Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report.

Department of Child and Maternal Medicine, Melloni Hospital, Milan, Italy.
The Journal of allergy and clinical immunology (Impact Factor: 11.25). 12/2010; 126(6):1119-28.e12. DOI: 10.1016/j.jaci.2010.10.011
Source: PubMed

ABSTRACT The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge.

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    ABSTRACT: Background Characterisation of the specific antibody response, including the epitope binding pattern, is an essential task for understanding the molecular mechanisms of food allergy. Examination of antibody formation in a controlled environment requires animal models. The purpose of this study was to examine the amount and types of antibodies raised against three cow’s milk allergens; β-lactoglobulin (BLG), α-lactalbumin (ALA) and β-casein upon oral or intraperitoneal (i.p.) administration. A special focus was given to the relative amount of antibodies raised against linear versus conformational epitopes. Methods Specific antibodies were raised in Brown Norway (BN) rats. BN rats were dosed either (1) i.p. with the purified native cow’s milk allergens or (2) orally with skimmed milk powder (SMP) alone or together with gluten, without the use of adjuvants. The allergens were denatured by reduction and alkylation, resulting in unfolding of the primary structure and a consequential loss of conformational epitopes. The specific IgG1 and IgE responses were analysed against both the native and denatured form of the three cow’s milk allergens, thus allowing examination of the relative amount of linear versus conformational epitopes. Results The inherent capacity to induce specific IgG1 and IgE antibodies were rather similar upon i.p. administration for the three cow’s milk allergens, with BLG = ALA > β-casein. Larger differences were found between the allergens upon oral administration, with BLG > ALA > β-casein. Co-administration of SMP and gluten had a great impact on the specific antibody response, resulting in a significant reduced amount of antibodies. Together results indicated that most antibodies were raised against conformational epitopes irrespectively of the administration route, though the relative proportions between linear and conformational epitopes differed remarkably between the allergens. Conclusions This study showed that the three-dimensional (3D) structure has a significant impact on the antibodies raised for both systemic and orally administered allergens. A remarkable difference in the antibody binding patterns against linear and conformational epitope was seen between the allergens, indicating that the structural characteristics of proteins may heavily affect the induced antibody response.
    08/2014; 4:25. DOI:10.1186/2045-7022-4-25
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    ABSTRACT: Food allergy is an aberrant immune-mediated reaction against harmless food substances, such as cow's milk proteins. Due to its very early introduction, cow's milk allergy is one of the earliest and most common food allergies. For this reason cow's milk allergy can be recognized as one of the first indications of an aberrant inflammatory response in early life. Classically, cow's milk allergy, as is true for most other allergies as well, is primarily associated with abnormal humoral immune responses, that is, elevation of specific immunoglobulin E levels. There is growing evidence indicating that cellular components of both innate and adaptive immunity play significant roles during the pathogenesis of cow's milk allergy. This is true for the initiation of the allergic phenotype (stimulation and skewing towards sensitization), development and outgrowth of the allergic disease. This review discusses findings pertaining to roles of cellular immunity in allergic inflammation, and tolerance induction against cow's milk proteins. In addition, a possible interaction between immune mechanisms underlying cow's milk allergy and other types of inflammation (infections and noncommunicable diseases) is discussed.
    Mediators of Inflammation 06/2014; 2014:249784. DOI:10.1155/2014/249784 · 2.42 Impact Factor
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    ABSTRACT: Nutritional and prohealth properties of mare’s colostrum and milk in human diet. The aim of the study was to determine the nutritional and health-oriented properties of mare’s colostrums and milk. The researches included colostrum and milk of Thoroughbred and Noble Half-Blood mares as well as the bulk milk obtained from Cold – Blooded mares. Colostrum was collected twice and milk was collected at four stages of lactation. In the milk samples the concentration of lactose, protein, fat, dry matter, citric acid, cholesterol, vitamins A, D, E, K,C, fatty acid profile and whey proteins as well as total bacteria count and somatic cell count, were analysed. Besides, following physico-chemical characteristics were evaluated: density, freezing point and potential acidity. Average fat concentration in mare’s colostrums represented 2.28%, lactose- 3.55%, protein- 9.73% and dry matter- 16.8%. Average number of somatic cells in mare’s colostrum was at the level of 282.9 103/ml, and concentration of vitamin C and cholesterol were 4.60 mg/dl and 21.79 mg/dl respectively. Values of phisico-chemical parameters (density, freezing point and potential acidity) were higher in colostrum then in milk. The average content of fat, protein, lactose and dry matter were at the levels of 1.22%, 2 . 1 1%, 6.63% and 9.74% respectively. The concentration of lactose and vitamin C increased and of protein, fat, cholesterol and citric acid decreased in subsequent days of lactation. Average somatic cell count in milk, during the lactation was 25 103/ml. Bulk milk was of a substantial hygienic quality, characterised by very low number of somatic cells (3.4 103/ml) and total bacteria count (1.6 103/ml). The fat fraction of bulk milk had a favourable (from the nutritional point of view) ratio of fatty acids from the family of n-6 to n-3. Saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acid made up approximately 40%, 34% and 22% of the total determined fatty acids, respectively. Concentration of fat soluble vitamins in mare milk was at the level of 40 µg/dl (vitamin A); 27.8 ng/dl (β-carotene); 0 . 1 2 mg/dl (vitamin E); 5.29 ng/dl (vitamin D) and 27.6 ng/dl (vitamin K). The most represented whey proteins in mare’s milk were β-lactoglobulin and α-lactoalbumin. The analysis showed that whey proteins of mare’s milk include high content of lysozyme, lactoferrin and immunoglobulin, 11.5%, 12.6% and 18.6% of total whey protein percentages, respectively. Freeze -dried milk showed smaller losses of vitamin C during 6 month of storage when compared to frozen milk, in which the looses were almost four times higher (p≤0.01) .
    06/2012, Degree: Ph.D., Supervisor: Jacek Wójtowski

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