Allergy to cow’s milk proteins as an Anaphylaxis trigger in children

T.S. Lepeshkova 1,2, E.K. Beltyukov 1, S.A. Tsarkova 1

1 Ural State Medical University, Еkaterinburg, Russia
2 «Children’s hospital № 13», Ekaterinburg, Russia

ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS, Volume 59 • Number 4 • December 2019, pp. 26 – 37
DOI: 10.24411/2500-1175-2019-00020

The problem of food Allergy in recent years is becoming more and more relevant. Symptoms of food anaphylaxis, as the most severe form of food Allergy, occur at lightning speed or very quickly, affect several systems of the human body, violating their normal functions and becoming in isolated cases fatal. The possibility to avoid such acute episodes of Allergy can be provided by the complete cessation of the use of the product, previously causing food anaphylaxis.
The article presents the latest literature data on Allergy and food Anaphylaxis to cow’s milk proteins, which are illustrated by clinical measures. In a number of presented clinical cases, it is the wrong actions of adults (recommendations of medical specialists, actions of parents) contributed to an increase in the degree of sensitivity to milk proteins and the occurrence of food anaphylaxis in children.
The work aims at presenting clinical cases of severe Allergy to cow’s milk proteins and the importance of in-depth allergological examination (ISAC, ImmunoCAP) for further prevention of new episodes of food Anaphylaxis in children.

  1. Филатова Т. А., Ипатова М. Г., Мухина Ю. Г., Таран Н. Н., Антонова Е. А. Пищевая аллергия у детей: клинические проявления, правильная диетотерапия, клинические случаи // Аллергология и иммунология в педиатрии. 2018. № 4 (55). С. 18–24.
  2. Simons F. E., Sampson H. A. Anaphylaxis epidemic: factor fiction? // J. Allergy Clin Immunol 2008; 122: 1166–1168.
  3. Panesar S. S., Javad S., de Silva D. et al. The epidemiology of anaphylaxis in Europe: a systematic review // Allergy. 2013; 68 (11): 1353–1361.
  4. Tejedor Alonso M. A., Moro M., Mugica Garcia M. V. Epidemiology of anaphylaxis // Clin. Exp. Allergy. 2015; 45:1027–1039.
  5. Фомина Д. С., Горячкина Л. А. Анафилаксия — диагностика и лечение: учебное пособие / ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования». — М.: ФГБОУ ДПО РМАНПО, 2017. — 95 с.
  6. Simons F. E. R., Ardusso L. R. F., Bilo M. B. et al. World Allergy Organization Guidelines for the assessment and management of anaphylaxis // World Allergy Organ. J. 2011; 4 (2): 13–37.
  7. Muraro A., Roberts G., Worm M. et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology // Allergy. 2014; 69: 1026–1045.
  8. Santos A. F., Lack G. Food allergy and anaphylaxis in pediatrics: update 2010–2012. // Pediatr. Allergy Immunol. 2012. Vol. 23. 8: 698–706.
  9. Food Allergy and Anaphylaxis Guidelines. Translating knowledge into clinical practice. EAACI. 2014.
  10. Teymourpour P., Pourpak Z., Fazlollahi M.R., Barzegar S., Shokouhi R., Akramian R. et al. Cow’s Milk Anaphylaxis in Children First Report of Iranian Food Allergy Registry Iran // J. Allergy Asthma Immunol. 2012; 11(1): 29–36.
  11. Saeideh B., Akramian R., Pourpak Z., Bemanian M. H., Shokouhi R., Mansouri M. et al. Common Causes of Anaphylaxis in Children. The First Report of Anaphylaxis Registry in Iran. // WAO J. 2010; 3(1): 9–13.
  12. Tomas Houmann Peterson et al. Cowˈs milk allergic children. Can component — resolved diagnostics predict duration and severety? // Pediatr Allergy Immunol. 2018; 6:1–6.
  13. Hoffer V., Scheuerman O., Marcus N., Levy Y., Segal N., Lagovsky I. et al. Anaphylaxis in Israel: experience with 92 hospitalized children // Pediatr. Allergy Immunol. 2011; 22(2): 172–177.
  14. Баранов А. А., Намазова-Баранова Л. С., Хаитов Р. М., Ильина Н. И., Курбачева О. М., Новик Г. А. и соавт. Федеральные клинические рекомендации по оказанию медицинской помощи детям с пищевой аллергией. М.: Союз педиатров России, 2015: 25.
  15. Есакова Н. В., Пампура А. Н. Анафилаксия к молоку у детей // Вопросы детской диетологии, 2014. Т. 12. № 1. С. 39–42.
  16. Host A., Halken S., Jacobsen H. P., Christensen A. E., Christensen A. E., Herskind A. M. et al. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood // Pediatr Allergy Immunol. 2002; 13(15): 23–28.
  17. Venter C., Pereira B., Grundy J., Clayton C. B., Roberts G., Higgins B. et al. Incidence of parentally reported and clinically diagnosed food hypersensitivity in the first year of life // J. Allergy Clin Immunol. 2006; 117(5): 1118–1124.
  18. Kvenshagen B., Halvorsen R., Jacobsen M. Adverse reactions to milk in infants // Arch Paediatr. 2008; 97(2): 196–200.
  19. Bock S. A., Munoz-Furlong A., Sampson H. A. Further fatalities caused by anaphylactic reactions to food, 2001–2006 // J. Allergy Clin Immunol. 2007; 119(4): 1016–1018.
  20. Pumphrey R. S., Gowland M. H. Further fatal allergic reactions to food in the United Kingdom, 1999–2006 // J. Allergy Clin Immunol. 2007; 119(4): 1018–1019.
  21. Huang F., Chawla K., Järvinen K. M., Nowak-Węgrzyn A. Anaphylaxis in a New York City pediatric emergency department: Triggers, treatments, and outcomes // J. Allergy Clin Immunol. 2012; 129(1): 162–168.
  22. Vetander M., Helander D., Flodstro C., Ostblom E., Alfvén T., Ly D. H. et al. Anaphylaxis and reactions to foods in children — a population-based case study of emergency department visits // Clinical & Experimental Allergy. 2012; 42(4): 568–577.
  23. Bartuzi Z., Cocco R. R., Muraro A., Nowak-Węgrzyn A. The contribution of the analysis of molecular allergens in the diagnosis of Allergy to milk // Curr Allergy Asthma Rep. 2017; 17: 46–52.
  24. Hochwaliner H., Schulmeister U., Swoboda I., Spitrauer S., Valenta R. Cowˈs milk allergy. From allergens to new forms of diagnosis, therapy and prevention // Methods. 2014. Mar. 1: 66 (1): 22–33.
  25. Remington B. C., Westerhout J., Campbell D. E., Turner P. J. Minimal effect of intensive heating of chicken eggs and cow’s milk in the food matrix on the threshold dose distribution curves // Allergy. 2017; 72: 1806–1809.
  26. Ehn B. M., Ekstrand B., Bengtsson U., Ahlstedt S. Modification of IgE binding during heat processing of the cow’s milk allergen beta-lactoglobulin // J. Agric Food Chem. 2004; 52(5): 1398–1403.
  27. Bloom K. A, Huang F. R, Bencharitiwong R., Bardina L., Ross A., Sampson H. A., etc. The Effect of heat treatment on the allergenicity of milk and egg proteins // Pediatr Allergy Immunol. 2014; 25: 740–736.
  28. Caubet J. C., Lin J., Ahrens B., Gimenez G., Bardina L., Niggemann B., etc. Natural development of tolerance in children with allergies to cow’s milk: binding of IgE and IgG4 epitopes // Allergy. 2017; 72: 1677–1685.
  29. Есакова Н. В. Клинико-иммунологические маркеры пищевой анафилаксии у детей. Автореферат дисс. на соиск. ученой степени к.м.н., Москва, 2014. C. 26.
  30. Pumphrey R. S. and Stanworth S. J. The clinical spectrum of anaphylaxis in north-west England // Clin Exp Allergy. 1996; 26 (12):1364–1370.
  31. Mullins R. J. Anaphylaxis: risk factors for recurrence // Clin Exp Allergy. 2003; 33 (8):1033–1040.
  32. Pumphrey R. S. and Gowland M. N. Further fatal allergic reactions to food in the United Kingdom, 1999–2006 // J. Allergy Clin Immunol. 2007; 119 (4): 1018–1019.
  33. Cantani A., Micera M. Allergenicity of a whey hypoallergenic formula in genetically at risk babies: four case reports // Eur Rev Med Pharmacol Sci. 2005; 9: 179–182.
  34. Ammar F., de Boissieu D., Dupont C. Allergy to protein hydrolysates. Report of 30 cases // Arch Pediat. 1999; 6: 837–843.
  35. Pessler F., Nejat M. Anaphylactic reaction to goat’s milk in a cow’s milk-allergic infant // Pediat Allergy Immunol 2004; 15: 183–185.
  36. Moneret-Vautrin D. A., Morisset M., Cordebar V. et al. Probiotics may be unsafe in infants allergic to cow’s milk // Allergy. 2006;4: 507–508.
  37. Levin M. E., Motala C., Lopata A. L. Anaphylaxis in a milk-allergic child after ingestion of soy formula cross-contaminated with cow’s milk protein // Pediatrics 2005; 116: 1223–1225.
  38. Kattan J., Konstantinou G., Cox A. et al. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy // Ibid. 2011; 128: 215–218.
  39. Parisi C., Smaldini P., Gervasoni M. et al. Hypersensitivity reactions to the Sabin vaccine in children with cow’s milk allergy // Clin Exp Allergy. 2013; 43: 249–254.
  40. Muraro A., Hoffmann-Sommerguber K., Hotzhauser et al. EAACI Food Allergy and Anaphylaxis Guideline. Protecting consumers with food allergies: understanding food consumption, meeting regulations and indentifyingunment needs. // Allergy. 2014;69: 14364–14372.
  41. Смолкин Ю. С., Грищенко Е. А. Современные представления о формировании оральной толерантности (часть 1) // Аллергология и иммунология в педиатрии. 2015. № 4 (43). С. 29–35.
  42. Смолкин Ю. С., Грищенко Е. А. Современные представления о формировании оральной толерантности (часть 2) // Аллергология и иммунология в педиатрии. 2016. № 1 (44). С. 8–14.

Lepeshkova TS, Beltyukov EK, Tsarkova SA. Allergy to cow’s milk proteins as an Anaphylaxis trigger in children. Allergology and Immunology in Pediatrics. 2019;59(4):26-37. (In Russ.)

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T.S. Lepeshkova


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