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The natural history of cow's milk protein allergy/intolerance.

Abstract

In prospective studies th incidence of cow's milk protein allergy and intolerance (CMPA/CMPI) in infancy in western industrialized countries has been estimated to be about 2-3% based on strict diagnostic criteria. A significant association between early neonatal exposure to cow's milk formula feeding and subsequent development of CMPA/CMPI has been documented. The small amounts of 'foreign' protein in human milk may rather induce tolerance than allergic sensitization. The findings of specific IgE to individual cow's milk proteins in cord blood of the majority of infants who later develop CMPA/CMPI suggests a prenatal sensitization may play a role in the pathogenesis of CMPA/CMPI. Perhaps a weak intrauterine education of low IgE-response may need to 'boosted' neonatally in order to cause clinical disease. The prognosis of CMPA/CMPI is good with a recovery of about 45-56% at one year, 60-77% at two years and 71-87% at three years. Associated adverse reactions to other foods, especially egg, soy, peanut and citrus develop in about 41-54%. Allergy to potential environmental inhalant allergens has been reported in up to 28% by three years and up to 80% before the age of puberty. Especially, infants with an early increased IgE response to cow's milk protein have an increased risk of persisting CMPA, development of persistent adverse reactions to other foods and development of allergy against environmental inhalant allergens. Cow's milk protein/intolerance (CMPA/CMPI), meaning reproducible adverse reactions to cow's milk protein(s) may be due to the interaction between one or more milk proteins and one or more immune mechanisms, possible any of the four basic types of hypersensitivity reactions. Immunologically mediated reactions are defined as CMPA. Mostly, CMPA is caused by IgE-mediated (type I) reactions, but evidence for type III (immune complex) reactions and type IV (cell mediated reactions) have been demonstrated as reviewed by Høst (1994) and Ortolani & Vighi (1995). Non immunologically reactions against cow's milk protein(s) are defined as CMPI. However, it should be stressed that many studies on 'cow's milk allergy' have not investigated the immunological basis of the clinical reactions. In most instances of cow's milk protein hypersensitivity only diagnostic investigations such as skin prick test and RAST indicative of IgE-mediated reactions are performed. In fact, CMPA cannot be ruled out unless extensive diagnostic tests for type II-III-IV reactions have proved negative. Thus, the classification of adverse reactions to cow's milk proteins depends on the extent and the quality of performed diagnostic tests for immune mediated reactions. At present, no single laboratory test is diagnostic of CMPA/CMPI, and differentiation between CMPA and CMPI cannot be based solely on clinical symptoms. Therefore the diagnosis has to be based on strict well-defined elimination and milk challenge procedure (Hill & Hosking, 1991), (Høst, 1994). Preferably, double-blind placebo-controlled challenges (DBPCFC) should be carried out in children older than 1-2 years of age. In infants open controlled challenges have been shown to be reliable when performed under professional observation in a hospital setting (Høst & Halken, 1990).

Authors+Show Affiliations

,

Department of Pediatrics, Odense University Hospital, Denmark.

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Source

European journal of clinical nutrition 49 Suppl 1: 1995 Sep pg S13-8

MeSH

Child, Preschool
Diagnosis, Differential
Humans
Hypersensitivity, Delayed
Incidence
Infant
Milk Hypersensitivity
Prognosis

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

8647059

Citation

Høst, A, et al. "The Natural History of Cow's Milk Protein Allergy/intolerance." European Journal of Clinical Nutrition, vol. 49 Suppl 1, 1995, pp. S13-8.
Høst A, Jacobsen HP, Halken S, et al. The natural history of cow's milk protein allergy/intolerance. Eur J Clin Nutr. 1995;49 Suppl 1:S13-8.
Høst, A., Jacobsen, H. P., Halken, S., & Holmenlund, D. (1995). The natural history of cow's milk protein allergy/intolerance. European Journal of Clinical Nutrition, 49 Suppl 1, pp. S13-8.
Høst A, et al. The Natural History of Cow's Milk Protein Allergy/intolerance. Eur J Clin Nutr. 1995;49 Suppl 1:S13-8. PubMed PMID: 8647059.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The natural history of cow's milk protein allergy/intolerance. AU - Høst,A, AU - Jacobsen,H P, AU - Halken,S, AU - Holmenlund,D, PY - 1995/9/1/pubmed PY - 1995/9/1/medline PY - 1995/9/1/entrez SP - S13 EP - 8 JF - European journal of clinical nutrition JO - Eur J Clin Nutr VL - 49 Suppl 1 N2 - In prospective studies th incidence of cow's milk protein allergy and intolerance (CMPA/CMPI) in infancy in western industrialized countries has been estimated to be about 2-3% based on strict diagnostic criteria. A significant association between early neonatal exposure to cow's milk formula feeding and subsequent development of CMPA/CMPI has been documented. The small amounts of 'foreign' protein in human milk may rather induce tolerance than allergic sensitization. The findings of specific IgE to individual cow's milk proteins in cord blood of the majority of infants who later develop CMPA/CMPI suggests a prenatal sensitization may play a role in the pathogenesis of CMPA/CMPI. Perhaps a weak intrauterine education of low IgE-response may need to 'boosted' neonatally in order to cause clinical disease. The prognosis of CMPA/CMPI is good with a recovery of about 45-56% at one year, 60-77% at two years and 71-87% at three years. Associated adverse reactions to other foods, especially egg, soy, peanut and citrus develop in about 41-54%. Allergy to potential environmental inhalant allergens has been reported in up to 28% by three years and up to 80% before the age of puberty. Especially, infants with an early increased IgE response to cow's milk protein have an increased risk of persisting CMPA, development of persistent adverse reactions to other foods and development of allergy against environmental inhalant allergens. Cow's milk protein/intolerance (CMPA/CMPI), meaning reproducible adverse reactions to cow's milk protein(s) may be due to the interaction between one or more milk proteins and one or more immune mechanisms, possible any of the four basic types of hypersensitivity reactions. Immunologically mediated reactions are defined as CMPA. Mostly, CMPA is caused by IgE-mediated (type I) reactions, but evidence for type III (immune complex) reactions and type IV (cell mediated reactions) have been demonstrated as reviewed by Høst (1994) and Ortolani & Vighi (1995). Non immunologically reactions against cow's milk protein(s) are defined as CMPI. However, it should be stressed that many studies on 'cow's milk allergy' have not investigated the immunological basis of the clinical reactions. In most instances of cow's milk protein hypersensitivity only diagnostic investigations such as skin prick test and RAST indicative of IgE-mediated reactions are performed. In fact, CMPA cannot be ruled out unless extensive diagnostic tests for type II-III-IV reactions have proved negative. Thus, the classification of adverse reactions to cow's milk proteins depends on the extent and the quality of performed diagnostic tests for immune mediated reactions. At present, no single laboratory test is diagnostic of CMPA/CMPI, and differentiation between CMPA and CMPI cannot be based solely on clinical symptoms. Therefore the diagnosis has to be based on strict well-defined elimination and milk challenge procedure (Hill & Hosking, 1991), (Høst, 1994). Preferably, double-blind placebo-controlled challenges (DBPCFC) should be carried out in children older than 1-2 years of age. In infants open controlled challenges have been shown to be reliable when performed under professional observation in a hospital setting (Høst & Halken, 1990). SN - 0954-3007 UR - https://www.unboundmedicine.com/medline/citation/8647059/The_natural_history_of_cow's_milk_protein_allergy/intolerance_ DB - PRIME DP - Unbound Medicine ER -