87 1. PART 2
FORMULAE AND COW'S WILK
RESTC ‘Y AND~COW’S MILK HYDROLYSATBS (CMH1. Roland Einarsson, N.-I.
There are "unerous slternatives to cow's milk have children. We allergic for formulae investigated the allerqenicfty Of several of these using RAST and RAST inhibition on serum from 15 known cow's milk allergic patients and 5 atopic raw The following milks were studied: controls. unprocessed cow's, goat and sheep's milk, standard cow's milk infant formulae, goat's milk infant soy infant formula (Wysoy), formula (Karltam), (ALllO, Prejomin, tiutramtgen, casein hydrolysatea whey hydrolyaates (Alfate and and Ptegestimil), Pepti-junior) end s" elemental feed (Neocate). All the patients e"d none of the controls had positive RAST results to cow's milk and sheep's 13115 were positive for goat's milk. Cov)s milk. infant formulae showed similar results and goat's to their raw milk eoutce. OnLy 1 patient had RAST >,3 for Wysay. S/IS patients had positive RASTs to All0 whilst only 2 patients showed e positive result for the other casein hydrolysates. Of the whey hydrolysates investigated, 6115 RASTS were positive for Pepti-junior but "one vss positive for Thus of the hype-allergenic formulae Alfars. Only Aifafe ~~38 negative for all CRA tested, All results were also negative for patients. Neocate. Preliminary RAST inhibition data on pooled serum from tha eeine patients agreed with the PAST Raw goat's and sheep milk, goat's milk results. formula and All10 all had IgE binding patterns very similar to that of cow'e milk whilst Wysoy, Prejomfn and Alfare, Pregestihil, Nutrsmige", NeOc&te produced significantly less inhibitio". low we have shown that despite claims of some of these alternative milks may allergenicity, still be antigenically recognised in-vitro by some allergic patients. This will be COW'S milk by in-viva challenge. investigated further
MR. Uppsala and Linkllping. Sweden. Various infant formulas, based on hydrolyscd casein or whey proteins, were evaluated for allergenicity in cow’s milk allergic children. Thirtytwo children, aged with a history
mths - 11 yrs (median age 3.9 yrs) cow’s milk allergy were recruited to the study. The patients were skin prick tested (SPT) with cow’s milk and 4 CMH (Alimenturn, Good Start H.A., Nutramigen, Profylac). Blinded oral provocation tests were performed three times in 18 of
patients comparing cow’s milk and CMH. The remaining antigenicily or allergenicity of Ihc CMH was tested in vitro by RAST (discs coupled with CMH). RAST inhibition, ELLSA (the content of betalactoglobulin (BLG)). Dot Immunobinding
Assay, Immunoblot. Histamine Release and SDSgradient PAGE (degree of hydrolysis). The degree of hydrolysis of CMH varied and the rest antigenicity of the CMH was low except for one of the CMH. a whey hydrolysate, which showed more
than 2000 times higher BLG content. That CMH also exhibited the highest rest allergenic&y and about 30% of the rested children gave a positive WT. The casein based CMH only gave occasional positive SPT The provocation test showed that one patient reacted on the highest concentration of a casein based retain
formula. The allergenicity
data indicate that and they should
most CMH be tested
before general use in cow’s milk allergic subjects or for prophylacric purposes.
526 TOPlCAL AND SYSTEMlC Ih#MEDIATE REACTORS TO COW’S MLLK (CM): &&I& Rochester, NY & m WV Subclassification (lA,lB,lC) of immediate reactors ;o CM (Hill’s Group 1), based upon a skin prick test (SPT) profile to CM, whey and casein hydrolysates, was proposed in 1990. Between 111189and 8/31/90, 50 immediate reactors (lA=20; lB=l7; lC=13) were studied. Those in 1A were SIT+ only to CM. 1B were SpT+ to CM and Good Start. 1C were SPTi to CM, Good Start and Nutramigen. Groups 1B and 1C differed from 1A clinically and immunologically. 1A had low serum IgE to CM (1.02~0.87 IWml), Rlactoglobulin(8-L=0.6O~O.56),andcasein(C=O.54~O.33). 18 had intermediate levels of IgE to CM (10.6* 12.l), E-L (2.9k-3. l), and C (3.9k5.3). 1C had high levels of IgE to CM (29.3*12.6), O-L (12.7&1X5), and C (ll.lil2.2). ANOVA revealed significant differences among the three groups @=0.0004). In formal CM challenge 1B (n=9) and 1C (n=4) had more systemic respiratory cough/wheeze (p=O.OOS)and rhinitis (p10.013) reactions than IA (n=l3). 1A had topical cutaneouscontact urticarial reactions (100%) and gastrointestinal vomiting reactions (54%). 1B + 1C had higher @=O.OOl) mean IgG4 to CM (14.8& 11.6 mcg/ml), 8-L (1X5&12.4), and C (22.9klS.O) than 1A had to CM (5.0*7.3), O-L (6.81t9.5) and C (8.1* 11.2). IgG4 to wheat was also higher (p-0.009) in 1B + 1C (20.3kl6.4) than in 1A (7.8f12.5). The subclassification scheme separates“topical” immediate reactors (IA) from “systemic” reactors (1B + 1C). It is helpful in diagnosis and management.The IgG4 observations suggest that 1B and 1C have either a primary or secondary defect of the G.I. mucosal barrier to food antigens.
IN-VW0 AND lNVf-fRO SNDIES ON THE ALLERGENIC ACllVlTY ff DlFFEPENT H’fPOAUERGENlC FORMULAE. & Rugo. M.D., R. Wahl, PhD. U. Wahn. M.D.. Berlin and Hambura, E!scIcf Tha allsrganic activity of profains in hypoallarganic formulae is reduced by hy&olysls, haat traatmant and ultrafiltration. In order to irweaffgata ln a comparativa study tha allergenic activity of differant protein hyUrolyaataa, which are marketed as dietary products for indivl&& with allergy to cow’s milk, we studii 20 chikfran (8 months to IO yaars) with a history of immediate reaction to co& milk and &tad savm IgE antibodies (RAST ’ 2) to cow’s II% Rree different whay hydrolyaales, ona of them ultraftlbatacl, two casein hydrolysatas as wall as ona hydrolysate pfepaed tom soy and bovlna collagen ware investigated by R&ST inhibitlon, leukocyte histamine release, skin prick test as wall as *atad oral povocaiion. In skin p&k testa compared to whole cow’s milk all hydrolysates induced significantly smaller (p c 0.01) reactions (mean wheal diirneters) The least akin reactivity was observed to casain testa immediate reactions hydrdyaatea. In oral provocation (Uticarfa) was observed in ttvaa patients upon challenge with whey hydrdysates, while al1 patients tolerated casein hybolyaates up to 20 ml. All hy&olyaatea were abla to inhibit IgE-binding to cow’s milk proteins in RASTjnbibltlon tests, the strongest inhibition was obaervad with non&trafiltratad whey hydrolyaatas and a product pepared loom soy and collagen. Histamine raleasa kom washed leukocytes was negative with all hydrolysates at the co-tlow tested. From ou data wa conclude that aspe&lly in whey hydrolysates. which are not ultrafiltrated, there ia conaiderabla remaining allergenic actfvity. which may account for IgE-me&tad raactions. Caaein hydroIysafe.s show liffle residual aNergenic acti*, both, in vilro and in vivo.