Clinical forms of cow milk protein intolerance in children

Fifty children aged between 2 months and 5 years with intolerance of cow milk proteins were analysed. The children were hospitalized between 1978 and 1984. The following clinical forms of protein intolerance were distinguished and characterized: gastro-enteric, skin, constitutional-cerebral with the respiratory and laryngological symptoms, and shock. An emphasis is on certain clinical symptoms characteristic for particular forms. Elimination of cow milk from the diet of these children during hospitalization period and following out-patient treatment has led to complete diminishment of the clinical symptoms.     

The provocation test in children with cow-milk protein and gluten intolerance: evaluation of the clinical response and lesions in the mucous membrane of the small intestine

Provocation test (re-introduction of the noxious protein) was carried out in two groups of patients: (a) with intolerance to the cow-milk proteins (41 children) treated with milk-free diet for 6-24 months, and (b) with gluten intolerance (26 children) treated with gluten-free diet for 6-36 months. The following parameters were compared: type and frequency of the clinical symptoms seen in these patients prior to the introduction of allergen-free diet. Moreover, the type of observed morphological changes in the small intestine mucosa following provocation test were analysed in the groups of 7 patients. A two-year elimination of milk from the diet produces milk tolerance in about 61% patients; clinical symptoms in the remaining children are diversified. Re-introduction of gluten with the diet (provocation test) produces recurrence of gluten intolerance in 96% of children treated with gluten-free diet for 2-3 years. Recurrence of the disease was accompanied by the atrophy of the intestinal villi.     

基于胃肠道表现就诊的婴儿牛奶蛋白过敏症临床分析

目的:探讨以胃肠道表现为首发症状的婴儿牛奶蛋白过敏症(cow milk protein allergy,CMPA)的临床特点,以减少误诊。方法:选择2012年7月至2015年6月我院消化门诊就诊的448例诊断为婴儿牛奶蛋白过敏患儿,采用问卷调查法收集临床资料和应用COMi SS症状评分法进行症状量化评估。结果:448例患儿中男216例,女232例,以0~6个月发病年龄为主。不同胃肠道首发症状就诊中腹泻50%,便血29%,反流或呕吐9%,阵发性哭闹7%,便秘5%。治疗前COMi SS评分均值10.24±2.60分,饮食回避2~4周后评分均值为3.68±1.17分,均值差6分。调查既往诊疗中误诊病例296例,不同胃肠道首发症状患儿的误诊率为:腹泻组71%,便血组68%,阵发性哭闹组50%,反流或呕吐组40%,便秘组66%。既往误诊病例中抗生素使用率达62%。误诊病例中发生营养不良112例,非误诊病例中营养不良4例,差异具有统计学意义(P0.05)。结论:胃肠型婴儿牛奶蛋白过敏主要症状为腹泻及便血。因症状缺乏特异性,临床实践中误诊发生率高。COMi SS症状评分法有助于临床医师对该病首发症状的识别和疗效观察。     

Height of primary school children and parents' perceptions of food intolerance

In the national study of health and growth parents'' responses to a self completed questionnaire were used to categorise children according to their experience of food intolerance. The heights of the children in each group were then compared. Useful responses to the questions on food intolerance were received for 6813 (85%) children in the sample and measurements of height obtained for 7856 (98%). Children with food intolerance were shorter than other children. A difference in height of about 1·5 cm remained after adjusting for social and biological factors and some common symptoms in childhood using multiple regression. The number of different types of food avoided was associated with shortness in the food intolerant group but not in the non-food-intolerant group.Regardless of the underlying aetiology, these findings suggest that parents'' complaints of food intolerance in their children should be taken seriously.     

青岛地区慢性荨麻疹患者食物不耐受结果分析

目的:探讨青岛地区慢性荨麻疹患者与食物不耐受的相关性。方法:选取慢性荨麻疹患者496名,采用酶联免疫吸附试验检测血清中14种食物特异性IgG。结果:385例患者食物不耐受阳性,以鸡蛋、牛奶、螃蟹、鳕鱼、大豆为主,分别占55.0%、28.6%、26.8%、19.5%、15.1%;不同年龄组中不耐受的食物所占的比例不同;其中,儿童组:以鸡蛋(84.0%)、牛奶(59.0%)、螃蟹、大豆(16.0%)、鳕鱼(15.3%)为主;青年组:以鸡蛋(55.1%)、牛奶(29.1%)、螃蟹(27.6%)、鳕鱼(22.8%)为主;中年组:以鸡蛋(39.9%)、螃蟹(32.5%)、鳕鱼(18.4%)、大豆(12.9%)为主;老年组:以螃蟹(35.5%)、鸡蛋(27.4%)、大豆(19.4%)、鳕鱼(17.7%)为主。结论:通过检测分析患者血清中特异性IgG,发现青岛及其周边地区慢性荨麻疹患者不耐受的食物以海产品为主,且随年龄增长其敏感性逐渐增加。     

Analysis of casein alpha S1 & S2 proteins from different mammalian species

Nowadays, the quality of any food used for human consumption is, to a considerable extent, considered by its possible contribution to the maintenance or improvement of the consumer's health. In developed countries there is increasing interest in goat milk and its derivates, the quality of which is considered of special importance in the light of current tendencies favouring healthy eating. In particular, goat's milk is a hypoallergenic alternative to cow's milk in the human diet. In the present work, we studied the casein alpha S1 and S2 proteins of cow, goat and sheep for comparative analysis. We found that the amino acid sequence of these proteins is almost same in goat and sheep but there are several changes at different base pairs when these two sequences are compared with cow. Prediction of secondary structures (GOR) was performed for alpha s1 and s2 proteins to gain functional insights. Our in silico study revealed considerable identity in chemical properties between goat and sheep but a considerable dissimilarity in cow with goat and sheep casein proteins. Moreover, the effect amino acid change on secondary structures in the three species is discussed. There was no significant difference found between goat and sheep alpha S1 and S2 proteins, so naturally both will be having same properties. The study concludes that sheep milk is another convenient alternative for the cow milk allergic children.     

Early-life gut microbiome and cow’s milk allergy- a prospective case - control 6-month follow-up study

Increasing evidence suggests that perturbations in the intestinal microbiota in early infancy are implicated in the pathogenesis of food allergy (FA); existing evidence on the structure and composition of the intestinal microbiota in human beings with FA is limited and conflicting. The main object of the study was to compare the faecal microbiota between healthy and cow’s milk allergy (CMA) infants at the baseline immediately after the diagnosis, and to evaluate the changes in the faecal microbiota after 6?months of treatment of CMA infants with hypoallergenic formula (HF), compared with healthy children fed on standard milk formulae. Sixty infants younger than 4?months of age with challenge-proven CMA and 60 healthy age-matched children were investigated in this prospective case - control follow-up study. Faecal samples were collected at baseline and at 6?months of follow-up, microbial diversity and composition were characterized by high-throughput 16S rRNA sequencing. The average age (±SD) of the infants at inclusion was 2.9?±?1.0?months. Children with CMA have lower gut microbiota diversity and an elevated Enterobacteriaceae to Bacteroidaceae (E/B ratio) in early infancy compared with healthy children (115.8 vs. 0.8, P?=?0.0002). After 6?months of treatment with HF, CMA infants had a higher Lactobacillaceae (6.3% vs. 0.5%, P?=?0.04) and lower Bifidobacteriaceae (0.3% vs. 8.2%, P?=?0.03) and Ruminococcaceae (1.5% vs. 10.5%, P?=?0.03) abundance compared with control children. Conclusion: Low gut microbiota diversity and an elevated E/B ratio in early infancy may contribute to the development of FA, including CMA. A strict elimination diet may weaken FA by reducing E/B ratio and promoting a gut microbiota that would benefit the acquisition of oral tolerance.     

Biopsy examinations of small intestinal mucosa in malabsorption syndrome of childhood]

The results of bioptic mucosal specimens examination are discussed. Samples of the small intestine were collected from 211 children with malabsorption syndrome of various etiology such as cow milk protein intolerance, gluten intolerance, spontaneous diarrhoea and other. The results obtained with microscopic examination scored with Shmerling scale were compared with those of light microscopic examination of histological preparations. The difficulties connected with proper sampling and handling of the bioptic specimen are discussed. Technical errors very often are the cause of the diagnostic failure.     

Study of human allergic milk whey protein from different mammalian species using computational method

Nowadays, safety and quality assessment of food used for human consumption have to consider by its possible contribution to the maintenance or improvement of the consumer''s health. Milk is an important food with many nutrients. Cow milk is an important source of energy, protein, vitamins and minerals for the growing child as well as adults. But, numerous cow milk proteins have been implicated in allergic responses and most of these have been shown to contain multiple allergic epitopes. The present study disclosed best alternatives to cow milk, which are not allergic and as good as cow milk in nutritional value. The in silico analysis of casein (alpha s1, alpha s2, beta and kappa) and beta-lactoglobulin, unveils that sheep milk is a more suitable alternate to cow milk for allergic infants and buffalo milk for allergic adult humans.     

Reproducibility of atopy patch tests with food and inhalant allergens

Although atopy patch tests (APT) seem a valuable additional tool in the diagnostic work-up for food allergy in children with atopic eczema/dermatitis syndrome, the immunopathology and some technical aspects of testing remain controversial. Few published data are available on the reproducibility of APT with inhalants and only two studies include fresh food allergens. In this study we therefore investigated the reproducibility of duplicate APT (left versus right side of the back) with native and commercially available food (cow s milk, hen s egg, tomato, wheat flour) and with inhalant allergens (Dermatophagoides pteronyssinus and mixed grasses) in a large unselected population of children. We tested a population of 277 Italian school children with three APT allergens: fresh food (cow s milk, hen s egg, tomato and wheat flour), standardised food allergens in petrolatum (the same four foods) and standardised inhalant allergens routinely used for skin prick testing. For the four food allergens (applied in the natural form or as the standardised commercial preparation) from one- to three quarters of the APT gave positive results on one side and negative reactions on the opposite side (Cohen s K coefficient between 0.38, fresh tomato and 0.81, fresh cow s milk). Conversely, APT with inhalant allergens were invariably reproducible (Cohen s K = 1.00). The possible technical and immunologic reasons explaining why reproducibility of APT differed for the two types of allergens await an answer from extensive controlled studies.     

Recent advances in exploiting goat's milk: Quality,safety and production aspects

Goat milk production is a dynamic and growing industry that is fundamental to the wellbeing of hundreds of millions of people worldwide and is an important part of the economy in many countries. The aim of the present review is to provide an integrated and critical analysis of the major aspects in this field to highlight unexploited nutritional potential of goat milk and the need for improvements, particularly in food safety. First, it should be kept in mind that goat milk like cow milk delivers many nutrients with relatively low energy content, and is relevant to the health of consumers throughout the life cycle. In addition, the review presents data suggesting that goat milk possesses many advantages over cow milk, for use as a nutritional source for infants and children and as a medicinal food. Furthermore, goats, by consuming large amounts of natural browsing plants all year around, are a potentially overlooked “treasure trove”, with respect to health promoting components. The survey suggests that total bacterial count that is currently used as the major quality measure to prevent pathogen-related food toxicity is not sufficiently effective. The proposal is to include somatic cell count as a routine criterion to qualify the hygienic status of goat milk in terms of the relevant physiology and biochemistry. The paper presents a novel mechanism controlling milk secretion, and demonstrates the use of this knowledge in making decisions for two major managerial tasks that farmers face, namely milking frequency that dictates to a large extent the milk yield and workload on the farm, and helping to deal with subclinical mastitis that is the single major cause for economical losses in dairy farms worldwide.     

The Content of Elements in Infant Formulas and Drinks Against Mineral Requirements of Children

The present study aimed at analysing the content of fluorine (F), calcium (Ca), magnesium (Mg), iron (Fe) and zinc (Zn) in the drinks for children and infant formulas, a popular supplement or substitute for breast milk produced from cow milk on an industrial scale. Ca, Mg, Zn and Fe concentrations were determined using atomic absorption spectrophotometer, while F levels using a potentiometric method. F levels in the examined formula samples increased with the intended age range, until the intended age of 1 year, and then decreased. A lower content of Ca, Mg and Zn was observed in formulas intended for children <1 year of age and higher for older children. Fe content increased with the age range. A statistically significant higher content of Ca, Mg, Zn and Fe in samples intended for children with phenylketonuria in comparison to those intended for healthy children or children with food allergies was noted. The content of the analysed elements in juices and nectars showed the highest contents in products intended for infants (under 6 months of age). The lowest levels of elements tested were found in drinks for children over 6 months of age. In conclusion, the concentrations of the examined elements in infant formulas and juices for children were decidedly greater than the standards for the individual age groups. Although the absorption of these elements from artificial products is far lower than from breast milk, there is still the fear of consequences of excessive concentrations of these minerals.     

Evaluation of dairy allergy among ulcerative colitis patients

The intestine is the largest mucosal organ of the body and also the first line immune homeostasis. Inflammatory bowel disease or IBD is divided into ulcerative colitis and Crohn''s disease. One of the problems that can occur with UC is dietary allergy to some foods. This study aimed to evaluated the dairy allergy among patients with ulcerative colitis. This study is a Case - control study, that studied 72 patients with Ulcerative Colitis, after recording history of the disease, colonoscopy and confirmed by biopsy and 72 person without history of colitis. In this study, in order to investigate of food allergy, used of the EUROMMUM kit with an international code number DP3420-1601-11E. We used chi-square and Monte Carlo method for analysis of data. Among UC patients, 30.6% mild, 52.8% moderate and 16.6% of cases were in sever stage. 9.7% of them reported a history of abdominal surgery due to disease. According to the chi-square and Monte Carlo methods, dairy allergy (including: cow milk, cow milk UHT and casein) in UC group was significant (P=0.00). This study indicated that there is significant relationship between UC and cow milk, cow milk UHT and casein. UC patients who are allergic to dairy products and the use of dairy products can increase the severity of UC.     

直肠癌切除术患者永久性与临时性造口术后生活质量变化及其与排便症状的相关性研究

摘要 目的：探讨直肠癌切除术患者永久性与临时性造口术后生活质量变化,并分析其生活质量与排便症状的相关性。方法：纳入我院2017年4月～2020年4月收治的直肠癌切除术患者110例,所有纳入者均行造口术。根据造口方式,分成永久性造口组（简称永久组,n=41）、临时性造口组（简称临时组,n=69）。记录两组造口并发症发生率,分别在患者术后1、3、6个月,采用简明生活质量量表（SF-36）评估其生活质量,采用排便症状量表评估患者排便症状的变化。经Pearson线性相关分析患者生活质量评分与排便症状评分的相关性。结果：临时组造口并发症发生率（8.90%）与永久组（12.20%）比较无差异（P＞0.05）。两组术后3、6个月SF-36各维度评分均高于术后1个月,术后6个月各评分高于术后3个月,且临时组术后3个月SF-36各维度评分高于永久组（P＜0.05）,但两组术后6个月各评分比较无差异（P＞0.05）。两组术后3、6个月大便症状各评分均低于术后1个月,术后6个月的排便急迫感、排便费力、里急后重评分及总分低于术后3个月,且临时组术后3个月的排便急迫感、排便费力、里急后重评分及总分低于永久组（P＜0.05）,但两组术后6个月排便症状各评分比较未见差异（P＞0.05）。Pearson线性相关分析显示,排便症状总分与机体疼痛、躯体功能、躯体角色受限、情感角色受限、心理健康、社会功能、总体健康评分呈负相关（P＜0.05）。结论：直肠癌切除术患者临时性造口能够进一步促进术后3个月生活质量、排便功能的改善,在术后6个月,永久性造口患者的生活质量、排便功能基本达到临时性造口患者的状态,且排便功能与生活质量具有相关性。     

Long term observation of children with Giardia intestinalis invasion treated with metronidazole and furazolidone]

The results of a long-term (3-year) follow-up of children infected with G. intestinalis treated with metronidazole and furazolidone are presented. Therapy was effective in 84-95% of cases, depending of the duration or the follow-up. Repetition of therapy with tinidazole was indicated in 5% of children after 6 months and in 15% of children after 1 and 2 years of observation because of persisting symptoms of the infection or recurrence. More frequent the treatment was necessary in children under 3 years of age. Some (14%) children required milk free diet and in a few cases (underlying disease--coeliac) gluten-free diet or a diet free of main allergens.     

Presence of adropin,nesfatin-1, apelin-12, ghrelins and salusins peptides in the milk,cheese whey and plasma of dairy cows

Biological fluids (milk and serum/plasma) and cheese whey milk-derived fluid contain numerous molecules, especially amino acids and proteins. Therefore, the purpose of this study was to find out whether cheese whey (n:6), cow milk (n:6) and its blood (n = 6) have adropin, nesfatin-1, apelin-12, ghrelins and salusin peptides. Adropin, nesfatin-1, apelin-12 concentrations were measured by ELISA, whereas ghrelin and salusin concentrations were measured by EIA methods. It was found that adropin, nesfatin-1, apelin-12, des-acylated ghrelin and salusins in cheese whey were higher than in the corresponding milk peptides and plasma of dairy cows, with the exception of salusin alpha and acylated ghrelin in milk being the same than that of the corresponding cheese whey concentration and plasma of dairy cows. A correlation was also found between milk peptides and cheese whey, as also with plasma of dairy cows. The data suggest that peptides in cow milk might be an important and nutritious food for (neonatal) calves and human diet due to their biological and physiological properties.     

Biochemical and palaeopathological investigations on weaning and infant mortality in the early Middle Ages

Weaning age of the children of the early medieval population at Wenigumstadt (Ldkr. Aschaffenburg, southern Germany, 500-700 AD) was estimated by stable nitrogen isotope analysis of bone collagen. The onset of weaning was by one year of age, when solid vegetal food subsequently replaced breast milk. In total, the change from mother's milk to solid adult food took about three years, the infants being fully weaned at this age. While the growing infant was sufficiently supported in utero and during the first months of life, the weanling's diet was insufficient for further growth and development. Starting with about 18 months of age, more and more symptoms of malnutrition are detectable on the skeletal remains, and the peak of both morbidity and mortality is reached at four years of age. Especially unspecific stress markers like Harris' lines and enamel hypoplasia clearly indicate the infants' risk of falling ill or die between three and four years of age. Malnutrition weakens the immune response, therefore the majority of inflammations detectable on the skeleton are found among the inadequately nourished children. The assumption that weaning is responsible for pathological skeletal lesions and early death in history is thus supported by archaeometry.     

Cows' milk protein intolerance: a possible association with gastroenteritis,lactose intolerance,and IgA deficiency.

Twenty-five children with cows'' milk protein intolerance were studied. Twenty had presented with an illness clinically indistinguishable from infantile gastroenteritis; an enteropathogenic Escherichia coli was isolated from the stools in two children, and in six another member of the family simultaneously developed acute diarrhoea and vomiting. Twenty-three children had lactose intolerance secondary to cows'' milk protein intolerance. Eight out of 20 children were found to be partially IgA deficient. An acute attack of gastroenteritis, in damaging the small mucosa, may act as a triggering mechanism in cows'' milk protein intolerance, and a deficiency in IgA may be a predisposing factor in so far as it allows the patient to become sensitised to foreign protein.     

Production performance and pattern of milk fat depression of high-yielding dairy cows supplemented with encapsulated conjugated linoleic acid

Several processes have been suggested to protect lipids from bioactivity of the rumen microorganisms. The majority of experiments with conjugated linoleic acid (CLA) were conducted using calcium salts of CLA. The objectives of this study were to determine the effects of encapsulated CLA (E-CLA) that was supplemented during days 21 to 100 post partum (PP), on milk fat depression, recovery rate and performance parameters. Forty-two multiparous Israeli-Holstein cows were divided at day 21 PP into two treatment groups: (i) control - supplemented with 43 g/day per cow of calcium salts of fatty acids (FAs). (ii) E-CLA - supplemented with 50 g/day per cow of encapsulated lipid supplement providing 4.7 g/day per cow of trans-10, cis-12 CLA. Post-treatment cows were followed for recovery rate until 140 days PP. Dry matter intake (DMI) during the treatment period was reduced by 2.5%, and milk yield was enhanced by 4.5% in the E-CLA cows. Milk fat percentage and yield were reduced by 13% and 9%, respectively, in the E-CLA treatment as compared with the control. The energy-corrected milk output was 3.6% higher in the control group than in the E-CLA group. Yields of trans-10, cis-12 CLA isomer in milk was 2.13-fold higher in the E-CLA cows than in the controls. Full recovery to milk fat percentage of the control group occurred 4 to 5 weeks after cessation of the E-CLA supplementation. No differences between groups were observed in any fertility parameter that was tested. In conclusion, the E-CLA supplement decreased DMI, enhanced milk yield, and decreased energy output in milk, and was effective in depressing milk fat. Full recovery to the milk fat content, but not yield, of the control group in the E-CLA group was relatively slow and occurred 4 to 5 weeks after termination of the supplementation.