Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Escenarios lácteos y microbiota intestinal en los primeros 1000 días / Milk scenarios and gut microbiota in the first 1000 days of life

La leche humana es el estándar de oro para la nutrición del bebé y debe iniciarse en la primera hora de vida. La leche de vaca, de otros mamíferos o las bebidas vegetales no se deben ofrecer antes del año de vida. Sin embargo, algunos niños requieren, al menos en parte, de fórmulas infantiles. Aun con las sucesivas mejoras a lo largo de la historia mediante la incorporación de oliogosacáridos, probióticos, prebióticos, sinbióticos y postbióticos, las fórmulas infantiles siguen siendo perfectibles para reducir la brecha de salud entre los bebés amamantados y aquellos alimentados con fórmula. En este sentido, se espera que la complejidad de las fórmulas siga aumentando a medida que se conozca mejor cómo modular el desarrollo de la microbiota intestinal. El objetivo de este trabajo fue realizar una revisión no sistemática del efecto de los diferentes escenarios lácteos sobre la microbiota intestinal.

Human milk is the gold standard for infant nutrition, and breastfeeding should be started within the first hour of life. Cow's milk, other mammalian milk, or plant-based beverages should not be offered before 1 year of age. However, some infants require, at least in part, infant formulas. Even with subsequent enhancements throughout history, with the addition of oligosaccharides, probiotics, prebiotics, synbiotics, and postbiotics, infant formulas still have room for improvement in reducing the health gap between breastfed and formula-fed infants. In this regard, the complexity of infant formulas is expected to continue to increase as the knowledge of how to modulate the development of the gut microbiota is better understood. The objective of this study was to perform a non-systematic review of the effect of different milk scenarios on the gut microbiota.

Tipos de leite consumidos durante o primeiro ano de vida e estado nutricional de lactentes do Sul do Brasil / Types of milk consumed during the first year of life and nutritional status of infants in Southern Brazil

Resumo Introdução A Organização Mundial da Saúde (OMS) recomenda o aleitamento materno exclusivo até o 6º mês de vida da criança e a sua manutenção com alimentação complementar até pelo menos os 2 anos de idade. Apesar da sua importância, a ingestão de substitutos do leite materno é altamente prevalente, sendo uma preocupação em saúde pública. Objetivo Avaliar a associação entre os tipos de leite ingeridos e o estado nutricional no primeiro ano de vida. Método Estudo longitudinal observacional com crianças brasileiras pertencentes a um estudo multicêntrico. Aos 3, 6, 9 e 12 meses de idade foram investigados os tipos de leite consumidos por meio de questionário de frequência alimentar (QFA) e foi realizada antropometria. As associações brutas e ajustadas foram avaliadas por intermédio de regressão linear. Resultados Das 2.965 duplas de mães-bebês rastreadas, 362 atenderam aos critérios e aceitaram participar do estudo (50% meninos). Aos 12 meses de idade, os maiores escores-z de peso para idade e de peso para comprimento foram observados nos meninos que consumiam apenas fórmula ou apenas leite de vaca. Os maiores escores-z de comprimento para idade foram encontrados entre as meninas que ingeriam apenas fórmula ou apenas leite de vaca aos 9 e 12 meses. Ambos foram comparados àqueles que ingeriam apenas leite materno nas mesmas idades. Conclusão Os tipos de leite consumidos associaram-se ao estado nutricional no primeiro ano de vida, sendo observadas diferenças entre os sexos. Os maiores índices antropométricos nas crianças que não recebiam leite materno chamam a atenção para a persistência futura desses desvios, em direção ao excesso de peso.

Abstract Introduction The World Health Organization (WHO) recommends exclusive breastfeeding up to the 6th month of life of the child and its maintenance with complementary feeding until at least 2 years of age. Despite its importance, the intake of breast milk substitutes is highly prevalent and a public health concern. Objective To evaluate the association between the types of milk ingested and nutritional status in the first year of life. Method Observational longitudinal study with Brazilian children from a multicentric study. At 3, 6, 9, and 12 months of age, the types of milk consumed were investigated using a food frequency questionnaire (FFQ), and anthropometric measurements were performed. Crude and adjusted associations were assessed by linear regression. Results Of the 2,965 pairs of mothers-babies screened, 362 met the criteria and accepted to participate in the study (50% of boys). At 12 months of age, higher weight-for-age and weight-for-length z-scores were observed in boys who consumed only formula or only cow's milk, compared to boys who consumed only breast milk. Higher length-for-age z-scores were found among girls who consumed only formula or only cow's milk at 9 and 12 months, compared to girls who consumed only breast milk at the same ages. Conclusion The types of milk consumed were associated with nutritional status during the first year of life, with differences between boys and girls. The higher anthropometric indexes in children who did not receive breastmilk call our attention to the persistence of such deviations toward excessive weight status in the future.

Advances in butyrates and intestinal immune tolerance in children with cow′s milk protein allergy / 国际儿科学杂志

Cow′s milk protein allergy is common in infants, which is an abnormal immune reaction caused by the imbalance of intestinal immune tolerance system.Butyrates, the fermentation product of intestinal anaerobic bacteria, can be used as a histone deacetylase inhibitors and a ligand of G protein-coupled receptors to regulate intestinal innate immunity and adaptive immune function, thereby inducing intestinal immune tolerance in children with cow′s milk protein allergy, which has potential clinical therapeutic value for cow′s milk protein allergy.However, this theory is still only based on the exploration of mechanisms at the cellular and animal levels and has not been applied in the clinic.This article reviews the intestinal immune mechanism of cow′s milk protein allergy, the anabolism of butyrates and the important role of butyrates in intestinal immune tolerance of cow′s milk protein allergy, aiming to lay a theoretical foundation for further clinical application of butyrate-induced intestinal immune tolerance of cow′s milk protein allergy.

Proctocolite induzida por proteína alimentar - teste de provocação oral deve ser realizado para confirmar o diagnóstico de alergia ao leite de vaca em neonatos? / Induced proctocolitis - oral food challenge should be done to confirm the diagnosis of cow's milk allergy in neonates?

ABSTRACT Background: Suspicion of food protein-induced proctocolitis based on empirical understanding of rectal bleeding can lead to misdiagnosis. Objective: to verify clinical and evaluative characteristics of patients who presented neonatal rectal bleeding and were on a restricted cow's milk diet. Methods: A cross-sectional retrospective study included patients followed up in a tertiary care center, who presented rectal bleeding in the neonatal period. The analyzed data included gender, gestational age, type of delivery, use of antibiotics during the last trimester of pregnancy, use of parenteral nutrition before the first manifestation, use of mechanical ventilation, initial clinical manifestations associated with rectal bleeding, diet before the first manifestation, period of elimination diet, oral food challenge (OFC) results and symptoms presented in cases of positive OFC. Fisher's exact test and Mann-Whitney test were used to analyze the data. The level of significance was set to 5%. Results: Forty-two patients were selected: 30 preterm infants, 34 cesarean deliveries, 10 exclusively breastfed patients before rectal bleeding. Median age at OFC was 6.3 months old. Median of length of the elimination period before OFC was 5.9 months. OFC was negative in 33/42 (79%) patients and positive in 9/42 (21%). There was no association between OFC results and the evaluated data. The main symptom observed in patients with positive OFC was blood in stools. Conclusion: OFC was negative in most cases of suspected cow's milk allergy due to rectal bleeding in neonates, most of them with a history of prematurity.

RESUMO Contexto: A suspeita de proctocolite induzida por proteína alimentar (PCIPA) com base na compreensão empírica de sangramento retal pode levar a diagnósticos equivocados. Objetivo Verificar as características clínicas e evolutivas de pacientes que apresentavam sangramento retal neonatal e faziam uso de dieta restrita com leite de vaca. Métodos: Estudo transversal retrospectivo com pacientes acompanhados em um centro terciário, que apresentaram sangramento retal no período neonatal. Os dados analisados incluíram: sexo, idade gestacional, tipo de parto, uso de antibióticos no último trimestre da gravidez, uso de nutrição parenteral antes da primeira manifestação, uso de ventilação mecânica, manifestações clínicas iniciais associadas ao sangramento retal, dieta antes da primeira manifestação, período de dieta de eliminação, resultados do teste de provocação oral (TPO) e sintomas apresentados em casos de TPO positivo. O teste exato de Fisher e o teste de Mann-Whitney foram usados para analisar os dados. O nível de significância adotado foi de 5%. Resultados: Quarenta e dois pacientes foram selecionados: 30 prematuros, 34 partos cesáreos, 10 pacientes amamentadas exclusivamente antes do sangramento retal. A idade média na ocasião do TPO foi de 6,3 meses. A mediana da duração do período da dieta de eliminação antes do TPO foi de 5,9 meses. O TPO foi negativo em 33/42 (79%) pacientes e positivo em 9/42 (21%). Não houve associação entre os resultados do TPO e os dados avaliados. O principal sintoma observado em pacientes com TPO positivo foi sangue nas fezes. Conclusão: O TPO foi negativo na maioria dos casos de suspeita de alergia ao leite de vaca devido a sangramento retal em neonatos, a maioria deles com história de prematuridade.

Fist report on fumagillin production by Aspergillus fumigatus sensu stricto gliotoxigenic strains recovered from raw cow milk and clinical samples in Argentina / Primer reporte en Argentina sobre la producción de fumagilina por cepas deAspergillus fumigatus sensu stricto productoras de gliotoxina, aisladas de lechecruda y de casos clínicos

Abstract In Argentina there are no reports on Aspergillus fumigatus fumagillin-producingstrains. In this study we describe the isolation and mycotoxin production capacity of ten A.fumigatus strains isolated from farm and clinical samples. Farm strains were isolated frommilk samples taken from dairy cows in Córdoba province, some of which were associated withsubclinical mastitis. A culture medium was defined to optimize fumagillin production and adetection method was developed by HPLC chromatography. It is known that in addition to thehost immune status, strain virulence is a fundamental characteristic that will determine itspathogenicity and, in this sense, fumagillin is considered to be among the virulence factors. Inthe present work, all the strains tested for the production of fumagillin were able to synthesizeit, highlighting that the strain A. fumigatus RC2243, from a milk sample from a cow with clinicalmastitis, was the most productive. The existence of fumagillin-producing strains represents apotential risk of mycotoxins being transferred to raw milk, constituting a public health risk.

Resumen En Argentina no existen reportes sobre cepas de Aspergillus fumigatus productoras de fumagilina. En este trabajo se describe el aislamiento y la producción de dicha micotoxina clínicaspor 10 cepas, provenientes del medioambiente rural y aisladas de muestras clínicas. Las cepasde origen rural fueron aisladas de vacas lecheras en tambos de la provincia de Córdoba, yalgunas de esas cepas se asociaron a casos de mastitis subclínica. Se definió la composición deun medio de cultivo para optimizar la producción de fumagilina y se desarrolló un método decromatografía HPLC para su determinación. Es conocido que, además del estado inmunitario delhuésped, la virulencia de la cepa es una de las características fundamentales que determinansu potencial patogénico y, en este sentido, la fumagilina es considerada un factor de virulencia. En el presente trabajo todas las cepas estudiadas fueron capaces de sintetizarla y la cepa A.fumigatus RC2243, proveniente de leche de una vaca con mastitis subclínica, se destacó comola cepa más productora. La existencia de cepas productoras de fumagillina representa un riesgopotencial por el pasaje de dicha micotoxina a la leche, lo cual constituye un problema para lasalud pública.

Cow's milk allergy immunoglobulin E-mediated: intake of proteins and amino acids

SUMMARY OBJECTIVE: Children with cow's milk allergy may be at nutritional risk due to the lower intake of nutrients, such as protein, calcium, and vitamin A, which are present in cow's milk. The objective was to evaluate children's diets with Children with cow's milk allergy compared with healthy controls as well as to compare the intake of proteins and amino acids from the diet followed by Children with cow's milk allergy who consume special infant formula or plant-based dairy alternatives with Children with cow's milk allergy who do not consume special infant formula or plant-based dairy alternatives. METHODS: Through a cross-sectional controlled study, the dietary intake of 57 children (27 with immunoglobulin E-mediated Children with cow's milk allergy and 30 healthy controls) was evaluated. Using 24-h nutritional recalls, the total energy intake value, macronutrients, and amino acids were calculated. RESULTS: No statistically significant difference was found between the Children with cow's milk allergy group and healthy controls for the intake of proteins and amino acids. However, the Children with cow's milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower protein (g/kg) and branched-chain amino acid (mg/kg) intake than the Children with cow's milk allergy consume special infant formula or plant-based dairy alternatives group. CONCLUSIONS: The Children with cow's milk allergy group achieved the recommendations for the intake of proteins and amino acids compared to the healthy control group. However, the Children with cow's milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower intake of protein (g/kg) and branched-chain amino acid (mg/kg) than the Children with cow's milk allergy consume special infant formula or plant-based dairy alternatives group.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity

Abstract Objective: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. Methods: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. Results: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). Conclusion: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

A NOTE ON COW MILK DATA USING RANDOMIZED COMPLETE BLOCK DESIGN

In a completely randomized design, the experimental material should be homogeneous. Usually, the experimental materials are not so homogeneous in nature, particularly in agricultural ?eld experiments. In such a situation, the principle of local control is adopted and the experimental material is grouped into homogeneous subgroups. In this paper, cow milk data are used and applied four different types of treatments. The yield of a cow is analyzed and interpreted using Randomized Complete Block Design (RCBD). Results are explored, tabulated and interpreted

Growth of infants with gastrointestinal manifestations of cow's milk protein allergy / Crescimento de lactentes com manifestações gastrointestinais de alergia à proteína do leite de vaca

ABSTRACT Objective To assess linear growth and weight gain in infants with suspected cow's milk protein allergy with gastrointestinal manifestations, seen at a gastropediatrics clinic. Methods A retrospective cohort study conducted with demographic, clinical, anthropometric and dietary information on 84 infants first seen between 2015 and 2018 and followed-up for six months. Stature-for-age, weight-for-age, and body mass index-for-age in z-scores were evaluated according to the cut off points established by the World Health Organization in 2006. Accelerated growth or catch-up was considered a gain ?0.67 in the z-score of the referred indices, evaluated at 3 and 6 months. Results Median age at baseline was 4.0 months and 88.1% of the infants were already in diet exclusion. Regarding the anthropometric evaluation short stature frequency was 15.5% and the underweight frequency was 8.3% and 3.6% respectively based on the weight-for-age and body mass index-for-age indices. High recovery growth was observed during the follow-up period but was not considered catch up. In boys, the gains in weight-for-age and body mass index-for-age were significant (p=0.02 and p=0.01 respectively) and close to the threshold that characterizes the catch up, 0.58 and 0.59, respectively. In girls, significant gains in stature-for-age and weight-for-age (0.38 and 0.37 respectively, p=0.02 for both) were observed. Conclusion Infants with suspected cow's milk protein allergy with gastrointestinal manifestations should have early access to specialized nutritional counseling to avoid exposure to allergenic food and control allergy symptoms, thereby avoiding malnutrition and ensuring adequate nutritional recovery.

RESUMO Objetivo Avaliar o crescimento linear e o ganho de peso de lactentes com suspeita de alergia à proteína do leite de vaca, com manifestações gastrointestinais, atendidos em um ambulatório de gastropediatria. Métodos Estudo de coorte retrospectivo, com informações demográficas, clínicas, antropométricas e dietéticas de 84 lactentes que iniciaram atendimento entre 2015 e 2018 e foram acompanhados durante seis meses. Foram avaliados os índices estatura/idade, peso/idade e índice de massa corporal/idade em escore-z, segundo os pontos de corte da Organização Mundial de Saúde de 2006. Considerou-se crescimento acelerado (ou catch-up growth) um ganho ?0,67 escore-z nos referidos índices, avaliados em três e seis meses. Resultados No baseline, a mediana de idade foi 4,0 meses e 88,1% dos lactentes já estavam em dieta de exclusão. A frequência de baixa estatura foi de 15,5% e a de baixo peso foi de 8,3% e de 3,6% segundo os índices peso/idade e índice de massa corporal/idade, respectivamente. Houve elevado crescimento de recuperação durante o período de acompanhamento, mas que não configurou catch up. Nos meninos, ganhos no peso/idade e índice de massa corporal/idade foram significantes (p=0,02 e p=0,01) e próximos do limiar que caracteriza catch up: 0,58 e 0,59, respectivamente. Nas meninas, foram observados ganhos significantes na estatura/idade e peso/idade, de 0,38 e 0,37 (p=0,02 para ambos). Conclusão Demonstrou-se que lactentes com suspeita de alergia à proteína do leite de vaca, com manifestações gastrointestinais, deveriam ter acesso precoce ao aconselhamento nutricional para evitar exposição ao alimento alergênico, controlar sintomas e, assim, evitar a desnutrição ou garantir recuperação nutricional adequada.

Guidelines for diagnosis and nutritional intervention of mild to moderate non-IgE mediated cow′s milk protein allergy in Chinese infants / 中华实用儿科临床杂志

Cow′s milk protein allergy (CMPA) is one of the most common presentations of food allergy seen in early childhood.It is an abnormal immune response caused by cow′s milk protein.CMPA can be clinically subdivided into either immediate-onset IgE mediated or delayed onset non-IgE mediated, or both.At present, concerns regarding the early and timely diagnosis of CMPA have been high-lighted over the years and there are many expert consensus on CMPA in China, but these consensus did not distinguish IgE mediated or non-IgE mediated CMPA.In view of the obvious clinical differences between the two type of CMPA and non-IgE mediated CMPA is more common in infancy, experts focus on pediatric gastroenterology, allergy/immunology, dermatology, nutrition and child healthcare convened by the Allergy Prevention and Control Professional Committee of Chinese Preventive Medicine Association present this guideline to help practitioners in primary care settings to early recognize and make suitable management of non-IgE mediated CMPA in China.The guideline incorporates the cutting-edge international guidance and the actual situation of Chinese children describing in detail the types, clinical features, diagnosis and nutritional intervention of non-IgE mediated CMPA.There are 42 recommendations in 7 categories in total referring to the common questions related to non-IgE mediated CMPA.

Perfil clínico e nutricional de crianças com alergia à proteína do leite de vaca / Clinical and nutritional profile of children with cow's milk protein allergy

RESUMO: Objetivo: Este estudo teve como objetivo identificar as principais características clínicas e nutricionais apresentadas pelas crianças com alergia à proteína do leite de vaca. Método: Tratou-se de um estudo observacional, transversal, quantitativo e correlacional, com amostra de conveniência, constituída por 22 crianças diagnosticados com alergia em diferentes estágios, na faixa etária de 6 meses a 6 anos, atendidas no ambulatório de Gastroenterologia Pediátrica do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro. Resultados: Evidenciou-se eutrofia em 81,8% das crianças, risco de sobrepeso em 4,5%, sobrepeso em 9,1% e obesidade em 4,5%. Nenhum dos pacientes apresentou diagnóstico nutricional de magreza. Os sintomas gastrointestinais (diarreia, vômito e sangue vivo nas fezes) foram os que mais acometeram os pacientes avaliados. Todos os pacientes (100%) com alergia em remissão e alergia resolvida mostraram nível de ferritina sérica normal, porém, 14,3% das crianças em alergia ativa estavam com esse valor abaixo do recomendado para idade. As crianças apresentam desmame precoce do leite materno, alimentação complementar dentro do que é indicado e o uso de fórmulas infantis corretas para atingir as recomendações nutricionais para a idade. Conclusão: Os achados indicam que o perfil clínico e nutricional de crianças com alergia está em conformidade com o esperado no que tange à escolha das fórmulas e desenvolvimento das crianças. (AU)

ABSTRACT: Objective: this study aimed to identify the main clinical and nutritional characteristics presented by children with cow's milk protein allergy. Method: this was an observational, cross-sectional, quantitative and correlational study, with a convenience sample, consisting of 22 children diagnosed with allergy in different stages, aged between six months and six years, seen at the Pediatric Gastroenterology Outpatient Clinic of the Clinical Hospital of the Federal University of the Triângulo Mineiro. Results: eutrophy was evident in 81.8% of the children, overweight risk in 4.5%, overweight in 9.1%, and obesity in 4.5%. None of the patients presented a nutritional diagnosis of thinness. Gastrointestinal symptoms (diarrhea, vomiting, and bloody stools) were the most frequent in the evaluated patients. All patients (100%) with allergy in remission and allergy resolved showed a normal serum ferritin level, but 14.3% of the children in active allergy were below the recommended level for their age. The children had early weaning from breast milk, complementary feeding within what is indicated and the use of correct infant formulas to achieve the nutritional recommendations for age. Conclusion: the findings indicate that the clinical and nutritional profile of children with allergy is as expected with regard to the choice of formulas and the children's development. (AU)

Effect of food avoidance therapy on gut microbiota in infants with cow′s milk protein allergy / 中国小儿急救医学

Objective:To investigate the effect of dietary avoidance therapy on gut microbiota in infants who were diagnosed as cow′s milk protein allergy by comparing the gut microbiota changes before and after the treatment.Methods:The infants with artificial feeding and clinical diagnosis of cow′s milk protein allergy were collected from the outpatient of Gastroenterology departement in our hospital.They were fed with amino acid formula instead of ordinary formula for 4 weeks.Among them, 23 cases of successful intervention were selected.The fecal samples before and after treatment were collected, and the fecal genomes were extracted respectively.The PCR products of specific segments of 16S rDNA were sequenced by high-throughput sequencing.The results were analyzed by bioinformatics, and the differences of flora composition before and after the intervention were compared to find the different species between groups.Results:No obvious difference was found between before and after treatment of gut microbiota diversity( P>0.05). The compose of gut microbiota of the cow′s milk protein allergy was changed after feeding with amino acid milk.At the level of phylum, proteobacteria decreased significantly after treatment.At the level of class, alphaproteobacteria and gammaproteobacteria decreased significantly.Enterobacteriaceae, enterobacteriaceae and streptococcus granulosus decreased significantly.At the family level, the number of peptostridium, peptostridium and clostridium decreased significantly compared with that before treatment.Lactobacillus eubacteriaceae and eubacterium, ruminococcaceae, limosum, pasteurella, pasteurellaceae, haemophilus parainfluenzae T3T1, infantis ATCC15697/JCM1222/DSM2008 and Pseudocatenulatum-DSM20438/JCM1200/LMG10505 were higher than that before treatment with statistically different( P<0.05). Conclusion:For children with cow′s milk protein allergy, the harmful bacteria in intestinal flora decreased and the beneficial bacteria increased after dietary avoidance treatment.

Research progress of cow′s milk protein allergy and intestinal flora characteristics in premature infants / 中华实用儿科临床杂志

Cow′s milk protein allergy (CMPA) is the most common food allergy in infancy.Since the early symptoms of CMPA in premature infants lack specificity and are prone to misdiagnosis or missed diagnosis, which would induce inappropriate fasting and unreasonable application of antibiotics, more attention should be paid to CMPA in premature infants.It has been proved in accumulating studies that the establishment and improvement of intestinal flora is the basic factor for the maturation of the immune system and the induction of immune response balance after birth.There are differences in the type and amount of intestinal flora between food allergic infants and non-allergic infants.Compared with term infants, preterm infants have significantly lower diversity and abundance of intestinal flora, immature gastrointestinal tract and immune system development, and are at greater risk for allergies.The use of probiotics can enhance intestinal barrier function and improve immune tolerance.The clinical diagnosis and treatment of preterm CMPA, the characteristics of intestinal flora and the use of probiotics in preterm infants would be reviewed in this paper.

Alergia a la proteína de la leche de vaca: reporte de un caso infrecuente en el período neonatal / Cow's milk protein allergy, a rare case report in the neonatal period

La alergia alimentaria se define como una reacción adversa que resulta de una respuesta inmunológica específica y reproducible desencadenada por la exposición al alimento. La respuesta inmune puede ser mediada por inmunoglobulina E, no mediada por inmunoglobulina E o mixta. Durante el primer año de vida, la proteína de la leche de vaca es la primera proteína a la cual se enfrentan los niños alimentados mediante lactancia materna o artificial, motivo por el cual constituye la forma de alergia alimentaria más frecuente en los primeros meses de la vida. El objetivo de este trabajo es presentar un caso clínico grave y poco frecuente de alergia a la proteína de la leche de vaca en el período neonatal.

Food allergy is defined as a reproducible adverse reaction that results from a specific and reproducible immune response triggered by exposure to food. The immune response can be mediated by immunoglobulin E, not mediated by immunoglobulin E or both. During the first year, cow´s milk protein is the first protein faced by children fed with breast milk or artificial milk. For that reason, it constitutes the form of food allergy most frequent in the first months of life. The objective of this paper is to describe a serious and rare clinical case of milk hypersensitivity in the neonatal period.

Milk quality of dual-purpose cows supplemented with biological fish silage (Pterygoplichthys sp.) as a protein source / Calidad de leche de vacas doble propósito suplementadas con ensilado biológico de pez diablo (Pterygoplichthys sp.) como fuente proteica / Qualidade do leite de vacas de duplo propósito suplementadas com silagem biológica de peixe (Pterygoplichthys sp.) como fonte protéica

Abstract Background: Devilfish (Pterygoplichthys sp.) is a pest of high impact in aquaculture production systems. Through a biological fermentation process, it could be used as a source of protein for dairy cows. However, milk palatability and smell could be limiting factors. Objective: to evaluate the quality of milk from cows supplemented with biological fish silage (Pterygoplichthys sp.) as a protein source. Methods: The treatments (T) evaluated were T1, 0% biological fish silage; T2, 10% biological fish silage; and T3, 20% biological fish silage. Twelve randomly selected cows were used in a Latin square experimental design, in which three treatments were tested with all of the cows during three time periods. Each period lasted 20 days (15-day adaptation period and 5-day experimental phase). Milk was analyzed for physicochemical, microbiological, sanitary condition and sensory characteristics. Analyses of variance were performed for all the response variables. Results: No significant differences for physicochemical variables were found among the treatments studied. Differences were observed in microbiological and sanitary variables among treatments, but values were in the range for high quality milk standards (˂100,000 CFU mL-1 aerobic mesophilic bacteria, and ˂400,000 somatic cells mL-1). In the sensory analyses, panelists did not detect strange odors nor fishy taste or odor in the milk of any of the treatments. Conclusion: Biological fish silage can be included up to 20% as a protein source in supplements for lactating cows.

Resumen Antecedentes: el pez diablo (Pterygoplichthys sp.) es una plaga de alto impacto en los sistemas de producción acuícolas. A través de los procesos de fermentación biológicos podría ser utilizado como fuente de proteína en los suplementos para vacas en producción. Sin embargo, el sabor y olor a pescado en la leche pudiera ser una limitante. Objetivos: evaluar la calidad de la leche de vacas suplementadas con ensilaje biológico de pez diablo como fuente de proteína. Métodos: los tratamientos (T) evaluados fueron T1, 0% de ensilaje biológico de Pterygoplichthys sp.; T2, 10% de ensilaje biológico de Pterygoplichthys sp.; y T3, 20% de ensilaje biológico de Pterygoplichthys sp.. Se utilizaron doce vacas seleccionadas al azar en un diseño experimental de cuadrado latino. Cada período tuvo una duración de 20 días (período de adaptación de 15 días y fase experimental de 5 días). La leche fue analizada para determinar su condición fisicoquímica, microbiológica, sanitaria y sensorial. Se realizaron análisis de varianza para todas las variables. Resultados: no se encontraron diferencias significativas entre los tratamientos estudiados para las variables fisicoquímicas las cuales estuvieron dentro de los estándares de leche de mayor calidad. Se observaron diferencias en las variables microbiológicas y sanitarias entre los tratamientos, pero los valores estuvieron dentro del rango para los estándares de leche de mayor calidad (˂100.000 UFC ml-1 de bacterias mesofílicas aeróbicas y ˂400.000 células somáticas ml-1). Los análisis sensoriales no detectaron olores extraños, ni olor ó sabor a pescado en la leche de los tratamientos estudiados. Conclusiones: se puede incluir hasta 20% de ensilaje biológico de Pterygoplichthys sp. como fuente de proteína en los suplementos de vacas en producción.

Resumo Antecedentes: o peixe cascudo (Pterygoplichthys sp.) é uma praga de alto impacto nos sistemas de produção aquícola. Por meio de processos de fermentação biológica poderia ser usado como fonte de proteína em suplementos para vacas em produção, porém o sabor e cheiro de peixe no leite podem ser uma limitação. Objetivos: avaliar a qualidade do leite de vacas suplementadas com silagem biológica de peixe cascudo como fonte de proteína. Métodos: os tratamentos (T) avaliados foram T1, 0% da silagem biológica de Pterygoplichthys sp.; T2, silagem biológica a 10% de Pterygoplichthys sp.; e T3, silagem biológica a 20% de Pterygoplichthys sp. Doze vacas selecionadas aleatoriamente foram utilizadas em um delineamento experimental de quadrado latino. Cada período durou 20 dias (período de adaptação de 15 dias e fase experimental de 5 dias). O leite foi analisado para determinar sua condição físico-química, microbiológica, sanitária e sensorial. Análises de variância foram realizadas para todas as variáveis. Resultados: não foram encontradas diferenças significativas entre os tratamentos estudados para as variáveis físico-químicas, os valores estavam dentro dos mais altos padrões de qualidade do leite. Observaram- se diferenças nas variáveis microbiológicas e sanitárias entre os tratamentos, mas os valores estavam dentro dos limites para os mais altos padrões de leite de qualidade (˂100.000 CFU ml-1 de bactérias mesofílicas aeróbicas e ˂400.000 células somáticas ml-1). As análises sensoriais não detectaram odores estranhos, nem cheiro ou sabor de peixe no leite dos tratamentos estudados. Conclusões: a silagem biológica de peixes pode ser incluída em até 20% como fonte de proteína em suplementos de vacas em produção.

Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Alergia a la proteína de la leche de vaca: enfoque diagnóstico y terapéutico / Diagnostic and therapeutic approach to cow's milk protein allergy

Resumen La prevalencia de la alergia a las proteínas de la leche de vaca (APLV) en el ámbito mundial es, aproximadamente, de 1,9 a 4,9 %. En Colombia, esta cifra se desconoce. En un alto porcentaje de los casos, no existe la sospecha por parte del personal de salud, y, por lo tanto, el diagnóstico y el tratamiento se retrasan. Esto acarrea un aumento en el tiempo y en los recursos que emplean los profesionales de la salud y los padres en procura de establecer la etiología del padecimiento de los niños que presentan esta enfermedad. Dentro de este contexto, la historia clínica es fundamental en la sospecha de la APLV, y es especialmente relevante la evaluación de antecedentes, en los cuales se destacan la presencia de la exposición temprana a la proteína, así como la atopia en familiares en primer grado de consanguinidad. La presentación de la APLV puede manifestarse con reacciones inmediatas a nivel digestivo (vómitos, diarrea aguda), cutáneo (urticaria, dermatitis, angioedema) y, con menos frecuencia, a partir de signos respiratorias y sistémicos. Sin embargo, la amplia variedad de manifestaciones clínicas y signos puede ser un reto para el profesional que no se encuentre sensibilizado con la patología, e incluso soslayar este diagnóstico retrasa la suspensión de la proteína de la leche de vaca de la dieta y demora el acceso a un tratamiento eficaz. El tratamiento ideal reconocido es la dieta de exclusión, la cual requiere un estricto cumplimiento. En los niños alimentados con lactancia materna exclusiva, será necesaria la dieta restrictiva de leche y sus derivados en la madre. En quienes no reciben lactancia, se deberá tratar mediante fórmulas de proteínas lácteas extensamente hidrolizadas (FEH) o a base de aminoácidos (FAA). Así bien, el pronóstico es favorable y la mayoría de niños tolerarán las proteínas de la leche de vaca a los 2 años, mientras que en pacientes con polisensibilización el proceso puede prolongarse. En el caso de no alcanzar la tolerancia, la inmunoterapia oral es una opción disponible.

Abstract The worldwide prevalence of cow's milk protein allergy (CMPA) is approximately 1.9% to 4.9%. Its prevalence in Colombia is unknown. A high percentage of cases are unsuspected by medical personnel resulting in delayed diagnosis and treatment which increase the time and resources used to establish the etiology of this condition in children. The clinical history is fundamental for diagnosis of CMPA, especially the background evaluation. Of special importance are early exposure to the protein and atopy in first degree relatives. CMPA's initial presentation may be digestive, cutaneous or respiratory. Digestive symptoms can include vomiting and acute diarrhea, and cutaneous symptoms include hives, dermatitis and angioedema. Respiratory and systemic manifestations occur less frequently. The wide variety of clinical manifestations and signs can challenge health care professionals who are not alert to this pathology to the point that the diagnosis is not even considered event though delaying the suspension of cow's milk protein from the diet delays access to an effective treatment. The well-recognized ideal treatment is an exclusion diet which requires strict compliance. For children who are exclusively breastfed, the mother's diet must restrict milk and its derivatives. Children who are not breastfed, should be fed formulas of extensively hydrolyzed milk proteins based on amino acids. The prognosis is favorable, and most children will tolerate cow's milk proteins at two years. The process may take more years for polysensitive patients. Oral immunotherapy is an option that is available for patients who do not achieve toleration.

Magnetic metal organic framework for pre-concentration of ampicillin from cow milk samples / 药物分析学报

The aim of this study is a present of a simple solvothermal synthesis approach to preparation of Cu-based magnetic metal organic framework (MMOF) and subsequently its application as sorbent for ultrasound assisted magnetic solid phase extraction (UAMSPE) of ampicillin (AMP) from cow milk samples prior to high performance liquid chromatography-Ultraviolet (HPLC-UV) determination. Characteristics of pre-pared MMOF were fully investigated by different techniques which showed the exclusive properties of proposed sorbent in terms of proper functionality, desirable magnetic property and also high specific surface area. Different influential factors on extraction recovery including sorbent dosage, ultrasonic time, washing solvent volume and eluent solvent volume were assessed using central composite design (CCD) based response surface methodology (RSM) as an operative and powerful optimization tool. This is the first report for determination of AMP using MMOF. The proposed method addressed some drawbacks of other methods and sorbents for determination of AMP. The presented method decreases the extraction time (4 min) and also enhances adsorption capacity (250 mg/g). Moreover, the magnetic property of presented sorbent (15 emu/g) accelerates the extraction process which does not need filtration, centrifuge and precipitation procedures. Under the optimized conditions, the proposed method is applicable for linear range of 1.0-5000.0μg/L with detection limit of 0.29μg/L, satisfactory recoveries (≥95.0％) and acceptable repeatability (RSD less than 4.0％). The present study indicates highly promising perspectives of MMOF for highly effective analysis of AMP in complicated matrices.

Research advances in animal models of cow's milk protein allergy / 国际儿科学杂志

Cow's milk protein allergy (CMPA) is the most common food allergy among infants and young children,which has an increasing incidence in recent years.Performing suitable animal experiments is a key to study CMPA,but currently there aren't proper models consistent with human physiological sensitization process.Ideal animal models can serve as critical tools to reveal the mechanisms of CMPA and develop preventive and therapeutic approaches.Animal species and strains,different types of the models,biological detection methods and evaluation are reviewed in this paper.It also summarizes characteristics of animal models,which will provide a reference for basic and applied researches of CMPA.