Giovanna Bruno

Allergenicity of milk protein hydrolysate formulae in children with cow's milk allergy

Cows milk protein hydrolysate formulae have been developed to lower or eliminate the allergenicity of cows milk proteins, and to reduce the antigenic load and the risk of sensitization. Cross-reactivity between different hydrolysate formulae and cows milk proteins has been demonstrated. We have studied 20 children (median age 31 months, range 15–76 months) with a history of IgE-mediated cows milk allergy. All the children had immediate allergic respiratory and/or cutaneous and/or gastro-intestinal reactions to cows milk ingestion. In addition, the children had positive prick skin tests and positive RAST to cows milk. Prick skin test, RAST, and double-blind placebo controlled food challenges were performed with three different hydrolysate formulae: a casein hydrolysate formula and two whey formulae, one partially and one extensively hydrolyzed. All 20 children had immediate allergic reactions after the challenge test with cows milk. Only 2/20 children had a positive challenge test with a casein hydrolysate formula (Alimentum): one developed asthma and one urticaria. Two of the 15 children challenged with an extensively hydrolysed whey formula (Profylac) developed perioral erythema. Nine out of 20 children had a positive challenge test with a partially hydrolysed whey formula (Nidina H.A.): four developed asthma, three urticaria and two lip oedema. All children had positive prick skin tests to cows milk proteins (casein and/or lactalbumin); 9 to Nidina H.A.; 3 to Profylac, and 3 to Alimentum. Specific IgE antibodies to cows milk were present in all children; in 13 to Nidina H.A., in 4 to Profylac, and in 3 to Alimentum.

Allergenicity and nutritional adequacy of soy protein formulas

Soy protein formulas are used for different conditions, including cow milk protein allergy, lactose and galactose intolerance, and severe gastroenteritis. Feeding soy protein formulas to normal term infants is associated with normal growth, normal protein nutritional status, and normal bone mineralization. Recent studies of infants fed soy protein formulas exclusively during the first months of life revealed no immunologic abnormality; however, the use of such formulas for management of cow milk protein allergy and for prevention of atopy is controversial. Although in the past decade many studies have stressed soy allergenicity, soy allergenicity has been confirmed by the challenge test in only a few studies. In this article we review the studies dealing with the allergenicity of soy protein formulas. We also present our own data on their use in the prevention and management of cow milk protein allergy.

Soy allergy is not common in atopic children: a multicenter study

The aim of the present study was to evaluate the prevalence of soy allergy (positive skin test and positive challenge test) in a large cohort of atopic children, many of them soy fed early in life for several months. In order to investigate the prevalence of soy allergy, two groups of children were enrolled into the study. The first group comprised a cohort of 505 children with personal history suggestive of food allergy. The second group included 243 children born of atopic parents, who had been soy protein formula fed for the first six months of life for the prevention of cows milk allergy and who had been prospectively followed up, from birth to 5 years.

Soy protein formulas in children: no hormonal effects in long-term feeding.

Recently, the finding of high plasma concentration of phyto-oestrogens in soy protein formula (SPF) fed children has focused scientific attention on the phyto-oestrogens (isoflavones genistein, daidzein, and their glycosides) contained in SPFs. The aim of this study was to evaluate some hormonal and metabolic effects of long-term (more than 6 months) SPF feeding. We enrolled 48 children, mean age 37 months (range 7-96 months), 27 males and 21 females. All children underwent physical examination. Bone age, urinary markers of bone metabolism, serum levels of bone alkaline phosphatase, osteocalcin, 17beta-oestradiol, and intact parathyroid hormone were measured. Eighteen healthy children represented the control group. No abnormalities were observed in auxological parameters; none of the enrolled girls showed signs/symptoms of precocious puberty and none of the boys presented gynecomastia; bone age was within the normal range. The serum level of bone alkaline phosphatase, osteocalcin, 17beta-oestradiol, and intact parathyroid hormone, and the urinary levels of the markers of bone metabolism were all within normal values. We conclude that long-term feeding with SPFs in early life does not seem to produce oestrogen-like hormonal effects.

Prevention and management of food allergy

The phenotypic expression and natural history of food allergy vary widely according to the patients age, disease presentation and type of offending food. Prevention of food allergy might be achieved by altering the dietary factors responsible for the sensitization and phenotypic expression of the disease. Owing to the peculiarity of the atopic status, a minute amount of allergens can trigger both sensitization and symptoms in atopic individuals. The oral dose of β‐lactoglobulin causing sensitization can be estimated to be between 1 ng and several milligrams. In food allergy, sensitization and treatment are allergen specific; therefore, for primary prevention (avoiding sensitization) and secondary prevention of food allergy (avoiding symptoms in an already sensitized subject), a product without immunogenic and allergenic epitopes should be given in each case. Babies of atopic parents are particularly prone to develop food allergy and for this reason they are called high‐risk babies. Cows milk is the most commonly offending food in both gastrointestinal and cutaneous manifestations. Cows milk proteins are potent allergens and around 2.5% of infants experience cows milk allergy in the first years of life. The major risk factors for cows milk allergy are positive family history of atopy and early exposure to cows milk proteins. Hydrolysate formulae have been developed for the purpose of reducing the allergenicity of cows milk proteins. More recently, partially and extensively hydrolysed formulae have also been used for feeding babies with a high risk of atopy for the prevention of cows milk allergy. However, according to the results of a recent randomized controlled study, only an extensively hydrolysated formula, and not a partially hydrolysated formula, significantly decreased the prevalence of cows milk allergy.

Effectiveness of a home‐made meat based formula (the Rezza‐Cardi diet) as a diagnostic tool in children with food‐induced atopic dermatitis

The aim of this study was to investigate the effectiveness of a home-made meat based formula (the Rezza-Cardi diet), as a diagnostic tool for children with atopic dermatitis and suspected multiple food hypersensitivity. Severity scores for atopic dermatitis, body weight and serum lipid profile were evaluated at baseline and four weeks following the feeding with the home-made meat based formula in 16 children with atopic dermatitis and suspected multiple food hypersensitivity. The severity score of the skin lesions improved considerably in all the children; no significant difference was observed in the serum lipid levels before and after one month following the feeding with the home-made meat based formula. All children gained weight according to the Italian Standards. The results of this study indicate that the home-made meat based formula is a useful elimination diet in children with atopic dermatitis and suspected multiple food hypersensitivity.

Soy protein for the prevention and treatment of children with cow-milk allergy.

Soy-protein formulas are widely used for feeding babies with cow-milk allergy. When they first were marketed, these formulas were the only available cow-milk substitute and they ensured a normal life for many children who were affected by the large spectrum of clinical manifestations of cow-milk allergy. Soy-protein formulas were also given to allergy-prone infants for the prevention of atopic diseases when breast milk was not available. Several researchers studied the prevalence of soy sensitization in allergic disease. Few studies used a challenge test for the diagnosis of soy allergy, even those in patients in whom soy allergy was suspected. In most studies the diagnosis of soy allergy was based on anecdotal case histories reported by parents and was not substantiated by scientific diagnostic criteria: no challenge test to soy was made nor were data available on specific immunoglobulin E to soy. In this paper we critically reviewed literature on the safety of feeding soy-protein formulas to babies with cow-milk allergy as well as on the prevention of cow-milk allergy.

Response to poliovirus immunization and type of feeding in babies of atopic families

The aim of the present study was to investigate the antibody response to oral poliovirus immunization, and to evaluate the infection morbidity in a group of infants with a positive family history of atopy who were soy‐protein‐formula fed during the first 6 months of life. We have selected and followed from birth to 4 yr, 107 babies, 18 of whom were exclusively soy‐protein‐formula fed during the first 6 months of life. All infants were seen at our clinic at the ages of 1, 3, 6, 9, and 12 months, and once‐a‐year afterwards. They regularly received the oral vaccine against polioviruses at the ages of 3, 5 and 12 months. At age 6, 12 and 24 months, poliovirus type 1, 2 and 3 antibodies were detected. There was no significant difference of seroconversion in the babies, breast, soy or breast and soy fed. Furthermore, no increase in infection morbidity was observed in the soy‐protein‐formula fed infants. Our data shows that soy‐protein‐formula feeding in the first 6 months of life does not induce any abnormal antibody response to the oral poliovirus vaccination, as well as no increase in infection morbidity.

Safety of measles immunization in egg‐allergic children

Measles vaccines are prepared in chick embryo fibroblast culture and used throughout the world. Since 1963 dramatic reductions in the incidence of measles have been observed where the vaccination was extensively applied in the pediatric population. The best results were observed when the target population in the initial phase was that which produced over 90% of cases in the pre‐vaccinal era. A possible limiting factor to the diffusion of measles vaccination is the assumption that allergy to egg proteins is a contraindication. In this paper current knowledge about the safety of measles immunization in children with egg allergy is discussed.

Measles vaccine in egg allergic children: poor immunogenicity of the Edmoston‐Zagreb strain

Despite the fact that a number of recent studies have shown that measles/ mumps/rubella vaccine is safe for egg allergic children, many pediatricians are still concerned about immunization in egg allergic children. In Europe, a measles vaccine with the Edmoston‐Zagreb strain (EZMV) grown in human fibroblast culture has been developed and recommended for children with egg allergy. However, some doubt arises on the efficacy of this strain due to its weak immunogenicity. The aim of this study was to investigate the immunogenicity of the EZMV in comparison to the measles vaccine with the Schwarz strain (SWMV) grown in a chick embryo fibroblast culture.