Brief Communication
  

The Most Common Cow's Milk Allergenic Proteins with Respect to Allergic Symptoms in Iranian Patients

Abstract

Cow's milk allergy (CMA) is an immunological response to cow's milk proteins such as casein, α-lactalbumin and β lactoglobulin. The aim of this study was to determine the most common cow's milk allergenic proteins in patients with CMA and identify the most effective proteins in different allergic symptoms. Eighty seven patients (≤18 years) with allergy to cow’s milk from 2006 to 2013 entered this study. They had a positive history of allergic reactions to cow’s milk and a positive specific IgE test to whole cow's milk. The patients’ symptoms were divided into four groups. Serum specific IgEs against four different main proteins of cow's milk were measured using RIDA Allergy Screen. Among 87 patients, 53 (60.5%) were male and the median age was 2.5 years. The frequency of respiratory, skin, gastrointestinal symptoms, and anaphylaxis were 63.3%, 55.7%, 20.3%, and 13.4%, respectively. Specific IgEs to total cow's milk protein (n=75, 89.3%), and the main Cow’s Milk Proteins including α-lactalbumin (n=65, 77.4%), casein (n=64, 75.3%), β-lactoglobulin (n=52, 62.7%), and bovine serum albumin (n=35, 44.9%) were detected. Specific IgE tests to β-lactoglobulin were positive in 90% of the patients with anaphylaxis. Moreover, significant relationship was found between specific IgE to β-lactoglobulin and anaphylaxis (p=0.04). Although it is presumed that α-lactalbumin and casein are the most common allergenic proteins of cow's milk, in this study there is a significant relationship between the anaphylaxis and the presence of β-lactoglobulin-specific IgE. Therefore, more precautions are recommended due to possible anaphylactic reactions in patients with a positive test history for β-lactoglobulin specific IgE.

1. Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P, et al. Cow's milk protein allergy in children: a practical guide. Ital J Pediatr 2010; 36:5.

2. Shek LP, Bardina L, Castro R, Sampson HA, Beyer K.Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and non-IgE- mediated disorders. Allergy 2005; 60(7):912-9.

3. Barzegar S, Rosita A, Pourpak Z, Bemanian MH, Shokouhi R, Mansouri M, et al. Common causes of anaphylaxis in children: the first report of anaphylaxis registry in Iran. World Allergy Organ J 2010; 3(1):9.

4. Savilahti EM, Saarinen KM, Savilahti E. Specific antibodies to cow's milk proteins in infants: effect of early feeding and diagnosis of cow's milk allergy. Eur J Nutr 2010; 49(8):501-4.

5. Teymourpour P PZ, Fazlollahi MR, Barzegar S, Shokouhi R, Akramian R, Movahedi M, Mansouri M, Mirsaeedghazi B, and Moin M. . Cow's Milk Anaphylaxis in Children First Report of Iranian Food Allergy Registry. Iran J Allergy Asthma Immunol 2012; 11(1).

6. Gaudin JC, Rabesona H, Choiset Y, Yeretssian G, Chobert JM, Sakanyan V, et al. Assessment of the immunoglobulin E-mediated immune response to milk- specific proteins in allergic patients using microarrays. Clin Exp Allergy 2008; 38(4):686-93.

7. Natale M, Bisson C, Monti G, Peltran A, Garoffo LP, Valentini S, et al. Cow's milk allergens identification by two-dimensional immunoblotting and mass spectrometry. Mol Nutr Food Res 2004; 48(5):363-9.

8. Avila Castanon L, Hidalgo Castro EM, del Rio Navarro BE, Sienra Monge JJ. [Cow-milk's protein allergy]. Rev Alerg Mex 2005; 52(5):206-12.

9. Wal JM. Cow's milk proteins/allergens. Ann Allergy Asthma Immunol 2002; 89(6 Suppl 1):3-10.

10. Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010; 3(4):57.

11. Martorell A, Garcia Ara MC, Plaza AM, Bone J, Nevot S, Echeverria L, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of the development of tolerance in cow's milk allergy. Allergol Immunopathol (Madr) 2008; 36(6):325-30.

12. Pourpak Z FA, Mahmoudi M, Movahedi M,Ghargozlou M,Kazemnejad A,Eslamnoor B. The Role of Cow Milk Allergy in Increasing the Severity of Atopic Dermatitis. Immunological Investigations 2004; 33(1):69-79.

13. Kneepkens CM, Meijer Y. Clinical practice. Diagnosis and treatment of cow's milk allergy. Eur J Pediatr 2009;168(8):891-6.

14. Sletten GB, Halvorsen R, Egaas E, Halstensen TS.Changes in humoral responses to beta-lactoglobulin in tolerant patients suggest a particular role for IgG4 in delayed, non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol 2006; 17(6):435-43.

15. Matsumoto N, Okochi M, Matsushima M, Kato R, Takase T, Yoshida Y, et al. Peptide array-based analysis of the specific IgE and IgG4 in cow's milk allergens and its use in allergy evaluation. Peptides 2009; 30(10):1840-7.

16. Ngamphaiboon J, Chatchatee P, Thongkaew T. Cow's milk allergy in Thai children. Asian Pac J Allergy Immunol 2008; 26(4):199-204.

17. Teymourpour P, Shokouhi R, Fazlollahi MR, Movahedi M, Mansouri M, Mirsaeedghazi B, et al. Factors Affecting the Severity of Cow’s Milk Anaphylaxis. Iran J Allergy Asthma Immunol 2013; 12(2):190-1.

18. Santos A, Dias A, Pinheiro JA. Predictive factors for the persistence of cow's milk allergy. Pediatr Allergy Immunol 2010; 21(8):1127-34.

19. Restani P, Ballabio C, Di Lorenzo C, Tripodi S, Fiocchi A. Molecular aspects of milk allergens and their role in clinical events. Anal Bioanal Chem 2009; 395(1):47-56.

20. Chen F-M, Lee J-H, Yang Y-H, Lin Y-T, Wang L-C, Yu H-H, et al. Analysis of α-lactalbumin-, β-lactoglobulin-, and casein-specific IgE among children with atopic diseases in a tertiary medical center in northern Taiwan. J Microbiol Immunol Infect 2014; 47(2):130-6.

21. Nakano T, Shimojo N, Morita Y, Arima T, Tomiita M, Kohno Y. Sensitization to casein and beta-lactoglobulin (BLG) in children with cow's milk allergy (CMA). Arerugi 2010; 59(2):117-22.

22. Hochwallner H, Schulmeister U, Swoboda I, Spitzauer S, Valenta R. Cow’s milk allergy: From allergens to new forms of diagnosis, therapy and prevention. Methods 2014; 66(1):22-33.

23. Liccardi G, Asero R, D’Amato M, D’Amato G. Role of sensitization to mammalian serum albumin in allergic disease. Curr Allergy Asthma Rep 2011; 11(5):421-6.

24. Chruszcz M, Mikolajczak K, Mank N, Majorek KA, Porebski PJ, Minor W. Serum albumins—Unusual allergens. Biochimica et Biophysica Acta (BBA)-General Subjects 2013; 1830(12):5375-81.

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IssueVol 15, No 2 (2016) QRcode
SectionBrief Communication
Keywords
α-lactalbumin β-lactoglobulin Bovine serum albumin Casein Cow's milk allergy Cow's milk proteins
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shokouhi Shoormasti R, Fazlollahi MR, Barzegar S, Teymourpour P, Yazdanyar Z, Lebaschi Z, Nourizadeh M, Tazesh B, Movahedi M, Kashani H, Pourpak Z, Moin M. The Most Common Cow’s Milk Allergenic Proteins with Respect to Allergic Symptoms in Iranian Patients. Iran J Allergy Asthma Immunol. 2016;15(2):161-165.