Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol 126:77-82.e71

Allergy and Immunology Institute, Assaf-Harofeh Medical Center, Zerifin, Israel.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 07/2010; 126(1):77-82.e1. DOI: 10.1016/j.jaci.2010.04.020
Source: PubMed


The diversity in the perceived prevalence, recovery, and risk factors for cow's milk allergy (CMA) necessitated a large-scale, population-based prospective study.
We sought to determine the prevalence, cross-reactivity with soy allergy, and risk factors for the development of CMA.
In a prospective study the feeding history of 13,019 infants was obtained by means of telephone interview (95.8%) or questionnaire (4.2%). Infants with probable adverse reactions to milk were examined, skin prick tested, and challenged orally.
Ninety-eight percent of the cohort participated in the study. The cumulative incidence for IgE-mediated CMA was 0.5% (66/13,019 patients). The mean age of cow's milk protein (CMP) introduction was significantly different (P < .001) between the healthy infants (61.6 +/- 92.5 days) and those with IgE-mediated CMA (116.1 +/- 64.9 days). Only 0.05% of the infants who were started on regular CMP formula within the first 14 days versus 1.75% who were started on formula between the ages of 105 and 194 days had IgE-mediated CMA (P < .001). The odds ratio was 19.3 (95% CI, 6.0-62.1) for development of IgE-mediated CMA among infants with exposure to CMP at the age of 15 days or more (P < .001). Sixty-four patients with IgE-mediated CMA tolerated soy, and none had a proved allergy to soy.
IgE-mediated CMA is much less common than generally reported. Early exposure to CMP as a supplement to breast-feeding might promote tolerance. Finally, soy is a reasonable feeding alternative in patients with IgE-mediated CMA.

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Available from: Eli Eisenberg, Oct 05, 2015
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    • "This hypothesis, however, is not so straightforward. Greater exposure at a young age to allergens such as peanut, hen’s egg, or cow’s milk can have the opposite result [17,18], whereby increased exposure supports tolerance. There also remains a lack of clinically-based recommendations for safe consumption levels of allergenic foods and the processed consumables made from these foods. "
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    ABSTRACT: Presented here are emerging capabilities to precisely measure endogenous allergens in soybean and maize, consideration of food matrices on allergens, and proteolytic activity of allergens. Also examined are observations of global allergy surveys and the prevalence of food allergy across different locales. Allergenic potential is considered in the context of how allergens can be characterized for their biochemical features and the potential for proteins to initiate a specific immune response. Some of the limitations in performing allergen characterization studies are examined. A combination of physical traits of proteins, the molecular interaction between cells and proteins in the human body, and the uniqueness of human culture play a role in understanding and eventually predicting protein allergy potential. The impact of measuring food allergens on determining safety for novel food crops and existing allergenic foods was highlighted with the conclusion that measuring content without the context of clinically relevant thresholds adds little value to safety. These data and findings were presented at a 2012 international symposium in Prague organized by the Protein Allergenicity Technical Committee of the International Life Sciences Institute's Health and Environmental Sciences Institute.
    04/2014; 4(1):11. DOI:10.1186/2045-7022-4-11
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    • "One possible explanation is the extended period of avoidance of cow's milk protein from the diet increases the risk of developing secondary IgE-CMA. The reason that this shift was not reported more frequently probably rests with earlier ambiguity in the diagnosis of IgE-mediated milk allergy and non-IgE mediated symptoms, in young infants [58]. Given that now the awareness and proper diagnosis of FPIES are increasing, it is expected that this phenomenon will be recognized more frequently, and likely with other foods, as well. "
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    ABSTRACT: Because of the paucity of reports and variability in the diagnostic criteria utilized, little is known regarding the natural outcome of patients with food protein-induced enterocolitis syndrome (FPIES). Data extracted from referenced manuscripts, as well as allergists' unpublished observations from across the globe, were used to form a cohesive opinion regarding its natural outcome. All authors concur that there is a generally high rate of recovery for FPIES. The most common foods causing FPIES are milk and soy. Depending upon which study is analyzed, by the age of 3-5 years, approximately 90% of patients recover from their disease. Recovery from FPIES to solid foods, occurs at a later age, but may reflect a later stage of introduction of the food into the diet. An important clinical outcome, although not common, is a shift from FPIES food hypersensitivity to an IgE-mediated food allergy. This necessitates a change in the oral food challenge protocol, if IgE-mediated sensitization is detected. Over the past several years, there has been an increasing awareness of FPIES. This knowledge should lead to a more timely diagnosis and should reassure parents and practitioners alike regarding its favorable course.
    Current Opinion in Allergy and Clinical Immunology 03/2014; 14(3). DOI:10.1097/ACI.0000000000000053 · 3.57 Impact Factor
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    • "Narrative review of soya infant formulas; includes studies considered in this review Pedrosa, 2006 (79) Analysis of palatability of soya and other infant formulas D'Auria, 2006 (80) Letter to editor related to paper by Seppo on the impact of soya formulas on growth Osbron, 2006 (81) Systematic review of the efficacy of soya in preventing allergy Ostrom, 2006 (82) RCT on soya infant formula efficacy for regurgitation treatment Ballmer-Weber, 2007 (83) Clinical characteristics of allergy to soya Fortres, 2007 (84) Portuguese paper on phyto-oestrogen intake and thelarche Halm, 2007 (85) Comparison of phyto-oestrogen levels in urine between children and adults eating soya nuts Turck, 2007 (86) Narrative review of indications of soya and safety issues Song, 2007 (87) Narrative review of the positive and negative effects of soya; studies on soya formula already considered Agostoni, 2007 (88) Effects of soya on weight/age and length/age in children aged 6– 12 months; does not include reports on the basal and final measurements of weight-only and height-only differences Wolff, 2008 (89) Cohort study related to puberty in girls analysing exposure to soya, but not to a soya infant formula Zuidmeer, 2008 (90) Prevalence of plant allergies, including allergy to soya, across countries; no safety parameters on infant formulas reported Johnson, 2008 (91) Narrative review of some articles that describe safety issues regarding soya infant formulas, already considered in this review Ngamphaiboon, 2008 (92) Description of CMPA in Thai children Mehr, 2008 (93) Food choices for CMPA; no safety parameters on soya analysed Boucher, 2008 (94) Epidemiological study of the early intake of soya and protective effect against breast cancer Kemp, 2008 (95) Consensus about the best treatment for CMPA; no safety parameters on soya analysed Bernbaum, 2008 (96) Pilot study to evaluate the validity of different techniques to measure breast bud, testicular volume and breast adipose tissue in children; no correlationship study between soya intake and maturation abnormalities Koplin, 2008 (97) Use of soya and allergy to peanuts; no other safety parameters analysed Caminiti, 2009 (98) Analysis of cross-reaction to soya; no other safety parameters analysed Antunes, 2009 (99) Analysis of allergy to soya and extensively hydrolysed formulas; no other safety parameters reported Badger, 2009 (100) Narrative review of some basic and clinical studies of the effects of soya on health; includes some papers considered in this review Lee, 2009 (101) Epidemiological study of the intake of soya during adolescence and protective effect against breast cancer Korde, 2009 (102) Epidemiological study of the early intake of soya and protective effect against breast cancer Guest, 2009 (103) Health economics model of treatment for CMPA; safety parameters on soya not evaluated Palmer, 2009 (104) Urogenital effects of in utero exposure to diethylstilbestrol in males; does not include studies on infant formulas Cederroth, 2009 (105) Effects of soya on male reproductive function; animal studies; does not include paediatric studies on soya infant formulas Vandenplas, 2011 (106) Narrative review on the safety of soya infant formulas; some papers cited are analysed in this review Dias, 2010 (107) Persistence of CMPA and use of different infant formulas; no safety parameters on soya reported Bolca, 2010 (108) Soya isoflavones in breast tissue of women under breast resection Cheng, 2010 (109) Cohort study of soya ingestion during adolescence; not related to infant formulas Terracciano, 2010 (110) Analysis of soya allergy; no other safety parameters reported Tillet, 2010 (111) Informative letter of toxicology classification Nacmias, 2010 (112) Paper related to allergy to soya in neonates; no other safety parameters reported Sladkevicius, 2010 (113) Health economics analysis of soya use Katz, 2010 (114) Paper related to allergy to soya; no other safety parameters reported Patisaul, 2010 (115) Narrative description of biochemical, basic, clinical and epidemiological studies of soya; includes analysis of papers related to soya infant formulas, already considered in this review Donovan, 2010 (116) Description of soya effects on intestinal cell proliferation and antirotavirus effect; no safety parameters on soya reported Dinsdale, 2010 (117) Narrative review focused on animal and human studies on potential soya toxicity; non-systematic analysis concludes that there is no evidence of soya infant formula toxicity in children Wada, 2011 (118) Cross-sectional study of the correlationship between soya in diet and urinary level of sex hormones in boys/girls aged 4 –6 years; no history about soya infant formulas is recorded McCarver, 2011 (119) Exhaustive narrative review focused on animal and human studies; non-systematic analysis concludes that there is no evidence of soya infant formula toxicity in children Kim, 2011 (120) Case – control study in 7–10·2-year-old girls to establish a correlationship between isoflavones in serum and precocious puberty; no diet history analysed; does not include a discussion on soya infant formulas Kattan, 2011 (121) Narrative review of soya allergy; no safety parameters on soya reported Dabeka, 2011 (122) Comparative analysis of aluminium in different food products for children; no safety parameters reported Degen, 2011 (123) Measurements of isoflavones in urine of 6–18-year-old children; no history about soya infant formulas reported Nguyen, 2011 (124) US measurements of different organs in children fed soya, cows' milk or HM; no mathematical data reported; only graphs and P values reported Jefferson, 2011 (125) Narrative review of basic, clinical and epidemiological studies of the effects of soya in animal models and human subjects; describes some important papers included in this review Durham, 2011 (126) Analysis of food allergy; no safety parameters on soya reported Levi, 2012 (127) Utility of atopy patch in atopic dermatitis; no safety parameters on soya reported Jefferson, 2012 (128) Narrative review of basic, clinical and epidemiological studies of the effects of soya in animal models and human subjects; describes some important papers included in this review Blom, 2012 (129) Analysis of allergy to soya; no other safety parameters reported Crinella, 2012 (130) Narrative review of different hypotheses related to ADHD, with focus on manganese toxicity; brief description of possible association of soya, manganese and ADHD CMPA, cows' milk protein allergy; RCT, randomised controlled trial; HM, human milk; ADHD, attention deficit hyperactivity disorder. "
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    ABSTRACT: Soya-based infant formulas (SIF) containing soya flour were introduced almost 100 years ago. Modern soya formulas are used in allergy/intolerance to cows' milk-based formulas (CMF), post-infectious diarrhoea, lactose intolerance and galactosaemia, as a vegan human milk (HM) substitute, etc. The safety of SIF is still debated. In the present study, we reviewed the safety of SIF in relation to anthropometric growth, bone health (bone mineral content), immunity, cognition, and reproductive and endocrine functions. The present review includes cross-sectional, case-control, cohort studies or clinical trials that were carried out in children fed SIF compared with those fed other types of infant formulas and that measured safety. The databases that were searched included PubMed (1909 to July 2013), Embase (1988 to May 2013), LILACS (1990 to May 2011), ARTEMISA (13th edition, December 2012), Cochrane controlled trials register, Bandolier and DARE using the Cochrane methodology. Wherever possible, a meta-analysis was carried out. We found that the anthropometric patterns of children fed SIF were similar to those of children fed CMF or HM. Despite the high levels of phytates and aluminium in SIF, Hb, serum protein, Zn and Ca concentrations and bone mineral content were found to be similar to those of children fed CMF or HM. We also found the levels of genistein and daidzein to be higher in children fed SIF; however, we did not find strong evidence of a negative effect on reproductive and endocrine functions. Immune measurements and neurocognitive parameters were similar in all the feeding groups. In conclusion, modern SIF are evidence-based safety options to feed children requiring them. The patterns of growth, bone health and metabolic, reproductive, endocrine, immune and neurological functions are similar to those observed in children fed CMF or HM.
    The British journal of nutrition 02/2014; 111(8):1-21. DOI:10.1017/S0007114513003942 · 3.45 Impact Factor
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