Search

The Cow's Milk-related Symptom Score (CoMiSS (TM)) was developed as a clinical tool aimed at increasing the awareness of health care professionals for the presence and intensity of clinical manifestations possibly related to cow's milk (CM) intake. This review summarizes current evidence on CoMiSS. We found twenty-five original studies, one pooled analysis of three studies, and two reviews on CoMiSS. Infants exhibiting symptoms possibly related to CM, present with a higher median CoMiSS (6 to 13; 16 studies) than apparently healthy infants (median from 3 to 4; and mean 3.6-4.7; 5 studies). In children with cow's milk allergy (CMA), 11 studies found that a CoMiSS of >= 12 predicted a favorable response to a CM-free diet; however, sensitivity (20% to 77%) and specificity (54% to 92%) varied. The decrease of CoMiSS during a CM elimination diet was also predictive of a reaction to an oral food challenge to diagnose CMA. A low CoMiSS (

Background Langerhans cell histiocytosis (LCH) is a heterogeneous disease with diverse clinical manifestations. Abdominal organ involvement is rare. Early diagnosis and active treatment are needed. The purpose of this article is to enable readers to have a better knowledge of LCH and prevent misdiagnosis. Case presentation A 2-month-old boy had diarrhea, hematochezia, and a rash, and was diagnosed as having a cow milk protein allergy (CMPA). He was given an amino acid-based formula, but there was no sign of improvement in his condition. The patient then had a skin biopsy and was diagnosed as having multisystem Langerhans cell histiocytosis (MS-LCH). The general condition of the child deteriorated after the first two doses of chemotherapy, and the child died. Conclusions MS-LCH is a protracted and progressive condition with poor prognosis. Early diagnosis and treatment are essential for survival. If a child has chronic diarrhea and hematochezia in the presence of a characteristic rash, the pediatrician should consider the possibility of this disease to avoid misdiagnosis.

The gastrointestinal digestion of food and further gut microbial activity render a myriad of different molecules that could be responsible for the biological activities that are classically assigned to their parent compounds. This has been previously shown for some phytochemicals whose antioxidant capacity was either increased or decreased after being metabolized by gut microbes. Whether a global antioxidant capacity that is extracted from food is determined by the gut microbial community structure is still not well described. In the present study, we in vitro digested and fermented 48 different foods that were submitted to different culinary treatments using the stools of lean children, obese children, celiac children and children with an allergy to cow’s milk proteins. Their antioxidant capacities were assessed with the DPPH and FRAP assays, and the percentage that each food contributed to their daily antioxidant intake as well as their antioxidant capacity by portion size was inferred. Overall, cereals, fruits and vegetables displayed a higher contribution to their daily antioxidant intake, while tubers, fish and meat exhibited a higher antioxidant capacity by serving size. The food that was fermented in the lean children’s and those children that were allergic to cow’s milk protein’s fecal material, showed a higher antioxidant capacity, which could imply that there is a larger role of the gut microbiota in this area.

Background Atopic dermatitis (AD) is the most common skin disease in childhood, and Cow's milk protein allergy (CMPA) is the most common cause of food allergies in infancy and may be characterized by atopic dermatitis with skin involvement as the first finding. The aim of this study is to determine the serum eosinophil cationic protein (sECP) levels, eosinophil counts and the frequency of AD and other skin manifestation among infants with CMPA. Materials and Methods: This cross-sectional study was conducted in Karabuk province, Turkey. Eighty-three infants who were diagnosed with CMPA and followed at the Karabuk Training Hospital Pediatric outpatient clinic. The first group consisted of 52 infants presenting with skin manifestations. The second group consisted of 31 infants who were not presenting skin manifestations. The sECP level of infants in both groups was measured using an Immulite 2000 XPi analyzer Immunoassay System (Germany). Results: Of 83 infants with CMPA, 62.6% (n=52) were detected skin involvement as the first finding. The proportions of atopic dermatitis and urticaria in CMPA infants with skin involvement were 90.4% and 9.6% respectively. The median sECP level and eosinophil counts (56.5 ng/mL vs 470/mm(3), p-value=0.001), in skin manifestations with CMPA group were significantly higher than that in the CMPA group without skin manifestations (33.1 ng/mL vs. 270/mm(3), p-value=0.006). Conclusion This study revealed that AD is the most common skin manifestation of CMPA and also found higher sECP levels in infants with skin involvement. The frequency of both diseases, which are easily treated with elimination diet, is increasing day by day. WOS:000632990500008

The use of proteins and protein-containing materials in a variety of industrial and commercial products is increasing, with applications in pharmaceuticals, agrochemicals and consumer and personal care products. As a consequence there is a need to ensure potential and environmental risks are understood. One important requirement is an appreciation of the ability of proteins to induce allergic sensitization and allergic disease. However, there is currently no clear guidance for determination of whether or not to accept a new protein in a product based on potential allergenicity. A key requirement for effective risk assessment in this respect is an understanding of sensitizing potency. Here we describe issues and challenges associated with measurement of allergenic potency and explore emerging opportunities and possible ways forward. Effective assessment of the risk of allergy demands not only information about the likely conditions of exposure, but also an understanding of the sensitizing potency of protein allergens. For the purposes of this article sensitizing potency can be viewed as being the ease with which, and the concentration at which, proteins will induce sensitization in a previously non-sensitized subject. The immunological bases of protein allergy are summarized, and the properties that confer on proteins the ability to induce allergic sensitization are considered prior to a detailed exploration of the issues that have to be addressed for evaluation of sensitizing potency. Included among the important considerations are: the impact of route of exposure, identification of relevant dose metrics, and the requirement for reference standards. Finally, new and emerging opportunities to evaluate the sensitizing potency of allergenic proteins are reviewed, including the use of in silico modeling.

The objective of this pilot study was to assess the fecal microbiome and different immunological parameters in infant feces and maternal milk from mother&ndash, infant pairs in which the infants were suffering from different gastrointestinal disorders (colic, non-IgE-mediated cow milk protein allergy (CMPA), and proctocolitis). A cohort of 30 mother&ndash, infant pairs, in which the infants were diagnosed with these gastrointestinal disorders or included as healthy controls, were recruited. Bacterial composition of infant feces and breast milk was determined by metataxonomic sequencing. Immunological compounds were quantified using multiplexed immunoassays. A higher abundance of Eggerthellaceae, Lachnospiraceae and Peptostreptococcaceae, and lower abundance of Bifidobacterium and higher abundance of Rothia were registered in fecal samples from the CMPA group. Eggerthellaceae was also significantly more abundant in milk samples of the CMPA group. There were no differences in the concentration of immunological compounds in infant fecal samples between the four groups. In contrast, differences were found in the concentration and/or frequency of compounds related to acquired immunity and granulocyte colony stimulating factor (GCSF) in breast milk samples. In conclusion, a few microbial signatures in feces may explain part of the difference between CMPA and other infants. In addition, some milk immunological signatures have been uncovered among the different conditions addressed in this pilot study.

The prevalence of food allergy and food intolerance is increasing and it is an important public health problem affecting children. Food allergy results from an immunological reaction to certain food(s) and affects numerous organs in the body. Food intolerances are non-immunological reactions including metabolic, toxic, pharmacological and undefined mechanisms. Cow milk is the most common cause of food allergy and food intolerance, especially in young children. Food intolerance can present with similar symptoms to those of food allergy. Health-care personnel, patients and their caregivers often confuse food intolerance with food allergy. This review focuses on the clinical manifestations, diagnostic evaluation, treatment and prevention of food allergy and food intolerance.

The aim of this review paper is to assess the applicability of donkey's milk to infants suffering from Cow Milk Protein Allergy (CMPA) compared to human and other available milk types. The bioactive and immune-supportive character which could be beneficial as a fortifier to the formula-fed infants is described while limitations of this type of milk are also discussed. Studies showed that human and donkey's milk have similar, overall, chemical composition as well as protein homogeneity and antigenic similarities. Several in vitro and in vivo studies showed that donkey's milk has nutraceutical and functional properties that can support immunity, alter metabolism and beneficially modify gut microbiota. Clinical studies illustrated that donkeys' milk is well tolerated (82.6%-88%) by infants. Finally, the effect that processing (i.e. thermal, non-thermal treatments, drying methods) has on donkey milk components is also discussed pointing out the need for minimally processing this type of milk.

Objective: Since the soluble enzymes can not be used in repeated reactions and are not stable in operational conditions and not suitable for continuous processes, this study aimed the covalent immobilization of Bacillus licheniformis protease (BLP) onto Eupergit CM. Methods: Optimum conditions for immobilization were determined by changing the conditions individually. The proteins and L-tyrosine were determined by UV/VIS spectrophotometer. Results: The immobilization resulted in 100% immobilization and 107.7% activity yields. The optimum pH (7–8) and the optimum temperature (70°C) have not changed after immobilization. The Km values for free and immobilized enzyme were 26.53 and 37.59 g/L, while the Vmax values were 2.84 and 3.31 g L-Tyrosine/L · min, respectively. The immobilized enzyme has not lost its initial activity during the repeated 20 uses and 20 days of storage. The milk proteins were hydrolyzed in 2 h by using immobilized enzyme. The pH of the milk dropped from 6.89 to 6.53, the color was clearer but there was no change in the smell or the taste. Conclusion: Consequently, it can be said that the immobilized BLP obtained can be used for industrial purposes., Siirt Üniversitesi BAP Koordinatörlüğü Proje No: 2016-SİÜFEB-03

Appendicitis is rare in the neonatal period. A 6-week-old baby presented with fulminant appendicitis. At the age of 6 months, the infant was diagnosed with Cow milk protein allergy. Association between CMPA and appendicitis was a rare association in our case, showing that CMPA can have a wide spectrum of gastrointestinal involvement.

An extensive safety assessment process exists for genetically-engineered (GE) crops. The assessment includes an evaluation of the introduced protein as well as the crop containing the protein with the goal of demonstrating the GE crop is “as-safe-as” non-GE crops in the food supply. One of the evaluations for GE crops is to assess the expressed protein for allergenic potential. Currently, no single factor is recognized as a predictor for protein allergenicity. Therefore, a weight-of-the-evidence approach, which accounts for a variety of factors and approaches for an overall assessment of allergenic potential, is conducted. This assessment includes an evaluation of the history of exposure and safety of the gene(s) source; protein structure (e.g. amino acid sequence identity to human allergens); stability of the protein to pepsin digestion in vitro; heat stability of the protein; glycosylation status; and when appropriate, specific IgE binding studies with sera from relevant clinically allergic subjects. Since GE crops were first commercialized over 20 years ago, there is no proof that the introduced novel protein(s) in any commercialized GE food crop has caused food allergy.

INTRODUCTION: The symptoms of cow's milk protein allergy (CMPA) in infancy can be non-specific which may delay a correct diagnosis and cause adverse clinical outcomes. The diagnosis of non-IgE-mediated CMPA is particularly complex as it involves a 2 to 4 week elimination diet followed by oral food challenge (OFC). The Cow's Milk-related Symptom Score (CoMiSS) is a clinical resource for primary healthcare providers which aims to increase awareness of CMPA symptoms to facilitate an earlier diagnosis. The aim of the present study is to assess if the CoMiSS can be used as a potential diagnostic tool in infants with suspected CMPA.METHODS AND ANALYSIS: Exclusively formula-fed infants aged 0-6 months presenting with symptoms suggestive of CMPA will be included in this prospective, multicentre trial which will be conducted in 10 centres in China. All infants will commence a 2-week trial of an amino acid-based formula (AAF) while eliminating all cow milk protein from their diets. After the AAF treatment period, infants will undergo an open OFC in hospital with standard cow's milk formula, followed by an open home challenge for another 2 weeks. Clinical symptoms will be documented on standardised symptom scorecards. The CoMiSS will be determined at study entry (CoMiSS 1, before the start of the AAF), after 2 weeks (CoMiSS 2, before the OFC) and after a further period of 2 weeks or when symptoms suggestive of CMPA reappear (CoMiSS 3). Weight and length will be measured at each visit. The difference between CoMiSS 1 and 2 as a predictor of the OFC outcome will also be assessed. The diagnostic accuracy of the baseline CoMiSS will be calculated.ETHICS AND DISSEMINATION: The study was approved by the Hunan Children's Hospital Medical Ethics Committee, Hunan, China. The findings of this trial will be submitted for publication in a peer-reviewed journal in paediatric nutrition or gastroenterology. Abstracts will be submitted to the relevant national and international conferences.TRIAL REGISTRATION NUMBER: NCT03004729; Pre-results.

BACKGROUND: Cow milk protein allergy is a very common disease, with a prevalence of 2 to 7.5% in the pediatric population. The diagnosis is often made clinically and appears early, usually during the first few months of life. Common clinical presentations include: reflux, atopic dermatitis, failure to thrive, chronic diarrhea, as well as rectal bleeding or enterocolitis. AIMS: Severe, life-threatening, presentations are very rare.The 2 reported cases show that cow milk protein allergy may have a very early and severe presentation and can even mimic some surgical diagnoses. METHODS: Case n°1 An 8-day-old formula-fed male infant with no significant personal or family history of atopic disease was transferred to our hospital with bilious vomiting and abundant hematochezia. Small intestinal volvulus was suspected, but laparotomy was normal. In the face of persistent rectal bleeding and severe anemia (Hgb 73g/l), rectal biopsy and upper endoscopy were performed and showed mild colitis and severe gastritis with mucosal desquamation. Biopsies revealed an important infiltration of eosinophilic cells (>100/HPF in the stomach and severe eosinophilic proctitis). Peripheral eosinophil count was initially normal, but hypereosinophilia appeared at day 3 of admission (maximum 2600 10(6)/L at 16 daysof life). After 8 days of bowel rest with total parenteral nutrition, progressive refeeding was initiated, with an amino acid based formula and was well tolerated. RESULTS: Case n°2 A newborn female infant was transferred to our hospital for suspected intestinal obstruction. She was breastfed and had a brother with cow’s milk protein allergy. She presented with bilious emesis and mild rectal bleeding a few hours after birth. Abdominal X-ray showed small bowel dilatation. Ultrasound and small bowel opacification did not demonstrate volvulus or malrotation. Enteral feeding was started with standard formula 48 hours after admission.Three days later, she suddenly deteriorated and developed acute diarrhea with hypernatremic dehydration (Na: 165mmol/l) and metabolic acidosis (pH: 7.145, bicarbonate level: 11mmol/l). Feedings were stopped but 24 hours later she once again developed rectal bleeding. A severe colitis was seen on endoscopy and biopsies showed eosinophilic infiltration of the mucosae with >70 eosinophils/HPF. Rectal bleeding stopped 3 days after she was made NPO. Peripheral eosinophilia (max 3000 10(6)/L) appeared at day 6 of life. She responded well to an amino acid based formula and peripheral hypereosinophilia resolved. CONCLUSIONS: The above cases show that cow milk protein allergy can have an acute and severe presentation and can even mimic surgical pathologies in early life. Atypical clinical manifestations of cow milk protein allergy need to be recognized by pediatricians and primary care physicians in order to improve the management of these patients. FUNDING AGENCIES: Ste Justine Fundation

Atopic dermatitis is characterised by protein allergy, a skewed immune system towards Th2, dry itchy skin with barrier impairment and a flexural dermatitis. There are conflicting reports as to whether metal allergy is more or less common in patients with atopic dermatitis compared to non-atopic individuals. Under experimental conditions, atopic dermatitis subjects are less readily sensitised to contact allergens; however, metal ions may be able to penetrate the atopic dermatitis skin barrier with greater ease. False-positive/irritant patch test reactions to metal are more common in atopic dermatitis individuals. Similarly, irritant contact reactions to metal may be more common in atopic dermatitis, and allergic contact dermatitis may more readily spread from the site of origin.

The article is dedicated to the problem of food allergy in children. The number of patients with this pathology continues to rise, which can be explained by multiple factors, which speaks for the relevance and the social importance of the matter. For food allergy, the causesignificant allergens are both simple and complex food proteins. Wheat is one of the most prevalent source of food allergens not only for children, but for adults too. The article contains the main information concerning the ley characteristics of this product; the protein content and the different roles of individual components in forming allergic reactions and cross activity are thoroughly investigated. The authors provide recommendations for the diagnostics and treatment of wheat protein allergy, and various difficulties in different clinical cases are examined. The article also contains main treatment approaches, which are relevant to the modern data. An individual approach in each case means regular monitoring of the main figures, preventing the negative consequences of an eliminative diet at wheat protein allergy through using specialized gluten-free products.

Introduction. Recent meta-analyses of population-based studies show considerable heterogeneity in the prevalence of perceived and confirmed allergic reactions, as well as sensitization to cow milk ingestion. Adverse reactions to cow milk ingestion have different prevalence patterns in different age groups. There is increasing public concern about the true prevalence and a possible increase of food allergies over time, particularly among parents, child care and school staff, health care providers, regulators and food producers. Materials and methods. We performed a retrospective study of children admitted in IOMC hospital in Bucharest between January 2011 to May 2013. The primary aim of this study was to establish and compare the prevalence of confirmed allergic reactions to food in young children from IOMC hospital to known symptoms established by different researches. Results. 312 patients were evaluated with IgE panel blood test, 64 were IgE positive to cow milk protein fraction. Discussion. We found that symptoms of adverse reactions to milk are common in infants and occur regardless of GA at birth or sex. As expected, we found that more children with CMA where living in urban than rural areas. The symptoms often appear during the first year of life, even in exclusively breastfed children. Important signs and symptoms to alarm CMA were found to be failure to thrive, anemia, gastrointestinal and respiratory complains.

We sought to describe the available evidence supporting the utilization of the molecular allergen analysis (MAA) for diagnosis and management of cow milk protein allergy (CMPA). Cow milk proteins are among the most common food allergens in IgE- and non-IgE-mediated food allergic disorders in children. Most individuals with CMPA are sensitized to both caseins and whey proteins. Caseins are more resistant to high temperatures compared to whey proteins. MAA is not superior to the conventional diagnostic tests based on the whole allergen extracts for diagnosis of CMPA. However, MAA can be useful in diagnosing tolerance to extensively heated milk proteins in baked foods. Children with CMPA and high levels of casein IgE are less likely to tolerate baked milk compared to children with low levels of casein IgE. Specific IgE-binding patterns to casein and betalactoglobulin peptides may predict the natural course of CMPA and differentiate subjects who are more likely to develop CMPA at a younger age versus those with a more persistent CMPA. Specific IgE-binding patterns to casein and beta-lactoglobulin peptides may also predict response to milk OITand identify patientsmost likely to benefit fromOIT.

Cow’s milk protein allergy (CMPA) is a food allergy mostly suffered by children aged 3 years that can be mediated by IgE or non-IgE or both. The prevalence of CMPA in children is heterogeneous between populations. Meta-analysis study showed that the prevalence was 2-3% in infants and 1% in children aged 6 years. Although the prevalence is quite small but proper management is very important because it affects the quality of life of children and to avoid the risk of anaphylactic reaction that threatens life. Therapy for CMPA is to avoid cow's milk protein and its derivatives; it is also recommended for breast-feeding mothers to do the same. Therapeutic milk formulas that can be given is extensively hydrolyzed formula (eHF) or soy infant formula (SIF). The selection of formula became adebate, especially about the safety, effectiveness and cost. Keywords: cow milk protein allergy, soy infant formula, extensively hydrolyzed formula

The biodegradable dialdehyde sodium alginate (DASA) was exploited to immobilize the proteins in the natural rubber latex (NRL) and the variations of the properties for the NRL films were estimated in detail. As demonstrated, the proteins were distributed more uniformly in the NRL films with DASA and the extractable protein (EP) content was effectively decreased. Particularly, the EP content was lowered to a value about 46 μg/g with 0.40% DASA, which could meet with the demands of the allergy protein threshold limit of 50 μg/g as described in ASTM D 5712 standard. Furthermore, there was some improve on the burial degradability of the NRL films modified with DASA. The mechanical properties, however, had no evident variation in the presence of DASA. In conclusion, the immobilization of the proteins with DASA should be a potential alternative to tackle the protein allergy problem for the NRL and its products.

Three preterm infants with cow milk protein allergy (CMPA) presented with feeding intolerance, sepsis-like episodes and persistent moderate-to-severe eosinophilia. After eliminating cow milk, the clinical symptoms improved significantly. CMPA can cause common manifestations in sick preterm infants such as feeding intolerance and eosinophilia.

Generally accepted approach to dietotherapy in children with cow milk protein allergy is hypoallergenic diet. When breast-fed, oligoantigenic diet is prescribed to a mother. When a child does not receive mother’s breast milk, it is necessary to use formulas, based on extensively hydrolyzed milk protein or amino-acids. The article includes critical analysis of goat’s milk-based formulas usage in order to prevent and treat cow milk protein allergy. The conception of hypoallergenity, causes of crossed reactions and conventional international recommendations are discussed in details.

Jennet milk as human food is hypoallergenic for patients affected by Cow Milk Protein Allergy and multiple food allergies. For these pathologies, jennet milk represents the best alternative to other types of milk. Therefore, jennet milk consumers are very sensible to the effects of pathogens' contaminations, and several hygienic practices during the milk production need to be adopted. During regular monitoring in one Sicilian jennet farm, Bacillus cereus in the milk was detected. In 3 bulk milk samples (maximum concentration: 1.2 x 103 ufc/ml), in 3 individual milk samples (10, 20 e 60 ufc/ml), in the milk filter (5 ufc/cm2), in the soil (maximum concentration: 1.5 x 103 ufc/g), on the hands and the gloves of two milkers, on the animal hide (from 1 to 3 ufc/cm2). No spores were detected. A total of 8 Bacillus cereus s.s. strains were analyzed for diarrhoic toxin, and 6 strains producing enterotoxins resulted. The improvement of environmental and milking hygienic conditions reduced Bacillus cereus concentration.

Cow’smilk protein allergy is one of themost common food allergies in infants and young children, with a prevalence of 2%e7%. NICE guidelines were recently published to assist the management of food allergy in primary care; aiming to help healthcare professionals increase their expertise in its diagnosis. This article aims to complement the NICE guidelines, highlighting the practical issues in following a cow’s milk protein free diet after diagnosis is made.

Cow milk protein allergy occurs in 2% to 6% of infants population. Goat milk has been used as an alternative to cow milk, but there is probably some cross-reactivity between the milks. Little is known about the allergenicity of goat milk per se. The aim of this study is to compare cow and goat milk allergenicity in a mouse atopy model.Balb/C mice were intragastrically sensitized to cow or goat milk by five doses administrated weekly. Six weeks after the first dose mice were killed, sera were collected and spleens removed for analysis.The number of mice with diarrhea was significantly higher in the cow milk-sensitized group than in the goat milk-sensitized group. Serum cow milk-specific immunoglobulin G1 and histamine levels were also significantly higher in cow milk-sensitized mice. Cytokine production by spleen derived T cells showed a Th2 response with high levels of interleukin-4 production and low levels of interferon-gamma in cow milk-sensitized mice. In addition, goat milk induced a lower lymphocyte sensitization as a result of a significant decrease in the specific proliferation ratio of these cells.Goat milk, when used as the first source of protein after a breast-feeding period, is less allergenic than cow milk in mice. Further studies are needed to clarify if goat milk is suitable as an alternative to cow milk in milk based formulas for infant nutrition.

Objectives Awareness of the considerable incidence of bovine protein allergy in infancy makes it necessary to eliminate cow's milk antigens from the diet in special cases. The primary objective of this review is to discuss the nutritional aspects and appropriate use of hypoallergenic formulas as a substitute for cow's milk formulas and to present new alternative feeding modalities in this field. Data Sources Related articles in PubMed (National Library of Medicine) were reviewed. This review is a synthesis of these sources along with the discussions with experts in this field and the expert opinion of the authors. Results Soy protein-based and hydrolyzed milk protein formulas are the most commonly used alternative protein sources in the case of bovine protein allergy. Despite the adequacy of their nutritional values, there are still some problems to be solved regarding these formulas. In addition, a considerable percentage of the infants with bovine protein allergy may also present allergenic reactions to soy proteins as well as to hydrolyzed milk proteins. Thus, there still exists chaos in the selection of the most appropriate formula for infants sensitized to cow's milk protein. Rice protein-based formulas, probiotics, and prebiotics are expected to be new effective alternatives. Conclusions Bovine protein allergy constitutes an important place in childhood food allergies. Soy protein-based and hydrolyzed protein formulas have some disadvantages and risk of allergenic activity that is not to be underestimated. So, substitution of cow's milk protein with an alternative protein source in sensitized infants has become an art rather than a science. Rice protein, prebiotics, and probiotics appear to be valuable alternatives giving hope for the future.

I nfant formula development in the US is an ongoing process of development and regulation. For many years, there were few infant formulas in use in the US. Formulas were either “routine” cow milk proteinbased, soy protein-based, or uncommonly, specialized formulas such as those for infants with a documented cow milk protein allergy or metabolic diseases. Decisions about formula selection were almost entirely at the discretion of a child’s pediatrician, and public advertising and marketing of infant formulas was not done or was extremely limited. This changed in the late 1980s with the introduction of several new formulas and a new infant formula company to the US marketplace. Currently, virtually every infant formula company in the US markets directly to consumers using a large range of media. Formulas with or without slightly different components are being released on a regular basis. Sometimes “older” marketed names are used; in other cases new names are introduced. There is no database for the public or pediatricians to track these introductions. However, many such changes and additions are occurring every year. Advertising is intense, and, in the US, includes the use of websites targeted directly to the consumer. The consequences of this marketing on both consumer and pediatric caregiver behavior have not been extensively studied, although limited data suggest it may affect consumer’s willingness to change formulas. Nonetheless, it is not surprising that there is considerable consumer confusion about choosing infant formulas, and it is almost impossible for any family member or even their pediatrician to know the subtle differences among formulas on the store shelf. In this discussion, I will consider specific issues related to new and modified infant formulas, some consequences of the changes in formula composition and marketing in recent years, and question whether the population might best be suited by slowing down the introduction of new formulas until clearer guidance and research are available about these formulas.

Presented here are emerging capabilities to precisely measure endogenous allergens in soybean and maize, consideration of food matrices on allergens, and proteolytic activity of allergens. Also examined are observations of global allergy surveys and the prevalence of food allergy across different locales. Allergenic potential is considered in the context of how allergens can be characterized for their biochemical features and the potential for proteins to initiate a specific immune response. Some of the limitations in performing allergen characterization studies are examined. A combination of physical traits of proteins, the molecular interaction between cells and proteins in the human body, and the uniqueness of human culture play a role in understanding and eventually predicting protein allergy potential. The impact of measuring food allergens on determining safety for novel food crops and existing allergenic foods was highlighted with the conclusion that measuring content without the context of clinically relevant thresholds adds little value to safety. These data and findings were presented at a 2012 international symposium in Prague organized by the Protein Allergenicity Technical Committee of the International Life Sciences Institute’s Health and Environmental Sciences Institute.

Summary The natural rubber latex (NRL) protein allergy issue has created one of the biggest market drivers for improved and new products in the glove industry. Manufacturers have responded by funding research into the area of understanding how their processes and products may have been involved in the cause and propagation of the allergy. Efforts were focused on how to reduce the NRL proteins during the manufacturing process. Reliable and relevant test methods for the protein allergen content are still being sought to help assist manufacturers in the monitoring of their products.

Amongst the industrial elastomers, natural rubber (NR) latex from Hevea is the largest source of renewable elastomer. The NR plantation industry has evolved over the years from a largely agricultural based product to that of a technically specified industrial feedstock producer that supports a multitude of industries on rubber products for diverse applications. So far NR is the only successful commercial source of technical elastomer extracted from nature. The rest of the elastomers are manufactured from monomers obtained from crude oil. The major NR producing countries are concentrated in South-East Asia and south Asia, producing more than 80% of the world's NR in their smallholdings and well-managed plantations. In this chapter a brief history of the development of the Hevea NR industry will be described and contrasted with that of the synthetic rubbers. The latex collected from the trees is a colloidal dispersion containing rubber hydrocarbon particles in addition to non-rubbers of biological origin. The colloidal properties of the NR latex and how its stability and preservation is affected by the biological components of the latex will be highlighted. The methods of purification and concentration of field latex into technically specified latex for the dipping industry are elaborated. Solid rubbers are produced from field latex or from a blend of latex and collected field coagula. Depending on the cleanliness of the source materials, different grades of crepe rubbers, sheet rubbers and block rubbers are produced. More than 80% of NR produced is block rubbers which are technically specified (TSR) as opposed to the visually graded sheet and crepe rubbers. The acceptance of these technically specified rubbers as standard rubbers for the global market on par with the synthetics is clear proof of their quality. Special grades of latices and rubbers including those chemically modified such as epoxidized NR (ENR) are produced to meet special product or processing needs. Some recent advances in addressing the rubber protein allergy issue in medical gloves, in searching for benign, safe, hazard-free accelerators and preservatives for latex; and measures in addressing the nitrosamines in rubber products will be dealt with in some detail. The diverse applications of latex and solid rubbers are also covered, highlighting some niche application areas where NR excels over the synthetics. The role of NR in moving forward to a low-carbon society would be briefly touched on.

The most frequent symptoms among the manifestations of cow milk protein allergy (CMPA) are gastrointestinal. CMPA pathogenesis involves immunological mechanisms with participation of immunocompetent cells and production of immunoglobulin E (IgE). Nevertheless, recent studies have been focused on the description of other forms of CMPA, not-mediated by IgE reactions, mostly involving the T lymphocite immune system. Thus, in this field it is important to note how different kind of cells are involved in the immunopathogenesis of CMPA, such as antigen-specific T cells, T regulatory cells, cytokines secreted by the different T lymphocite subsets, B lymphocytes, antingen-presenting cells, mast cells, that together orchestrate the complex mechanism leading to the phenotipic expression of CMPA. The progress in the diagnosis of immunologic disorders allowed the recent literature to develop new models for immuno-mediate disorders, involving new cells (such as Treg cells) and thus allowing the acquisition of a new vision of the pathogenesis of atopic diseases. The aim of this review is to describe the immunopathogenetic aspects of CMPA in view of these new discoveries in the immunologic field, considering the immunologic pathway at the basis of both IgE- and not-IgE mediated CMPA.

Cow milk protein allergy (CMPA) is an abnormal IgE-mediated reaction to cow milk proteins. Donkey’s milk could be considered suitable for feeding young children affected by severe IgE-mediated CMPA because its nutritional properties and composition are very close to human milk. Since donkey’s milk is available during a limited range of months during the year, it may be useful to find better storage conditions for this product. This study investigated the effects of the lyophilization treatment on donkey’s milk nutritional characteristics, and the results were compared with those obtained on fresh and frozen milk. Nutritional properties of lyophilized donkey’s milk remained basically unchanged compared with fresh milk. Two different probiotic strains were added to lyophilized donkey’s milk, and their viability was evaluated after milk reconstitution. The results obtained confirmed the possibility of producing a probiotic infant formula with beneficial properties using donkey’s milk as raw material.