Giovanna Monti

High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children: predictive value of skin prick test and radioallergosorbent test to egg proteins.

Background Egg skin prick test (SPT) and/or radioallergosorbent test (RAST) positivity has been described in infants and children with a food allergy, or in infants at high risk of atopy who have never eaten eggs. Clinical reactions are also observed when some of these children or infants eat eggs for the first time.

Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life

BACKGROUND Recently, rice-based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. AIM To evaluate the growth of infants fed with a rice-based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. METHODS A total of 88 infants were enrolled between March 2002 and March 2004. Fifty-eight infants with atopic dermatitis (AD) and cows milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice-based hydrolysate formula (RHF), 17 with a soy-based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cows milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3-monthly intervals in the first year of life, and at 6-monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z-scores of weight for age were calculated. STATISTICS One-way analysis of variance and Students t-test were used for statistical comparison. Significance was set at p<0.05. RESULTS No significant differences between the RHF, SF and eHCF groups were observed for the z-score of weight for age during the first 2 y of life, but a significantly lower difference was seen in the RHF group compared to the control group in the intervals 9 mo-1 y (p=0.025) and 1-1.5 y (p=0.020) of age. In contrast, the SF and eHCF groups were comparable to the control group, but the eHCF group was significantly lower (p=0) in the first trimester of life. CONCLUSION Even if our findings show no significant difference between RHF and control, low weight observed in infants fed with RHF raises doubts about the nutritional adequacy of rice-hydrolysate formulas.

Relationship between maternal- and fetal-specific IgE.

Aim:  A positive correlation between maternal and cord‐blood IgE levels is well documented for total IgEs, but not for specific IgEs. The difficulty in detecting specific cord‐blood IgEs is due to their low concentrations, which hinder their dosage by low‐sensitivity methods. The study aimed to correlate maternal and foetal specific IgEs against individual cows milk proteins, detected by highly sensitive and specific techniques.

Detection of specific IgE to human milk proteins in sera of atopic infants

Specific IgE (sIgE) for cows milk proteins (CMP) have been reported to be present in blood sera of exclusively breast‐fed infants. The aim of this study was to find whether the presence of sIgE to human milk proteins in the sera of exclusively breast‐fed infants could explain the apparent detection of sIgE to CMP in infants that were never previously in contact with cows milk. sIgE for human milk whey proteins were found in the blood sera of atopic infants, and these sIgE strongly cross‐reacted with the corresponding CMP. In none of the sera examined were sIgE to bovine β‐lactoglobulin detected.

Multiple Bone Fractures in an 8-Year-Old Child with Cow’s Milk Allergy and Inappropriate Calcium Supplementation

The case of an 8-year-old boy with severe bone mass reduction and 4 fractures as a result of an unsupervised diet established to treat cow’s milk allergy is presented. Endocrine, genetic and orthopedic pathologies were excluded. While vitamin D intake had always been appropriate, his calcium intake had been inadequate for many years. This clinical report suggests that both vitamin D and calcium supplementation are necessary when a cow’s milk protein-free diet is prescribed, even when a hypo- or non-allergenic formula is provided.

Atopic Dermatitis of Infancy and Urinary Tract Infections

BACKGROUND Infants under evaluation for atopic dermatitis (AD) at our clinic undergo a battery of examinations that include urinalysis and urine culture tests with antibiograms. The prevalence of cases with significant bacteriuria and leukocyturia (SBL) appeared to be unexpectedly high. OBJECTIVE This study attempts to establish whether infants with AD should be suspected of having a higher prevalence of urinary tract infections (UTI). METHODS A retrospective analysis of urine and urine culture tests was performed in 131 infants (84 males and 47 females) aged 1-24 months with untreated AD and in 1,327 control subjects (621 male, 706 female) aged 1-24 months. RESULTS SBL was present in 27.5% of cases versus 3% of controls (p < 10(-5)). After routine treatment for AD and antibiotic treatment on the basis of a urine antibiogram, the recurrence rate of SBL, evaluated monthly over a 6-month period, was only 8.3%. CONCLUSION Infants with AD might be at a greater risk for developing UTI, and when treated for AD this risk might be reduced.

Efficacy of donkey’s milk in treating highly problematic cow’s milk allergic children: an in vivo and in vitro study: Letter to the Editor

Editor, The letter by C. Alessandri and A. Mari raises so many major and minor points that we would like to replay to it point by point, as it looks very much like as a referee comment. Line 3: Up to now children have never been fed with donkey milk (DM) . This statement is only acceptable for the general population but not for children and specially not for cow s milk allergic children, as for instance is clearly reported by A. Carroccio et al. in Clinical and Experimental Allergy 1999: 29: 1014–1016 (p. 1015: We have a long experience in the use of ass milk, in patients with CMA/I and/or multiple food allergy ). Among older people, and also older paediatricians, it is very well known that donkey s milk had been traditionally used to feed problematic children in many southern Italian regions, not only in Sicily. Lines 8–12: The wealth of knowledge on protein sequences from different organisms gives us the.... This is absolutely true from a general, aspecific point of view but cannot be applied to such a complex protein mixture as a natural milk, especially if only a very few number of sequences are known for that species, as is the case for the donkey. Indeed, the letter s authors were able to report the Blast sequence comparison for only three proteins (a-lactalbumin and two isoforms of b-lactoglobulin), certainly not the most allergenic proteins of cow s milk, because of this lack of knowledge. Lines 13–22: FAO and WHO1 defined an algorithm to evaluate the introduction of new proteins in... . The algorithm, or decision tree, cited by Alessandri and Mari deals only and specifically with proteins (single, specific and very well-described proteins) derived from genetically modified foods, as is clearly stated already in the title of this Report of Expert Consultation. Even if donkeys were to be considered as genetically modified cows, this decision tree could not be applied to the whole set (100s) of proteins contained in donkey s milk. Lines 23–25: Monti s paper shows two IgE immunoblotting with CM and DM respectively. Authors... . The IgE immunoblotting with DM (Fig. 1b of the paper Pediatr Allergy Immunol 2007: 18: 258–264) shows an aspecific binding of donkey s milk proteins to the IgE of cow s milk allergic children in such a way that is not possible to discriminate, with this method, those children tolerating donkey s milk and those not. Actually, in the figure reported, it is very visible that there is not a lack of IgE binding to DM but a lack of specific binding. Lines 25–30: The two milks employed for food challenge, and ... . Indeed, the two milks employed for in vitro and in vivo tests underwent similar treatments: commercial fresh (cow s) milk does not mean raw but pasteurized, even when this is not specifically stated. That is why the donkey s milk was heated to 70 C and then skimmed, to resemble the heat treatment undergone by the cow s milk. Lines 31–35: Furthermore, the studied population was not homogeneous to reach convincing.... . The 46 children enrolled in our study were all clinically allergic to cow s milk proteins and none of them could be fed with any of the usual cows milk substitutes recommended in these cases (extensively hydrolysed formulas, pure amino-acid formulas, soy-protein-based formulas): in this respect, it should be considered a homogeneous group. Lines 36–38: According to authors, DM does not achieve the 90% tolerability value required to define an... . As reported in the letter, we are very well aware that only 82% of our children tolerated donkey s milk – even taking into account that these 46 children were not normal cow s milk allergic children but highly problematic cow s milk allergic children. For this very Pediatr Allergy Immunol 2008: 19: 90–91

Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life: Growth of infants fed with a rice-hydrolysate formula

Background: Recently, rice‐based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. Aim: To evaluate the growth of infants fed with a rice‐based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. Methods: A total of 88 infants were enrolled between March 2002 and March 2004. Fifty‐eight infants with atopic dermatitis (AD) and cows milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice‐based hydrolysate formula (RHF), 17 with a soy‐based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cows milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3‐monthly intervals in the first year of life, and at 6‐monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z‐scores of weight for age were calculated. Statistics: One‐way analysis of variance and Students t‐test were used for statistical comparison. Significance was set at p<0.05. Results: No significant differences between the RHF, SF and eHCF groups were observed for the z‐score of weight for age during the first 2 y of life, but a significantly lower difference was seen in the RHF group compared to the control group in the intervals 9 mo–1 y (p=0.025) and 1–1.5 y (p=0.020) of age. In contrast, the SF and eHCF groups were comparable to the control group, but the eHCF group was significantly lower (p=0) in the first trimester of life.