Clinical aspects of cow milk protein and gluten intolerance in children

In two comparative groups of 50 children with cow milk proteins and 45 children with gluten intolerance retrospective analysis of initial symptoms was carried out. The initial symptoms of intolerance included: vomiting, loss of appetite, recurrent diarrhoea, and weight gain disorders. These symptoms closely correlated with the type of nutrition (mixed, artificial) and the duration of exposition to harmful component of the food. The symptoms appeared within first days after birth with peak intensity in 6-8 weeks of life in the group with cow milk proteins intolerance. The symptoms of intolerance were most frequent in children of group II in 7-12 months of life. To prevent food intolerance in Polish children, it is recommended to feed them naturally as long as possible and to introduce flour and 4 basic grains late (after the 6th months of life).     

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.     

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.     

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。     

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。     

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.     

Effect of antigen load on development of milk antibodies in infants allergic to milk.

The phenomenon that large amounts of antigen, such as are absorbed during the neonatal period, suppress the IgE response while low-dose exposure enhances it was investigated by analysing the antibody responses of infants allergic to milk according to their degree of exposure to cows''-milk protein. IgG, IgA, and IgM milk-specific antibodies in these infants and in age-matched controls were measured by enzyme-linked immunosorbent assay. Milk-specific IgE and total IgE were also measured. Children allergic to milk who were breast fed and had had minimal exposure to cows'' milk had decreased titres of IgG, IgA, and IgM milk antibodies compared with infants allergic to milk who, before diagnosis, had been fed substantial volumes of cows'' milk. Conversely, the infants with minimal exposure to cows'' milk showed vastly increased total and milk-specific IgE antibodies compared with the milk-fed infants. These results support recent experimental evidence that appreciable amounts of allergen suppress rather than stimulate IgE production. These data may have important implications for dietary regimens in at-risk infants. The results also lend support for the role of IgE in immediate-type allergic reactions and suggest that various non-IgE immune mechanisms play a part in the aetiology of intolerance to cows''-milk protein in some children.     

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.     

Immunological similarities of mammalian xanthine oxidases

The degree of relatedness among mammalian xanthine oxidases (XO) was determined by microcomplement fixation. Rabbit anti bovine milk XO serum was tested against xanthine oxidase (homologous protein) and against the heterologous proteins of bovine liver, monkey liver, rat liver, lactating cow serum, nonlactating cow serum, and steer serum. The indices of dissimilarity for the heterologous proteins were expressed as units of immunological distance and the percent sequence differences among these proteins inferred from the y=5x relationship where y is immunological distance and x is percent sequence difference. Rat liver XO differed by approximately 27% in amino acid sequence from bovine milk XO. In order of increasing immunological distance from bovine milk XO, the sources of XO ranked as follows: lactating cow serum < nonlactating cow serum < steer serum = beef liver < monkey liver < rat liver. The monkey ranked much closer than the rat in order of phylogenetic kinship to the cow. Starch gel electrophoresis of liver, milk, and serum showed that the milk and the serum contained only cationic forms of xanthine oxidase while all the liver samples tested contained cationic as well as anionic forms of the enzyme. The electrophoretic mobility properties of xanthine oxidase confirmed the polymorphic nature of the enzyme as revealed by the immunological data.This investigation was supported by the National Dairy Council, Chicago, Illinois, and by USPHS Grant AM16726.     

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.     

Secretion of Radioiodine in Milk Following a Single Oral Administration in the Cow

The secretion of radioiodine in the milk following the administration of a single oral dose was studied using I131. All of the values are corrected for the physical decay of the isotope. I131 began to appear in the milk 30 minutes after administration with a maximal concentration of, on the average, 1.7 per cent of the given dose per 1 of milk at about six hours following administration. The subsequent reduction in the concentration showed a two exponential course with biological half-lives of 0.6 days and 10 days, respectively. The total secretion in the milk was between 10 and 27 per cent of the given dose of I131 in six days. The total secretion of radioiodine in the milk was seen to be dependent upon the cow’s milk production.     

Amino acids content and electrophoretic profile of camel milk casein from different camel breeds in Saudi Arabia

This study aimed to evaluate amino acids content and the electrophoretic profile of camel milk casein from different camel breeds. Milk from three different camel breeds (Majaheim, Wadah and Safrah) as well as cow milk were used in this study.Results showed that ash and moisture contents were significantly higher in camel milk casein of all breeds compared to that of cow milk. On the other hand, casein protein of cow milk was significantly higher compared to that of all camel milk breeds. Molecular weights of casein patterns of camel milk breeds were higher compared to that of cow milk.Essential (Phe, Lys and His) and non-essential amino acids content was significantly higher in cow milk casein compared to the casein of all camel milk breeds. However, there was no significant difference for the other essential amino acids between cow casein and the casein of Safrah breed and their quantities in cow and Safrah casein were significantly higher compared to the other two breeds. Non-essential amino acids except Arg and the essential amino acids (Met, Ile, Lue and Phe) were also significantly higher in cow milk α-casein compared to α-casein from all camel breeds. Moreover, essential amino acids (Val, Phe and His) and the non-essential amino acids (Gly and Ser) content was significantly higher in cow milk β-casein compared to the β-casein of all camel milk breeds and the opposite was true for Lys, Thr, Met and Ile. However, Met, Ile, Phe and His were significantly higher for β-casein of Majaheim compared to the other two milk breeds. The non-essential amino acids (Gly, Tyr, Ala and Asp) and the essential amino acids (Thr, Val and Ile) were significantly higher in cow milk κ-casein compared to that for all camel milk breeds. There was no significant difference among all camel milk breeds in their κ-casein content of most essential amino acids.Relative migration of casein bands of camel milk casein was not identical. The relative migration of α_s-, β- and κ-casein of camel casein was slower than those of cow casein. The molecular weights of α_s-, β- and κ-casein of camel caseins were 27.6, 23.8 and 22.4 KDa, respectively. More studies are needed to elucidate the structure of camel milk.     

Influence of goat and cow milk on the digestive and metabolic utilization of calcium and iron

The effects of goat and cow milk on the digestive and metabolic utilization of calcium and iron were studied in rats using a standard (non-milk) control diet. The digestive utilization of calcium is greater when the animals consume the goat-milk-based diet rather than that based on cow milk or the standard diet. The digestive utilization of iron, however, is similar for the goat-milk diet and the standard diet, and in both cases superior to that based on cow milk. The calcium content in the femur, sternum and Longissimus dorsi muscle (L.D. muscle) provides an indication of what happens during the utilization of the mineral; more is deposited when the rats consume a milk-based diet, particularly one based on goat milk. The iron content in the reserve organs, namely the liver and the spleen, is greater with the standard diet and the goat milk diet than with that containing cow milk. There is an obviously beneficial effect of goat milk on the metabolism of calcium and iron, which minimizes any interaction between the two minerals.     

Effects of some thermal, chemical and mechanical treatments on lipase activity in Shammi goat milk

The effects of heating (20, 37 or 50 °C), cooling (5 °C), pasteurisation (71 °C for 15 s), boiling (100 °C), agitation (5 or 10 min), pH (acid or alkaline), and addition of chemicals such as silver and lead nitrates, copper sulphate and sodium chloride on lipase activity in Shammi goat milk were studied. There were non-significant differences (P < 0.01) in chemical composition between Shammi goat milk and Arabi cow milk. Lipase activity in Shammi goat milk was non-significantly (P < 0.01) lower than in Arabi cow milk. Lipase activity in milk of Shammi goats and Arabi cows was reduced when the milk was subjected to heating, cooling, pasteurisation, boiling, or when chemicals or acid was added, whereas in agitated and alkaline milk, the lipase activity was increased. The increase following agitation was greater after 10 min than 5 min. It can be concluded that heating, pasteurising, boiling, cooling, addition of certain chemicals and acidity are means by which lipase activity in milk can be reduced.     

21例奶蛋白过敏患儿临床特征分析及诊治方法

目的：探讨奶蛋白过敏患儿的临床特点及诊治方法。方法：收集2012年2月-2013年2月我院接诊的21例奶蛋白过敏患儿的临床资料,将临床表现、特异性皮肤点刺试验、回避试验等结果进行总结分析。结果：患儿皮肤粘膜、消化道等症状出现时间较早,湿疹症状出现最多（71．43％）,仅有1例患儿出现发育迟缓（4．76％）;皮肤点刺试验奶蛋白阳性者12例（57．14％）,回避试验阳性率为100．00％;经过改善饮食及对症治疗,21例患儿皮肤粘膜、消化道、呼吸道系统等症状一般在4周内消失,发育迟缓在正规治疗2．4周开始缓解,8周内消失。结论：奶蛋白过敏缺乏特异症状表现,临床在出现症状后加强实验室检查。结合详细病史进行确诊,才能减少误诊的发生,及时治疗,保证患儿的正常生长发育。     

The effect of out-wintering pad design on dirtiness score, somatic cell score and mastitis incidence in dairy cows

This study aimed to compare three woodchip out-wintering pad (OWP) designs, and indoor cubicle housing with regard to cow dirtiness scores during the winter housing period, and udder health during both the winter period and the following lactation, for spring-calving dairy cows. The treatments were: an uncovered (UP) and covered (CP) OWP with a concrete feed apron; an uncovered OWP with self-feed silage pit provided directly on the woodchips (SP); and indoor cubicle housing (IC). Data were compared during 2 years: year 1 was a case study while year 2 was an experimental study. In year 1, treatments were UP (space allowance = 12 m2/cow), CP (6 m2/cow) and IC. In year 2, all three OWP designs (12 m2/cow) were compared with IC. Animals were assigned to treatments at the end of lactation in the autumn, and remained there while dry until calving the following spring. Subsequently, all cows were at pasture during lactation. Outcome measures for analysis were cow dirtiness score, somatic cell score (SCS) and incidence of clinical mastitis during the dry period and during lactation. Quarter milk samples were also taken at drying off, calving and 3 weeks post partum both years, and at approximately 113 days in milk in year 2. Samples were analysed for presence of mastitis-causing agents and SCS was determined. Sub-clinical mastitis was diagnosed when cows had an SCS greater than 200 000, or California mastitis test greater than 1 in at least one quarter. In year 1, cows in CP were dirtier than cows in the other two treatments. These animals also had the highest SCS during lactation and tended to have more mastitis-causing agents isolated from quarter milk samples. In year 2, when all cows were stocked at the same density, cows in the sheltered OWP (i.e. CP) had similar dirtiness scores to cows in cubicles and significantly lower dirtiness scores than cows in the unsheltered OWP designs, i.e. UP and SP. However, there were no effects on SCS or quarter sample results. Cleaning of OWP's stocked at 12 m2/cow reduced cow dirtiness scores. However, cleaning of CP in year 1 when cows were stocked at 6 m2/cow had no effect on dirtiness scores. We conclude that dry cows stocked at 12 m2/cow on OWP's are unlikely to have udder health problems in the subsequent lactation. Furthermore, provision of shelter and cleaning of the woodchips are management factors that help to keep cows clean on OWP's.     

Does increasing milk yield per cow reduce greenhouse gas emissions? A system approach

Milk yield per cow has continuously increased in many countries over the last few decades. In addition to potential economic advantages, this is often considered an important strategy to decrease greenhouse gas (GHG) emissions per kg of milk produced. However, it should be considered that milk and beef production systems are closely interlinked, as fattening of surplus calves from dairy farming and culled dairy cows play an important role in beef production in many countries. The main objective of this study was to quantify the effect of increasing milk yield per cow on GHG emissions and on other side effects. Two scenarios were modelled: constant milk production at the farm level and decreasing beef production (as co-product; Scenario 1); and both milk and beef production kept constant by compensating the decline in beef production with beef from suckler cow production (Scenario 2). Model calculations considered two types of production unit (PU): dairy cow PU and suckler cow PU. A dairy cow PU comprises not only milk output from the dairy cow, but also beef output from culled cows and the fattening system for surplus calves. The modelled dairy cow PU differed in milk yield per cow per year (6000, 8000 and 10 000 kg) and breed. Scenario 1 resulted in lower GHG emissions with increasing milk yield per cow. However, when milk and beef outputs were kept constant (Scenario 2), GHG emissions remained approximately constant with increasing milk yield from 6000 to 8000 kg/cow per year, whereas further increases in milk yield (10 000 kg milk/cow per year) resulted in slightly higher (8%) total GHG emissions. Within Scenario 2, two different allocation methods to handle co-products (surplus calves and beef from culled cows) from dairy cow production were evaluated. Results showed that using the 'economic allocation method', GHG emissions per kg milk decreased with increasing milk yield per cow per year, from 1.06 kg CO2 equivalents (CO2eq) to 0.89 kg CO2eq for the 6000 and 10 000 kg yielding dairy cow, respectively. However, emissions per kg of beef increased from 10.75 kg CO2eq to 16.24 kg CO2eq due to the inclusion of suckler cows. This study shows that the environmental impact (GHG emissions) of increasing milk yield per cow in dairy farming differs, depending upon the considered system boundaries, handling and value of co-products and the assumed ratio of milk to beef demand to be satisfied.     

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.     

Selenium content of milk and milk products of Turkey. II

Selenium content of 1028 milk and milk products of Turkey are presented in this study. The selenium content of human milk (colostrum, transitional, and mature milk), various kinds of milk [cow, sheep, goat, buffalo, paper boxes (3%, 1.5%, 0.012% fat), bottled milk, condensed milk (10% fat), mineral added milk (1.6%), and banana, strawberry, and chocolate milk] and milk products (kefir, yogurt, Ayran, various cheese, coffee cream, ice cream, butter, margarine, milk powder, and fruit yogurt) in Turkey were determined by a spectrofluorometric method. The selenium levels of cow milks collected from 57 cities in Turkey were also determined. Selenium levels in cow milk varied with geographical location in Turkey and were found to be lowest for Van and highest for Aksaray. The results [milk (cow, sheep, goat, buffalo and human) and milks products] were compared with literature data from different countries.     

Extent, pattern and factors associated with late embryonic loss in dairy cows

Intensive genetic selection for increased milk production, coupled with increased dry matter intakes has led to significant improvements in cow milk yield, however, this increase in milk output has been accompanied by a decline in cow fertility. It has been suggested that there is a higher increment of late embryonic loss in high-yielding than in moderate yielding cows or in heifers. The objectives of this study were to establish the extent and pattern of embryonic loss, from days 28 to 84 of gestation, and to examine possible relationships between cow milk yield, cow genetic merit, parity, calving to insemination interval and embryonic loss in dairy cows managed mainly under pasture-based milk production systems. Multiparous dairy cows (n=1046) located on 8 farms and nulliparous dairy heifers (n=162) located on five of these farms were used in this study. The extent and timing of embryonic loss was measured by ultrasound scanning of the cows and heifers at 14-day intervals between days 28 and 84 of gestation. Positive diagnosis of pregnancy was based on the presence of an embryo or foetus with a visible heartbeat and, at the later scans, visible movement, whose size was compatible with stage of gestation and also on the presence of clear amniotic fluid of the cows and heifers presented as presumed pregnant on day 28 after insemination, 67 and 81%, respectively had a viable embryo. The subsequent embryonic loss rate between days 28 and 84 of gestation was similar (P>0.05) for cows (7.2%) and heifers (6.1%) and the pattern of loss over this period was also similar (P>0.05) for cows and heifers. There was no significant association (P>0.05) between level of milk production or milk energy output measured to day 120 of lactation and embryonic loss rate. Similarly, there was no significant relationship (P>0.05) between % milk fat, % milk protein and % milk lactose and embryonic loss rate. The extent and pattern of embryonic loss were not related (P>0.05) to either cow or to cow sire genetic merit. There was no significant (P>0.05) relationship between the calving to first service interval and embryonic loss. The extent of embryonic loss was greater (P<0.05) in cows that lost body condition between days 28 and 56 of gestation compared with cows than either maintained or improved in body condition.