Kinder- und Jugendmedizin 2022; 22(06): 429-438
DOI: 10.1055/a-1958-6184
Schwerpunkt

Kuhmilchallergie im Kindesalter

Fokus ToleranzCows milk protein allergyFocus on tolerance
Eberhard Lurz
1   Dr. von Haunersches Kinderspital, Klinikum der Universität München (KUM)
› Author Affiliations

ZUSAMMENFASSUNG

Blutig schleimige Durchfälle bei Säuglingen und Kleinkindern sind häufig Anzeichen einer Kuhmilchallergie. Dabei liegt in der Mehrzahl der Fälle eine IgE-vermittelte Allergie vor, jedoch sind IgE-negative Formen nicht selten. Die Langzeitprognose, eine Toleranz zu entwickeln, ist gut, insbesondere, wenn frühzeitig mit einer Re-Exposition von Kuhmilchprotein, idealerweise initial in verbackener Form, begonnen wird.

ABSTRACT

Bloody stools in a well appearing infant are frequent and often associated with cow’s milk protein allergy (CMPA). Most of these allergies are IgE related but also non-IgE related CMPA is frequent. Overall long-term prognosis for both forms is favorable, especially when early measures to achieve tolerance such as re-exposure, especially in form of baked milk products, are taken systematically.



Publication History

Article published online:
14 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG,
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 de Silva D, Halken S, Singh C. et al Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials. Pediatr Allergy Immunol 2020; 31: 813-826
  • 2 Fiocchi A, Bognanni A, Brozek J. et al World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions. World Allergy Organ J 2022; 15: 100609
  • 3 Annesi-Maesano I, Fleddermann M, Hornef M. et al Allergic diseases in infancy: I – Epidemiology and current interpretation. World Allergy Organ J 2021; 14: 100591
  • 4 Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018; 141: 41-58
  • 5 Flom JD, Sicherer SH. Epidemiology of Cow’s Milk Allergy. Nutrients. 2019: 11
  • 6 Schoemaker AA, Sprikkelman AB, Grimshaw KE. et al Incidence and natural history of challenge-proven cow’s milk allergy in European children – EuroPrevall birth cohort. Allergy 2015; 70: 963-972
  • 7 Petrus NC, Schoemaker AF, van Hoek MW. et al Remaining symptoms in half the children treated for milk allergy. Eur J Pediatr 2015; 174: 759-765
  • 8 Rohrl DV, Brandstetter S, Siziba LP. et al Food allergy in infants assessed in two German birth cohorts 10 years after the EuroPrevall Study. Pediatr Allergy Immunol 2022; 33: e13689
  • 9 Venter C, Brown T, Meyer R. et al Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP – an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy 2017; 07: 26
  • 10 Arasi S, Cafarotti A, Fiocchi A. Cow’s milk allergy. Curr Opin Allergy Clin Immunol 2022; 22: 181-187
  • 11 Sackesen C, Altintas DU, Bingol A. et al Current Trends in Tolerance Induction in Cow’s Milk Allergy: From Passive to Proactive Strategies. Front Pediatr 2019; 07: 372
  • 12 Guo J, Lv Q, Ariff A. et al Western oropharyngeal and gut microbial profiles are associated with allergic conditions in Chinese immigrant children. World Allergy Organ J 2019; 12: 100051
  • 13 Clemente JC, Pehrsson EC, Blaser MJ. et al The microbiome of uncontacted Amerindians. Sci Adv 2015; 01 (03) e1500183
  • 14 Lee KH, Song Y, Wu W. et al The gut microbiota, environmental factors, and links to the development of food allergy. Clin Mol Allergy 2020; 18: 5
  • 15 Azad MB, Konya T, Guttman DS. et al Infant gut microbiota and food sensitization: associations in the first year of life. Clin Exp Allergy 2015; 45: 632-643
  • 16 Feehley T, Plunkett CH, Bao R. et al Healthy infants harbor intestinal bacteria that protect against food allergy. Nat Med 2019; 25: 448-453
  • 17 Koletzko S, Niggemann B, Arato A. et al Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012; 55: 221-229
  • 18 Nowak-Wegrzyn A, Bloom KA, Sicherer SH. et al Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol 2008; 122: 342-347 347 e. 341–342
  • 19 Caubet JC, Nowak-Wegrzyn A, Moshier E. et al Utility of casein-specific IgE levels in predicting reactivity to baked milk. J Allergy Clin Immunol 2013; 131: 222-224 e221–224
  • 20 Bartnikas LM, Sheehan WJ, Hoffman EB. et al Predicting food challenge outcomes for baked milk: role of specific IgE and skin prick testing. Ann Allergy Asthma Immunol 2012; 109: 309-313 e301
  • 21 Mehr S, Turner PJ, Joshi P. et al Safety and clinical predictors of reacting to extensively heated cow’s milk challenge in cow’s milk-allergic children. Ann Allergy Asthma Immunol 2014; 113: 425-429
  • 22 Vandenplas Y, Dupont C, Eigenmann P. et al A workshop report on the development of the Cow’s Milk-related Symptom Score awareness tool for young children. Acta Paediatr 2015; 104: 334-339
  • 23 Vandenplas Y, Althera Study G, Steenhout P, Grathwohl D. A pilot study on the application of a symptom-based score for the diagnosis of cow’s milk protein allergy. SAGE Open Med 2014; 02: 2050312114523423
  • 24 Vandenplas Y, Steenhout P, Jarvi A, Garreau AS, Mukherjee R. Pooled Analysis of the Cow’s Milk-related-Symptom-Score (CoMiSS) as a Predictor for Cow’s Milk Related Symptoms. Pediatr Gastroenterol Hepatol Nutr 2017; 20: 22-26
  • 25 Vandenplas Y, Zhao ZY, Mukherjee R. et al Assessment of the Cow’s Milk-related Symptom Score (CoMiSS) as a diagnostic tool for cow’s milk protein allergy: a prospective, multicentre study in China (MOSAIC study). BMJ Open 2022; 12: e056641
  • 26 Du Toit G, Roberts G, Sayre PH. et al Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372: 803-813
  • 27 Du Toit G, Sayre PH, Roberts G. et al Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. N Engl J Med 2016; 374: 1435-1443
  • 28 Perkin MR, Logan K, Tseng A. et al Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. N Engl J Med 2016; 374: 1733-1743
  • 29 Katz Y, Rajuan N, Goldberg MR. et al Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol 2010; 126: 77-82 e71
  • 30 Leonard SA. Debates in allergy medicine: baked milk and egg ingestion accelerates resolution of milk and egg allergy. World Allergy Organ J 2016; 09: 1
  • 31 Nowak-Wegrzyn A, Berin MC, Mehr S. Food Protein-Induced Enterocolitis Syndrome. J Allergy Clin Immunol Pract 2020; 08: 24-35