Low colostral IgA associated with cow's milk allergy.

During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.     

Development of healthy gut microbiota early in life

A healthy intestinal microbiota profile in early life is related to health later in life. An aberrant composition is associated with risks of systemic problems, such as obesity, diabetes and allergic diseases, including asthma and enteric inflammatory conditions, sometimes manifesting at 7 years of age. A healthy and balanced gut microbiota profile in infancy, especially with regard to bifidobacteria, is directly related to mode of delivery (natural birth) and quality of breast milk, which in turn is affected by the mother's own systemic health and nutritional status. Pregnant women of normal body weight and healthy microbiota profiles, both gut microbiota and breast milk microbiota, have greater opportunities to pass on compounds, antigens modified by the mother's gut and other agents that promote the development of a healthy immune system in the breastfed infant.     

Feeding a soy formula to children with cow's milk allergy: the development of immunoglobulin E-mediated allergy to soy and peanuts.

Peanut allergy has been associated with the intake of soy milk or a soy formula. We studied the development of immunoglobulin E antibodies specific to soy and peanuts and of allergic reactions caused by peanuts, in children with confirmed cow's milk (CM) allergy fed either a soy formula or an extensively hydrolyzed formula (EHF). One hundred and seventy infants with documented CM allergy (CMA) were randomly assigned to receive either a soy formula or an EHF. The children were followed to the age of 4 yr. Peanut-specific immunoglobulin E was measured at the age of 4. A detailed history of the occurrence of allergic reactions caused by peanuts was recorded by the parents. Soy-specific immunoglobulin E antibodies were measured at the time of diagnosis and at the ages of 1, 2 and 4 yr. Immunoglobulin E antibodies to soy (> or =0.35 kU/l) were found in 22 of 70 children fed the soy formula, and in 14 of 70 of the children fed the EHF (p = 0.082). In an open challenge with soy at the age of 4, no immediate reactions were observed. One of 72 children from the soy group had a delayed reaction. immunoglobulin E antibodies to peanuts (> or =0.35 kU/l) were found in 21 of 70 children fed the soy formula and 17 of 69 infants fed the EHF (p = 0.717). The incidence of reported peanut allergy in the soy group was two of 72 (3%) and four of 76 (5%) in the EHF group (p = 0.68). Development of immunoglobulin E-associated allergy to soy and peanuts was rare in our study group of milk allergic children. The use of a soy formula during the first 2 yr of life did not increase the risk of development of peanut-specific immunoglobulin E antibodies or of clinical peanut allergy.     

Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy

Although children allergic to eggs, milk or wheat in infancy tend to become tolerant by school age, the allergic status of these children at school age has not been well evaluated. To investigate the allergic status of schoolchildren who avoided eggs, milk or wheat because of an immediate-type allergic reaction at <1-yr-old (food avoiders in infancy), we conducted a large-scale questionnaire-based survey of schoolchildren. A questionnaire on allergic diseases was distributed to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan. Of these, 13,215 responded (response rate, 90.1%). The rate of 7-yr-old children who were food avoiders in infancy was 5.4%. This rate decreased as the current age of the children increased, down to 3% in 15-yr-old children, indicating that food allergy in infancy tended to become more prevalent over the past 8 yr. Although more than 80% became tolerant to these foods by school age, the prevalence of bronchial asthma, atopic dermatitis, allergic rhinitis and allergic conjunctivitis were significantly higher in this group. Moreover, avoidance of other foods (buckwheat, shellfish, fruits and others) at school age was seen at much higher frequencies than in non-food avoiders in infancy (adjusted odds ratio, 7.7; confidence interval, 5.9–10.2). This risk did not differ significantly between those who did and did not develop tolerance to eggs, milk and wheat by 3 yr old. In conclusion, food avoiders in infancy appear to have a higher risk of not only other allergic diseases ('atopic march') but also allergy to other foods ('food allergen march') at school age, indicating the need for continuous attention to food allergy.     

Content of β‐casomorphins in milk of women with a history of allergy

The prevalence of food allergies increased over the past decade. Most symptoms of food allergy appear during the first 2 yr of life. The aim of this study was to determine the β‐casomorphin‐5 and ‐7 (BCMs) in colostrum and milk of 12 breast‐feeding women with a history and clinical manifestation of food allergy. The results were compared with the data obtained from a control group of healthy age‐matched breast‐feeding women. The level of BCM in women with food allergy was constant during lactation, whereas the highest level of opioid peptides was found in colostrums of healthy women with a subsequent rapid decrease in mature milk. These differences in BCMs profile between allergic and healthy breast‐feeding women suggest that BCM content in the human milk may be an indicator of allergic conditions.     

Human milk polyunsaturated long‐chain fatty acids and secretory immunoglobulin A antibodies and early childhood allergy

The possible protective effect of breast milk against atopic manifestations in infancy, i.e. atopic eczema and food allergy, has been controversial for the last decades. Besides the methodological problems, differences in the composition of human milk could explain these controversies. The aim of this study was to investigate the composition of polyunsaturated fatty acids (PUFA) and secretory immunoglobulin A (S‐IgA) levels to food proteins (ovalbumin and β‐lactoglobulin) and an inhalant allergen (cat) in milk from mothers of allergic and non‐allergic children. Blood samples were obtained at birth and at 3 months from 120 children. Skin prick tests were performed at 6, 12 and 18 months, and the development of atopic diseases was assessed in the children. Breast milk samples were collected from their mothers at birth and monthly during the lactation period. Milk PUFA composition was measured by gas chromatography, and enzyme‐linked immunosorbent assay (ELISA) was used to measure total S‐IgA, anti‐cat S‐IgA, anti‐ovalbumin S‐IgA, and anti‐β‐lactoglobulin S‐IgA. Allergic disease developed in 44/120 children (22/63 children of allergic mothers and 22/57 children of non‐allergic mothers). Lower levels of eicosapentaenoic acid, C20:5 n‐3 (EPA), docosapentaenoic acid C22:5n‐3 (DPA), and docosatetraenoic acid C22:4 n‐6 (DHA) (p < 0.05 for all) were found in mature milk from mothers of allergic as compared to milk from mothers of non‐allergic children. The total n‐6 : total n‐3 and the arachidonic acid, C20:4 n‐6 (AA) : EPA ratios were significantly lower in transitional and mature milk from mothers of allergic children, as compared to milk from mothers of non‐allergic children. The PUFA levels in serum of allergic and non‐allergic children were largely similar, except for higher levels of C22:4 n‐6 and C22:5 n‐6 (p < 0.05 for both) and a higher AA : EPA ratio in serum phospholipids in the former group (p < 0.05). Changes in the levels of milk PUFA were reflected in changes in PUFA serum phospholipids, particularly for the n‐6 PUFA. The AA : EPA ratio in maternal milk was related, however, to the AA : EPA only in serum from non‐allergic children, while this was not the case in allergic children. The levels of total S‐IgA, anti‐cat S‐IgA, anti‐ovalbumin S‐IgA, and anti‐β‐lactoglobulin S‐IgA in milk from mothers of allergic, as compared to non‐allergic, children were similar through the first 3 months of lactation. Low levels of n‐3 PUFA in human milk, and particularly a high AA : EPA ratio in maternal milk and serum phospholipids in the infants, were related to the development of symptoms of allergic disease at 18 months of age. The milk PUFA composition influenced the composition of PUFA in serum phospholipids of the children. We also showed that the lower levels of colostral anti‐ovalbumin S‐IgA and lower total S‐IgA in mature milk from atopic mothers did not influence the development of allergic disease in the children up to 18 months of age. The findings indicate that low α‐linolenic acid, C18:3 n‐3 (LNA) and n‐3 long‐chain polyunsaturated fatty acids (LCP) 20–22 carbon chains, but not the levels of S‐IgA antibodies to allergens, are related to the development of atopy in children.     

婴儿期食物过敏的预后研究

目的了解婴儿期食物过敏（FA）的预后及影响因素。方法对119例患儿进行回顾性研究,采用Kaplan-Meier法计算食物耐受的累积概率,非条件Logistic回归模型分析食物耐受形成的预测因素和其他过敏性疾病发生的影响因素。结果鸡蛋、牛奶耐受的累计概率在诊断后1年分别为31％、42％;2年为62％、63％;3年为80％、77％;4年后均可达100％。牛奶、鸡蛋过敏患儿的皮肤点刺试验阳性强度是持续牛奶、鸡蛋敏感的预测因素（OR=2．535,95％CI：1．159～5．543;OR=2．654,95％CI：1．302～5．410,P均〈0．05）。本组13例患儿发生其他FA,危险因素是持续鸡蛋敏感（OR=6．109,95％CI：1．818～20．527,P〈0．05）;4例发生变态反应性鼻炎,15例发生支气管哮喘,危险因素是持续鸡蛋敏感和呼吸道过敏症状（OR=3．596,95％CI：1．429～9．045;OR：4．235,95％CI：1．152～15．563,P均〈0．05）。结论至少75％的鸡蛋或牛奶过敏患儿在诊断后3年内可获耐受。10．9％、12．6％和3．4％的FA儿童发生其他FA、支气管哮喘和变态反应性鼻炎。加强持续FA高危儿的筛查和管理,可能有助于改善FA的预后。     

Cytokine, chemokine and secretory IgA levels in human milk in relation to atopic disease and IgA production in infants

The relationship between breast-feeding, IgA production and development of atopic disease in children is a matter of controversy. Some of this controversy might be due to individual differences in the composition of breast milk. The aim of this study was to relate the levels of cytokines, chemokines and secretory (S)-IgA antibodies in breast milk to the development of atopic manifestation and salivary IgA production in infants. Cytokine, chemokine and SIgA levels, as measured with enzyme-linked immunosorbent assay (ELISA), in colostrum and mature milk were analyzed in relation to the development of positive skin-prick tests (SPT), allergic symptoms and salivary IgA antibody production during the first 2 years of life in 53 infants. There was no association between levels of IL-4, -5, -6, -8, -10, -13, -16, IFN-γ, TGF-β1, -β2, RANTES, eotaxin or SIgA levels in the breast milk with either SPT-positivity, development of allergic symptoms or salivary IgA levels during the first 2 years of life in the infants. Thus, differences in the composition of cytokines, chemokines and SIgA in breast milk did not, to any major degree, affect the development of a positive SPT, atopic symptoms, nor salivary IgA antibody production during the first 2 years of life.     

Comparison of fecal microflora in children with atopic eczema/dermatitis syndrome according to IgE sensitization to food

Atopic eczema/dermatitis syndrome (AEDS) commonly often arises during early infancy. In several intervention studies a beneficial influence on AEDS course of certain intestinal bacteria, administered as 'probiotics', has been described. To evaluate the possible role of the natural intestinal microflora in children with allergic eczema/dermatitis syndrome regarding immediate type hypersensitivity to food allergens, children with food allergy (AAEDS, n = 68) have been compared with children without detectable food allergy (NAEDS, n = 25). All children (n = 93) in preschool age, mean age of 2.6 (+/-1.8) years, diagnosed with AEDS who were treated as inpatients in 2003 in a dermatological hospital were included. The correlation between fecal microflora, parasites and specific immunoglobulin E (IgE) antibodies against common food allergens was analyzed. A similar composition of intestinal microflora in children with AAEDS and NAAEDS was found. The food allergens that were most frequently detected were egg white, cow milk, casein, peanut and hazelnut. Furthermore, a significant association between IgE sensitization against important food allergens and components of the fecal microflora could not be demonstrated. With aging changes occur in the intestinal microbiota [Proteus/Klebsiella and age (rho = -0.607) and Enterococcus and age (rho = -0.428)]. In two subjects of the AAEDS group Blastocystis hominis was found. The composition of natural intestinal microflora in children with AAEDS and NAAEDS was similar. Hence, there is no evidence of a role of the intestinal microflora with regard to the development of infant (food) allergy in children with AEDS. The possible consequences for allergic diseases later in life require further investigation.     

Use of infant formulas in infants with cow milk allergy

Allergic (immune-mediated) reactions to cow milk and other dietary proteins encountered during infancy are responsible for some of the adverse symptoms and syndromes observed in infants intolerant to cow milk, infant formulas and occasionally human milk. Iron deficiency anemia associated with gastrointestinal blood loss, protein losing enteropathy, enterocolitis, colitis, and malabsorption syndrome are examples of putative allergic reactions to dietary antigens which occur in infancy. A number of symptoms referable to the gastrointestinal tract such as, vomiting, colic and chronic non-specific diarrhea occur in infants both with and without immune-mediated reactions to dietary antigens. Verification of adverse reactions to dietary antigens, including allergic reactions, should be accomplished through the use of double-blind, placebo-controlled food challenge, with the dietary antigen to be tested presented in a liquid vehicle or, in older children, in capsule form. Approximately 8%–25% of children with immediate hypersensitivity to cow milk have been found to be allergic to soy products. Soy and other intact protein substitutes for cow milk, such as beef and lamb based formulas, have produced anaphylactic reactions both in human infants and in animal models. Hypoallergenic formulas should have a chemically modified protein base which demonstrates significant reduction in anti-genicity when tested in the laboratory both in vitro and in vivo. Such formulas should meet rigorous standards for hypoallergenicity in clinical testing in human allergic infants or infants at high risk for developing allergy before being labelled hypoallergenic.     

益生元与婴儿肠道健康

众多研究证实接受母乳喂养婴儿的肠道菌群以双歧杆菌占绝埘优势,而这种优势不能通过牛乳或其他哺乳动物的乳汁喂养获得.这种人类独特的优势,取决于母乳喂养过程营造的肠道厌氧环境,更取决于人乳中促进双歧杆菌增殖的低聚精.人乳低聚糖可在维持肠道舒适的同时,建立肠道微生态平衡,提高肠道自然屏障和防御功能,并可促进营养素的吸收.良好的肠道环境,有利于婴儿肠道正常的消化和吸收、分泌及免疫功能的建立,更有利于婴儿口后的生长和神经系统发育,并可降低免疫相关性等非传染性疾病的发生.对于不能接受纯母乳喂养的婴儿,通过接受含有模拟人乳低聚糖的益生元的婴儿配方奶粉,也可改变肠道菌群的组成和活性,同样可利于宿主的舒适和健康.     

Clinical manifestations of allergy related to breast and cows' milk feeding

The frequency of allergic manifestations in the first year of life was studied. The prevalence of allergic signs affecting the skin and respiratory tract in infants who had been started on breast feeding was compared with the prevalence of such signs in infants started on cows' milk formulae. The relationship of allergy to family history was investigated. Eczema and rhinitis were found to be present as often in the initially breast-fed group as in the initially cows' milk-fed group. Bottle-fed infants developed asthma and bronchitis more often than their breast-fed counterparts. Infants of allergic parents exhibited more allergy than those from non-allergic families, and this difference was particularly pronounced for asthma or bronchitis. Breast feeding gave some protection against the development of respiratory tract allergies in infants of non-allergic parents. Among the infants with a positive family history of allergy, fewer with eczema or chronic rhinitis were found in the initially breast-fed group group but this did not achieve statistical significance.     

Clinical manifestations of allergy related to breast and cows' milk feeding.

The frequency of allergic manifestations in the first year of life was studied. The prevalence of allergic signs affecting the skin and respiratory tract in infants who had been started on breast feeding was compared with the prevalence of such signs in infants started on cows'' milk formulae. The relationship of allergy to family history was investigated. Eczema and rhinitis were found to be present as often in the initially breast-fed group as in the initially cows'' milk-fed group. Bottle-fed infants developed asthma and bronchitis more often than their breast-fed counterparts. Infants of allergic parents exhibited more allergy than those from non-allergic families, and this difference was particularly pronounced for asthma or bronchitis. Breast feeding gave some protection against the development of respiratory tract allergies in infants of non-allergic parents. Among the infants with a positive family history of allergy, fewer with eczema or chronic rhinitis were found in the initially breast-fed group group but this did not achieve statistical significance.     

Nucleotide and polyamine levels in colostrum and mature milk in relation to maternal atopy and atopic development in the children

The prophylactic benefit of breastfeeding against atopic disease is still controversial. It seems to be limited to infants with genetic propensities to allergy in combination with late solid food introduction. Lower levels of n-3 polyunsaturated fatty acids in human milk have been related to atopy in children, stressing a non-specific role of nutritional components in the development of atopy. Nucleotides and polyamines have been related to intestinal integrity and immune function in infancy. The main sources of these nutrients are human milk nucleotides and polyamines early in life. Our aim was to study the composition of nucleotides and polyamines in colostrum and mature milk from atopic and non-atopic mothers and the relationship to sensitization against egg, milk or cat in their children during the first year of life. The nucleotide/nucleoside and polyamine levels were measured by HPLC in colostrum and in milk at 3 mo of lactation from mothers of 21 atopic and 14 non-atopic children. Among the mothers, 10 were atopic and 25 non-atopic. The nucleotides cytidine monophosphate (CMP), uridine monophosphate (UMP), adenosine monophosphate (AMP) and guanosine monophosphate (GMP) and the nucleosides cytidine and uridine were detected in human milk. In colostrum, CMP dominated, and the levels increased in mature milk, while the levels of the other compounds remained constant. The nucleotide/nucleoside composition was similar in colostrum from all mothers independent of the development of sensitization in their babies, except for the higher cytidine levels in mature milk from atopic mothers of atopic babies, as compared to healthy mothers of atopic babies. The polyamine levels were similar in colostrum from atopic and non-atopic mothers. However, putrescine and spermine levels were lower in mature milk from atopic mothers than non-atopic mothers. No relationship was found between milk putrescine and spermine levels and development of atopy in the children. In conclusion, low levels of human milk putrescine and spermine seem to be related to maternal atopy.     

Low Colostral IgA Associated with Cow's Milk Allergy

ABSTRACT. During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.     

IgA antibodies, TGF-beta1 and -beta2, and soluble CD14 in the colostrum and development of atopy by age 4

Specific defense factors in breast milk together with length of breast-feeding and genetic predisposition may modulate the development of allergy. We studied whether IgA, soluble CD14 (sCD14), or transforming growth factor (TGF)-beta in colostrum could affect the development of atopy in children up to age 4. From a cohort of 4676, we selected four groups of children with either long or short exclusive breast-feeding (>3.5 or <0.5 mo); these groups further differed in the presence or absence of atopic heredity. In colostrum from mothers, we measured total IgA, IgA antibodies to cow's milk (CM) and casein, sCD14, and TGF-beta1 and -beta2. The children were divided into three groups: those with no atopic symptoms or IgE, those with allergic symptoms, and those with both outcomes. Mothers of infants later showing atopic symptoms or, in addition, having IgE sensitization (verified atopy) had a lower concentration of IgA casein antibodies in their colostrum than did mothers of infants with no indication of atopy at age 4. Low concentration of IgA casein antibodies was a significant risk for verified atopy. sCD14 levels were lower in colostrum of mothers with infants developing atopic symptoms and IgE sensitization than of those of infants with no atopy. Specific IgA antibodies to CM antigens and sCD14 in colostrum significantly associated with the appearance of both symptomatic and verified atopy by age 4.     

Infant formulas supplemented with prebiotics: intestinal microbiota and immune responses

It is well known that the type of feeding influences the composition of the gut microflora after birth. Human milk favours the growth of a 'bifidus flora' which, according to several evidences, may activate the immune system and defend from pathogens. Breast milk oligosaccharides, which are involved in many functional effects both at local and systemic level, are thought to stimulate the growth of health promoting microbes, such as bifidobacteria, and may ultimately influence the immune system. In accordance with this current working hypothesis, dietary modulation of the gut microbiota to obtain a 'bifidus flora' also in bottle-fed infants may be a useful way to stimulate immunological functions and to harbour a biological barrier against pathogens. In several clinical trials prebiotic oligosaccharides have been used to mimic the beneficial effects of breast milk oligosaccharides. A mixture of oligosaccharides has shown its efficacy in stimulating the establishment of a 'bifidus flora', with stools closer to those found in breast-fed infants. Several experimental data also indicate that oligosaccharides might modulate the immune system and contribute to the improvement of the protective properties of infant formulas.     

Chemoattractant factors in breast milk from allergic and nonallergic mothers

The allergy-preventing effect of breast-feeding remains controversial, possibly because of individual variations in the composition of the breast milk. Recently, we showed that allergic mothers had higher concentrations of IL-4 and lower concentrations of ovalbumin-specific IgA in their breast milk than nonallergic mothers. The aim of this study was to investigate the concentrations of chemokines and cytokines that are chemotactic to cells involved in allergic reactions in breast milk from allergic and nonallergic mothers. Cytokine and chemokine concentrations were determined with ELISA in colostrum and mature milk samples from 23 mothers with and 25 mothers without atopic symptoms. IL-8 was detected in all milk samples. RANTES (regulated on activation, normal T cell expressed and secreted), eotaxin, and IL-16 were detected in 50%, 76%, and 48%, respectively, in colostrum and less commonly in mature milk. Macrophage inflammatory protein-1alpha, however, could not be detected in any of the samples. The concentrations of IL-8 and RANTES were higher in breast milk from allergic, compared with nonallergic, mothers. In conclusion, the presence of chemoattractant factors in breast milk may be responsible for the traffic of leukocytes from the maternal circulation to the breast milk. The higher concentrations of RANTES and IL-8 in allergic mothers may partly explain the controversy regarding the protective effect of breast-feeding against the development of allergy by stronger chemotaxis and activation of cells involved in allergic diseases, and possibly by elevated IgE production.     

Markers of inflammation in the feces of infants with cow's milk allergy

Growing evidence exists that exposure to cow's milk elicits inflammation in the gut of infants with cow's milk allergy, irrespective of symptoms. To demonstrate inflammation and increased protein leakage from the gut during a cow's milk elimination‐challenge test in fecal samples of infants presenting with different symptoms suggestive of cow's milk allergy, we measured the concentrations of α₁‐antitrypsin (AT), eosinophil cationic protein (ECP), immunoglobulin (Ig) A, and cow's milk‐specific IgA antibodies, in fecal samples of 208 infants with a mean age of 7 months. Prechallenge samples were collected after a mean 3‐week elimination period, and post‐challenge samples were obtained 4 days after starting the challenge. Fecal levels of prechallenge total IgA (p = 0.02) and post‐challenge AT (p = 0.001) were higher in infants with a positive challenge. Of these infants, pre‐ and post‐challenge levels of ECP were higher in those reacting after 24 h than in those reacting within 1 h (p = 0.006 and p = 0.045). Prechallenge levels of ECP were higher in those showing intestinal symptoms (p = 0.008), and both pre‐ and post‐challenge levels of total IgA were higher in those with an IgE‐mediated reaction to cow's milk (p = 0.04 and p = 0.008). Regardless of the challenge result, total IgA increased during the challenge (p < 0.001 for both challenge‐positive and ‐negative infants) and was higher in those breast‐fed until the challenge than in those fed formula only (p < 0.01). Hence, in infants reacting to the cow's milk challenge, higher prechallenge levels of fecal IgA indicate increased antigenic stimuli in the gut, and higher post‐challenge levels of AT reflect increased protein loss as a result of intestinal inflammation. In infants with slowly evolving gastrointestinal symptoms, increased fecal ECP may help in distinguishing patients from those who tolerate cow's milk. Individual serial follow‐up of fecal IgA and ECP can be used to estimate the degree of inflammation in the gut and an appropriate time for a challenge test, but are not diagnostic tools for cow's milk allergy.     

Time course of allergy to extensively hydrolyzed cow's milk proteins in infants

We report on the follow-up of 22 infants allergic to cow's milk proteins who did not tolerate extensively hydrolyzed protein formulas. After successful use of an amino acid-based diet for a duration of 11.8 +/- 8.7 months, evolution differed according to the presence or absence of associated allergy to other foods. Cow's milk protein tolerance occurred earlier in the patients (n = 9) whose allergy was limited to cow's milk proteins and to extensively hydrolyzed protein formulas.