed the natural history of CMA. Before this, patients had to strictly avoid the food allergen, resulting in a decline in quality of life and subsequent nutritional, social, and psychological impairments. Thanks to the introduction of OIT, the passive approach involving rigid exclusion has changed to a proactive one. Both the heterogeneity in the diagnostic process among the studies and the variability of OIT data limit the comprehension of the real epidemiology of CMA, and, consequentially, its natural history. Therefore, well-planned randomized controlled trials are needed to standardize CMA diagnosis, prevention, and treatment strategies. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
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20 pages, 1244 KiB  
Review
Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis
by Katy Sorensen, Abbie L. Cawood, Glenn R. Gibson, Lisa H. Cooke and Rebecca J. Stratton
Nutrients 2021, 13(3), 935; https://doi.org/10.3390/nu13030935 - 14 Mar 2021
Cited by 25 | Viewed by 7879
Abstract
Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four [...] Read more.
Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four randomised controlled trials comparing an amino acid formula (AAF) with an AAF containing synbiotics (AAF-Syn) in infants with CMPA (mean age 8.6 months; 68% male, mean intervention 27.3 weeks, n = 410). AAF and AAF-Syn were equally effective in managing allergic symptoms and promoting normal growth. Compared to AAF, significantly fewer infants fed AAF-Syn had infections (OR 0.35 (95% CI 0.19–0.67), p = 0.001). Overall medication use, including antibacterials and antifectives, was lower among infants fed AAF-Syn. Significantly fewer infants had hospital admissions with AAF-Syn compared to AAF (8.8% vs. 20.2%, p = 0.036; 56% reduction), leading to potential cost savings per infant of £164.05–£338.77. AAF-Syn was associated with increased bifidobacteria (difference in means 31.75, 95% CI 26.04–37.45, p < 0.0001); reduced Eubacterium rectale and Clostridium coccoides (difference in means −19.06, 95% CI −23.15 to −14.97, p < 0.0001); and reduced microbial diversity (p < 0.05), similar to that described in healthy breastfed infants, and may be associated with the improved clinical outcomes described. This review provides evidence that suggests combining synbiotics with AAF produces clinical benefits with potential economic implications. Full article
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
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