Tolerance to extensively heated milk in children with cow's milk allergy

Department of Pediatrics and Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.25). 08/2008; 122(2):342-7, 347.e1-2. DOI: 10.1016/j.jaci.2008.05.043
Source: PubMed

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.

    • "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). "
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    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). "
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