Tolerance to extensively heated milk in children with cow's milk allergy
ABSTRACT Cow's milk allergy is the most common childhood food allergy. Previously we noted that children who outgrew their milk allergy had milk-specific IgE antibodies primarily directed against conformational epitopes; those with persistent milk allergy also had IgE antibodies directed against specific sequential epitopes.
Because high temperature largely destroys conformational epitopes, we hypothesized that some children with milk allergy would tolerate extensively heated (baked) milk products.
Children with milk allergy were challenged with heated milk products; heated milk-tolerant subjects were subsequently challenged with unheated milk. Heated milk-tolerant, unheated milk-reactive subjects ingested heated milk products for 3 months and were then re-evaluated. Immune responses were assessed in all subjects; growth and intestinal permeability were followed in heated milk-tolerant subjects.
One hundred children (mean age, 7.5 years; range, 2.1-17.3 years) underwent heated milk challenges. Sixty-eight subjects tolerated extensively heated milk only, 23 reacted to heated milk, and 9 tolerated both heated and unheated milk. Heated milk-reactive subjects had significantly larger skin prick test wheals and higher milk-specific and casein-specific IgE levels than other groups. At 3 months, subjects ingesting heated milk products had significantly smaller skin prick test wheals and higher casein-IgG(4) compared with baseline; other immunologic parameters, growth, and intestinal permeability were not significantly different. Heated milk-reactive subjects had more severe symptoms during heated milk challenge than heated milk-tolerant subjects experienced during their unheated milk challenge.
The majority (75%) of children with milk allergy tolerate heated milk.
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- "Clinical trials have demonstrated that a high percentage of children, with milk and egg allergies, tolerated heated products with milk or egg. This clinical effect goes along with increased levels of specific IgG4 antibodies (Lemon-Mulé et al., 2008; Nowak-Wegrzyn et al., 2008). We have previously demonstrated that food processing, such as treatments based on pressure and heat, seem to influence the IgE binding capacity of nut proteins (Cabanillas et al., 2012). "
ABSTRACT: This study aimed to analyze the influence of thermal processing on the IgE binding properties of three forms of peanut, its effects in the content of individual allergens and IgE cross-linking capacity in effector cells of allergy. Three forms of peanut were selected and subjected to thermal processing. Immunoreactivity was evaluated by means of immunoblot or ELISA inhibition assay. Specific antibodies were used to identify changes in the content of the main allergens in peanut samples. The ability of treated peanut to cross-link IgE was evaluated in a basophil activation assay and Skin Prick Testing (SPT). The results showed that thermal/pressure treatments at specific conditions had the capacity to decrease IgE binding properties of protein extracts from peanut. This effect went along with an altered capacity to activate basophils sensitized with IgE from patients with peanut allergy and the wheal size in SPT. Copyright © 2015 Elsevier Ltd. All rights reserved.Food Chemistry 09/2015; 183. DOI:10.1016/j.foodchem.2015.03.023 · 3.26 Impact Factor
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- "The use of processed food with diminished IgE binding capacity is also an attractive strategy for oral immunotherapy. Clinical trials have shown that around 70% of tested children, with milk and egg allergies, tolerated heated products with milk or egg with an association of increased levels of specific IgG4 antibodies and decreased in SPT wheals size (Lemon-Mulé et al., 2008; Nowak-Wegrzyn et al., 2008). "
ABSTRACT: The aim of this study was to investigate changes in walnut allergenicity after processing treatments by in vitro techniques and physiologically relevant assays. The allergenicity of walnuts subjected to high hydrostatic pressure and thermal/pressure treatments was evaluated by IgE-immunoblot and antibodies against walnut major allergen Jug r 4. The ability of processed walnut to cross-link IgE on effector cells was evaluated using a rat basophil leukaemia cell line and by skin prick testing. Susceptibility to gastric and duodenal digestion was also evaluated. The results showed that walnuts subjected to pressure treatment at 256 kPa, 138 °C, were able to diminish the IgE cross-linking capacity on effector cells more efficiently than high pressure treated walnuts. IgE immunoblot confirmed these results. Moreover, higher susceptibility to digestion of pressure treated walnut proteins was observed. The use of processed walnuts with decreased IgE binding capacity could be a potential strategy for walnut tolerance induction.Food Chemistry 08/2014; 157:141–147. DOI:10.1016/j.foodchem.2014.02.025 · 3.26 Impact Factor
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- "Chez 100 enfants âgés en moyenne de 7,5 ans (2,1–17,3 ans) allergiques au lait de vache, 75 % tolèrent le lait cuit sous forme de gâteaux et crêpes bien cuits (muffin et waffle). Chez ces enfants, la poursuite pendant trois mois d'une consommation de lait cuit s'accompagne d'un profil immunologique en faveur de l'acquisition d'une tolérance, sans qu'il n'apparaisse de signe de souffrance de la muqueuse intestinale . En cas d'allergie à la noisette, DA Moneret-Vautrin propose un moyen simple pour savoir s'il est possible de consommer de la noisette cuite, telle qu'elle est présente dans le Nutella 1 (noisette chauffé à 160˚C lors de la préparation). "
ABSTRACT: Elimination diets are still the basic means of managing food allergy. In the past, such diets were very severe and strict. Recent work has shown that a large number of elimination diets, previously prescribed, were not very useful, could even be iatrogenic. The diet can and must be adapted to each situation. Most often, it is not very limiting. It can sometimes even be therapeutic. We will first discuss the objectives and the basis of diets for food allergy, and then we will consider some practical aspects of these diets, based on the results of the allergy workup.Revue Française d Allergologie 04/2009; 49(3):112-115. DOI:10.1016/j.reval.2009.01.022 · 0.22 Impact Factor