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Acharyya BC, Mukhopadhyay M. Escalation of soya cross-allergy in infants with cow's milk allergy. World J Clin Pediatr 2025; 14:101663. [DOI: 10.5409/wjcp.v14.i2.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 12/15/2024] [Accepted: 02/21/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Cow's milk allergy (CMA) is a common condition in infants, requiring alternative protein sources in their diets. Soya milk has become a popular substitute, especially in developing countries where it is a more affordable option compared to expensive hypoallergenic feeds for infants with insufficient breast milk supply. However, recent observations have shown an increase in soya cross-allergic reactions among infants with CMA.
AIM To determine how often infants diagnosed with CMA also had soya cross-allergy and to examine the symptoms and outcomes of these infants at 2 years of age.
METHODS Data from two pediatric centers were analyzed, looking at clinical records of children under 2 years old diagnosed with CMA from August 2015 to July 2023, divided into two four-year periods.
RESULTS The records of 432 infants with CMA were analyzed. In the first four-year period from August 2015 to July 2019, 142 infants were studied, with 27 (19%) found to have soya-protein allergy as well. In the second four-year period, a total of 290 infants were studied, and soya allergy was found in 136 babies (47%). This represents a significant increase (P < 0.0001) in cases of soya protein cross-allergy among infants with CMA. The most common symptoms observed were gastroesophageal reflux disorder (39%), followed by failure to thrive, bloody diarrhea, watery diarrhea, and constipation. At 2 years of age, these infants showed significant growth failure compared to infants with CMA only.
CONCLUSION In conclusion, this study emphasizes the importance of being cautious when using soy protein in infants with cow's milk protein allergy, especially in areas where cost is a major concern.
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Affiliation(s)
- Bhaswati C Acharyya
- Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
- Department of Paediatric Gastroenterology, Manipal Hospital, Kolkata 700099, West Bengal, India
| | - Meghdeep Mukhopadhyay
- Department of Pediatric Gastroenterology and Hepatology, Institute of Child Health, Kolkata 700017, West Bengal, India
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Meyer R, Cianferoni A, Vazquez-Ortiz M. An update on the diagnosis and management of non-IgE-mediated food allergies in children. Pediatr Allergy Immunol 2025; 36:e70060. [PMID: 40110885 DOI: 10.1111/pai.70060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 02/20/2025] [Accepted: 03/05/2025] [Indexed: 03/22/2025]
Abstract
The spectrum of non-IgE mediated conditions includes well-defined conditions like Food Protein-Induced Enterocolitis Syndrome (FPIES), Eosinophilic Oesophagitis (EoE), Food Protein-Induced Enteropathy, and Food Protein-Induced Allergic Proctocolitis, but also the more controversial food protein-induced dysmotility disorders like food protein-induced gastroesophageal reflux disease (FPGORD) and food protein-induced constipation (FPC). Typically, non-IgE mediated reactions are delayed, with symptom onset from hours to days after exposure to a culprit food. The diagnosis is mostly clinical, and food elimination followed by reintroduction is the primary diagnostic method. Apart from EoE, the diagnosis of these conditions remains challenging, and there is a need to develop specific diagnostic tests. Acute FPIES presents with distinct symptoms, but misdiagnosis is common due to poor recognition. In contrast, some presentations, particularly FPGORD and FPC, overlap with the common, often benign disorders of gut-brain interaction, previously known as functional gastrointestinal disorders. This raises concerns about overdiagnosis and can lead to an unnecessary restrictive diet in infants and breastfeeding mothers. A systematic approach to an elimination diet and the support of a registered dietitian/nutritionist are recommended to ensure nutritional adequacy, suitable alternatives, promote timely introductions when appropriate, support breastfeeding where required as well as prevent nutritional deficiencies and feeding difficulties. This publication aims to provide an update on the spectrum of non-IgE-mediated food allergic conditions and intends to provide clinicians with practical guidance on the diagnosis and management of each condition. The authors acknowledge the need for further research in a range of areas to inform best evidence-based practice.
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Affiliation(s)
- Rosan Meyer
- Department of Nutrition and Dietetics, Winchester University, Winchester, UK
- Department of Medicine, KU Leuven, Leuven, Belgium
| | - Antonella Cianferoni
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
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Meyer R, Groetch M, Santos A, Venter C. The evolution of nutritional care in children with food allergies - With a focus on cow's milk allergy. J Hum Nutr Diet 2025; 38:e13391. [PMID: 39587736 PMCID: PMC11589409 DOI: 10.1111/jhn.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 10/18/2024] [Accepted: 10/22/2024] [Indexed: 11/27/2024]
Abstract
Cow's milk allergy (CMA) remains one of the most common and complex paediatric food allergies. In the last decade, our understanding has advanced in terms of immunoglobulin E (IgE)-mediated CMA and focus is now also paid to non-IgE-mediated CMA, particularly in some Western countries where incidence rates are high. We have had significant progress in the last 10 years in relation to our understanding of existing supportive tests for IgE-mediated CMA, with the advancement of newer tests, such as the basophil activation test (BAT), which have shown great promise. However, little advancement has been made in terms of tests for non-IgE-mediated CMA, and controversy still exists around symptoms. Our understanding of the natural history of CMA has also advanced with more awareness of different phenotypes. While the mainstay of management remains cow's milk elimination, the importance of supporting breastfeeding and avoidance of unwarranted cow's milk elimination diets in breastfeeding mothers has been highlighted. For non-breastfed children, there has been some advancement in the formulas offered for the management of CMA, including the recognition of hydrolysed rice-based formulas and increased demand for nutritionally complete plant-based options, some of which are currently being assessed. The addition of pro, pre and synbiotics is considered safe to use, although research and guidance on routine use remain absent. Knowledge of tolerance induction from studies on the early introduction of peanuts has also highlighted the importance of a more active approach to managing CMA with the use of milk ladders, primarily in non-IgE-mediated CMA and baked milk (BM) introduction in IgE-mediated CMA. In addition, modulation of the microbiome and diet diversity during complementary feeding has been a major advancement in the last 10 years. While data on poor growth and feeding difficulties in children with CMA has not changed much, increased rates of obesity are now also reported. Finally, novel approaches, including oral immunotherapy, the use of milk ladders and earlier consideration of BM, have advanced somewhat in the last decade, although the risks and benefits of these novel approaches require further research. While CMA remains a complicated allergy to diagnose and manage, the evolution of science has advanced our knowledge and brought some novel innovations, which combined have enhanced our practice.
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Affiliation(s)
- Rosan Meyer
- Department of Nutrition and DieteticsUniversity of WinchesterWinchesterUK
- Department of MedicineKU LeuvenLeuvenBelgium
| | - Marion Groetch
- Department of Pediatrics, Icahn School of Medicine at Mount SinaiDivision of Pediatric Allergy and ImmunologyNew YorkNew YorkUSA
| | - Alexandra Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, King's College LondonFaculty of Life Sciences and MedicineLondonUK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial SciencesKing's College LondonLondonUK
- Children's Allergy Service, Evelina London Children's HospitalGuy's and St Thomas’ HospitalLondonUK
| | - Carina Venter
- Section of Allergy and ImmunologyUniversity of Colorado/Children's Hospital ColoradoBoulderColoradoUSA
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Battisti I, Ebinezer LB, Lomolino G, Masi A, Arrigoni G. Label-free quantitative proteomics of commercial rice beverages reveals the presence of high amounts of exogenous amylases. Food Res Int 2025; 200:115464. [PMID: 39779121 DOI: 10.1016/j.foodres.2024.115464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/15/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025]
Abstract
Rice milk is known for its wide range of beneficial effects on human health. Despite an increasing inclination towards rice drinks consumption, not much is known regarding the protein composition of commercial rice beverages. Hence, using a label-free quantitative proteomics approach we analyzed 9 different commercially available rice drinks and identified 259 rice proteins and 4 exogenous microbial α-amylases. Unexpectedly, exogenous α-amylases, when present, were the most abundant in terms of percentage mass. Interestingly, a very strong correlation between the amount of exogenous α-amylases and amylase inhibitors was observed and so was the correlation between α-amylases and the content of free sugars. We identified 20 potential rice allergens which, together with the exogenous microbial proteins, accounted for 32.3% of the total average percent mass. Taken together, our results have improved the understanding of the protein composition of commercial rice beverages.
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Affiliation(s)
- Ilaria Battisti
- Department of Biomedical Sciences, University of Padova, via U. Bassi 58/B, 35131 Padova, Italy; Department of Agronomy, Food, Natural Resources, Animals, and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro, Italy; Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, via G. Orus 2/B, 35129 Padova, Italy.
| | - Leonard Barnabas Ebinezer
- Department of Agronomy, Food, Natural Resources, Animals, and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro, Italy.
| | - Giovanna Lomolino
- Department of Agronomy, Food, Natural Resources, Animals, and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro, Italy.
| | - Antonio Masi
- Department of Agronomy, Food, Natural Resources, Animals, and Environment, University of Padova, Viale dell'Università 16, 35020 Legnaro, Italy.
| | - Giorgio Arrigoni
- Department of Biomedical Sciences, University of Padova, via U. Bassi 58/B, 35131 Padova, Italy; Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, via G. Orus 2/B, 35129 Padova, Italy.
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Zhang L, Hu Y, Jiang L. Advancements in emulsion systems for specialized infant formulas: Research process and formulation proposals for optimizing bioavailability of nutraceuticals. Compr Rev Food Sci Food Saf 2024; 23:e70043. [PMID: 39455164 DOI: 10.1111/1541-4337.70043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 09/13/2024] [Accepted: 09/25/2024] [Indexed: 10/28/2024]
Abstract
With the rapid advancements in nutrition and dietary management, infant formulas for special medical purposes (IFSMPs) have been developed to cater to the unique nutraceutical requirements of infants with specific medical conditions or physiological features. However, there are various challenges in effectively preserving and maximizing the health benefits of the specific nutraceuticals incorporated in IFSMPs. This review provides an overview of the nutritional compositions of various IFSMPs and highlights the challenges associated with the effective supplementation of specific nutraceuticals for infants. In addition, it emphasizes the promising potential of emulsion delivery systems, which possess both encapsulation and delivery features, to significantly improve the solubility, stability, oral acceptance, and bioavailability (BA) of nutraceutical bioactives. Based on this information, this work proposes detailed strategies for designing and developing model IFSMP emulsions to enhance the BA of specially required nutraceuticals. Key areas covered include emulsion stabilization, selective release mechanisms, and effective absorption of nutraceuticals. By following these proposals, researchers and industry professionals can design and optimize emulsion-based IFSMPs with enhanced health benefits. This review not only outlines the developmental states of IFSMP formulations but also identifies future research directions aimed at improving the physiological health benefits of IFSMPs. This effort lays the theoretical groundwork for the further development of emulsion-type IFSMP in infant formula (IF) industry, positioning the IF industry to better meet the complex needs of infants requiring specialized nutrition.
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Affiliation(s)
- Liling Zhang
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Food Science and Light Industry, Nanjing Tech University, Nanjing, Jiangsu, China
| | - Yang Hu
- Department of Scientific and Technological Innovation, Future Food (Bai Ma) Research Institute, Nanjing, Jiangsu, China
- Division of Microbiology, Brewing and Biotechnology, School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Ling Jiang
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Food Science and Light Industry, Nanjing Tech University, Nanjing, Jiangsu, China
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Herrera-Quintana L, Vázquez-Lorente H, Hinojosa-Nogueira D, Plaza-Diaz J. Relationship between Infant Feeding and the Microbiome: Implications for Allergies and Food Intolerances. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1030. [PMID: 39201963 PMCID: PMC11353207 DOI: 10.3390/children11081030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024]
Abstract
Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications.
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Affiliation(s)
- Lourdes Herrera-Quintana
- Department of Physiology, Schools of Pharmacy and Medicine, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.)
- Biomedical Research Center, Health Sciences Technology Park, University of Granada, 18016 Granada, Spain
| | - Héctor Vázquez-Lorente
- Department of Physiology, Schools of Pharmacy and Medicine, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (H.V.-L.)
- Biomedical Research Center, Health Sciences Technology Park, University of Granada, 18016 Granada, Spain
| | - Daniel Hinojosa-Nogueira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Laboratorio del Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario de Málaga (Virgen de la Victoria), 29590 Málaga, Spain;
| | - Julio Plaza-Diaz
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, Campus de Cartuja s/n, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
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Ramirez-Farias C, Oliver JS, Schlezinger J, Stutts JT. Tolerance of Infants Fed a Hydrolyzed Rice Infant Formula with 2'-Fucosyllactose (2'-FL) Human Milk Oligosaccharide (HMO). Nutrients 2024; 16:1863. [PMID: 38931218 PMCID: PMC11206301 DOI: 10.3390/nu16121863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The purpose of this research was to assess the growth, tolerance, and compliance outcomes associated with the consumption of a hydrolyzed rice infant formula (HRF) enriched with 2'-Fucosyllactose (2'-FL) a Human Milk Oligosaccharide (HMO), and nucleotides in an intended population of infants. METHODS This was a non-randomized single-group, multicenter study. The study formula was a hypoallergenic HRF with 2'-FL, Docosahexaenoic acid (DHA), Arachidonic acid (ARA), and nucleotides. Infants 0-90 days of age who were formula fed and experiencing persistent feeding intolerance symptoms, symptoms of suspected food protein (milk and/or soy) allergy, or other conditions where an extensively hydrolyzed infant formula was deemed an appropriate feeding option were recruited by pediatricians from their local populations. The primary outcome was maintenance of weight-for-age z-score. Weight, length, head circumference, formula intake, tolerance measures, clinical symptoms and questionnaires were collected. Thirty-three infants were enrolled, and 27 completed the study, on study product. RESULTS Weight-for-age z-scores of infants showed a statistically significant improvement from Visit 1 to Visit 4 (p = 0.0331). There was an adequate daily volume intake of 762 ± 28 mL/day, average daily number of stools of 2.1 ± 0.3, and mean rank stool consistency of 2.38 ± 0.18. After 28 days of switching to a HRF, 86.8 ± 5.9% of the symptoms resolved or got better by Visit 4 as reported by parents. CONCLUSIONS HRF with 2'-FL HMO was safe, well tolerated, and supported weight gain in infants with suspected cow's milk allergy or persistent feeding intolerance.
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Affiliation(s)
- Carlett Ramirez-Farias
- Scientific & Medical Affairs, Abbott Nutrition, Columbus, OH 43219, USA; (J.S.O.); (J.T.S.)
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Lee CC, Suttikhana I, Ashaolu TJ. Techno-Functions and Safety Concerns of Plant-Based Peptides in Food Matrices. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:12398-12414. [PMID: 38797944 DOI: 10.1021/acs.jafc.4c02464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Plant-based peptides (PBPs) benefit functional food development and environmental sustainability. Proteolysis remains the primary method of peptide production because it is a mild and nontoxic technique. However, potential safety concerns still emanate from toxic or allergenic sequences, amino acid racemization, iso-peptide bond formation, Maillard reaction, dose usage, and frequency. The main aim of this review is to investigate the techno-functions of PBPs in food matrices, as well as their safety concerns. The distinctive characteristics of PBPs exhibit their techno-functions for improving food quality and functionality by contributing to several crucial food formulations and processing. The techno-functions of PBPs include solubility, hydrophobicity, bitterness, foaming, oil-binding, and water-holding capacities, which subsequently affect food matrices. The safety and quality of foodstuff containing PBPs depend on the proper source of plant proteins, the selection of processing approaches, and compliance with legal regulations for allergen labeling and safety evaluations. The safety concerns in allergenicity and toxicity were discussed. The conclusion is that food technologists must apply safe limits and consider potential allergenic components generated during the development of food products with PBPs. Therefore, functional food products containing PBPs can be a promising strategy to provide consumers with wholesome health benefits.
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Affiliation(s)
- Chi-Ching Lee
- Department of Food Engineering, Faculty of Engineering and Natural Sciences, Istanbul Sabahattin Zaim University, Halkalı Avenue No: 28, Halkalı, Küçükçekmece, Istanbul 34303, Türkiye
| | - Itthanan Suttikhana
- Department of Multifunctional Agriculture, Faculty of Agriculture and Technology, University of South Bohemia in České Budějovice, České Budějovice, Branišovská 1645/31a, 370 05 České Budějovice 2, Czechia
| | - Tolulope Joshua Ashaolu
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Viet Nam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Viet Nam
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Nocerino R, Coppola S, Carucci L, Oglio F, Cozzolino M, Masino A, Ozen G, Farnetano M, Berni Canani R. Growth pattern of paediatric patients affected by cow milk protein allergy fed with rice hydrolyzed formula. J Pediatr Gastroenterol Nutr 2024; 78:909-917. [PMID: 38374730 DOI: 10.1002/jpn3.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Formulas made from hydrolyzed rice proteins (HRPF) are well-tolerated plant-based alternatives to cow's milk protein (CMP)-based formulas for the dietary management of paediatric patients with CMP allergy (CMPA). Growth in patients with CMPA fed with HRPF has been evaluated in several studies with conflicting results. The aim was to evaluate the growth pattern of children with CMPA over a 12-month follow-up period. METHODS Prospective cohort study evaluating growth patterns in challenge proven CMPA paediatric patients receiving HRPF for 12 months. Outcomes were anthropometry (body weight, body length, head circumference), adherence to the study formula and occurrence of adverse events (AEs). RESULTS Sixty-six children were included and completed the 12-month study. At baseline, all CMPA patients were weaned. For the entire CMPA pediatric patients' cohort, from baseline to the end of the study period, the growth pattern resulted within the normal range of World Health Organization (WHO) growth references. The formula was well tolerated. Adherence was optimal and no AEs related to HRPF use were reported. CONCLUSIONS HRPF is well tolerated and can help support healthy growth and development in infants and young children with CMPA. These type of formula can be given with complementary foods in the dietary management of CMPA.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Marica Cozzolino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonio Masino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Gulsum Ozen
- Department of Pediatrics, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Margherita Farnetano
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
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Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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EFSA Panel on Contaminants in the Food Chain (CONTAM), Schrenk D, Bignami M, Bodin L, Chipman JK, del Mazo J, Grasl‐Kraupp B, Hogstrand C, Hoogenboom L(R, Leblanc J, Nebbia CS, Nielsen E, Ntzani E, Petersen A, Sand S, Vleminckx C, Wallace H, Barregård L, Benford D, Broberg K, Dogliotti E, Fletcher T, Rylander L, Abrahantes JC, Gómez Ruiz JÁ, Steinkellner H, Tauriainen T, Schwerdtle T. Update of the risk assessment of inorganic arsenic in food. EFSA J 2024; 22:e8488. [PMID: 38239496 PMCID: PMC10794945 DOI: 10.2903/j.efsa.2024.8488] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.
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12
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Chouraqui JP. Vegetarian diets and diets which restrict animal-source foods during childhood in high-income countries. Paediatr Int Child Health 2023; 43:57-82. [PMID: 37649436 DOI: 10.1080/20469047.2023.2245186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 09/01/2023]
Abstract
Increasing numbers of populations in the West are restricting their intake of meat and other animal products for reasons relating to health or ethics; in many countries, these restrictions are already common for cultural, religious, or socio-economic reasons. By following their parent's diet, children are exposed in parallel. This narrative review aims at assessing current data regarding vegetarian diets in children from birth to 18 years of age, which include, by increasing degree of restriction, flexitarian, lacto-ovo-vegetarian, lacto-vegetarian, pescatarian, vegan and macrobiotic diets. The 202 references include 45 studies in children. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Of particular concern are vitamin B12, iron, zinc, calcium, n-3 long-chain polyunsaturated fatty acids, and protein and energy intake, especially in pregnant and nursing women, infants and young children. Providing an adequate lacto-ovo-vegetarian diet is relatively easy, whereas the maintenance of more restrictive diets may be challenging. The benefits and risks of vegetarian diets in adults are relatively well documented, but data for children are scarce. Vegan and macrobiotic diets should be discouraged in pregnant and lactating mothers as well as in young children, who, otherwise, should pay careful attention to ensuring nutritional adequacy, blood testing and appropriate supplementation. The health consequences of a chosen diet should be discussed with parents and adolescents to ensure the best possible adherence to advice and prescriptions. There is a need for well conducted studies in children but also for better knowledge of nutrition in healthcare professionals.Abbreviations: ALA: α-linolenic acid; ARA: arachidonic acid; ASF: animal source foods; BMC: bone mineral content; BMD: bone mineral density; DHA: docosahexaenoic acid; DRV: dietary reference value; EPA: eicosapentaenoic acid; FLD: flexitarian diet; LA: linoleic acid; LC-PUFA: long-chain polyunsaturated fatty acids; LOVD: lacto-ovo-vegetarian diet; LVD: lacto-vegetarian diet; MAD: macrobiotic diet; OMD: omnivorous diet; PSF: plant-source foods; SFA: saturated fatty acids; VGD: vegetarian diets; VND: vegan diet.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Division of Nutrition and Gastro-Enterology, Department of Paediatric, Grenoble-Alpes University Hospital (CHUGA), Grenoble, France
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Jones E, Burton AE. Exploring Vegan Mothers' Experiences of Making Food Choices for Infants and Young Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:624-633. [PMID: 37542483 DOI: 10.1016/j.jneb.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Our study aimed to explore vegan mothers' experiences and decision-making processes when feeding their children (up to 3 years old). METHODS We conducted a qualitative photo-elicitation interview study in the United Kingdom. Eight vegan mothers provided 5 photographs of food choices they had made for their children and completed online photo-elicitation interviews to discuss these images. Data were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS Five themes were developed: role modeling eating behavior, shared decision-making, nutritional guidance for vegan parents, fear of judgment for being vegan, and desire for convenience. CONCLUSIONS AND IMPLICATIONS Findings illustrate the complexity of the decision-making process and highlight the need for targeted resources for vegan parents. There is a need for awareness raising and training for health care professionals and the development of vegan-specific child-feeding resources to facilitate the provision of evidence-based nutritional guidance for vegan parents.
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Affiliation(s)
- Eliza Jones
- Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, United Kingdom
| | - Amy E Burton
- Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, United Kingdom.
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Martín-Masot R, Díaz-Martín JJ, Santamaría-Orleans A, Navas-López VM. Spanish Pediatricians' Positions Regarding Prevention, Diagnosis, Nutritional Management, and Challenges in Cow's Milk Protein Allergy. Nutrients 2023; 15:3586. [PMID: 37630776 PMCID: PMC10458855 DOI: 10.3390/nu15163586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Management of cow's milk protein allergy (CMPA) can vary depending on the experience and area of expertise of the clinician responsible for the patient's follow-up, which may or may not align with the recently published literature. To analyze the perspectives of Spanish pediatricians on this topic, a survey was conducted. The survey aimed to determine the current opinions and attitudes of 222 primary care and hospital pediatricians toward CMPA prevention and nutritional management. Participating pediatricians completed the questionnaire, providing insights into their daily clinical practices, including access to testing, attitudes with respect to various aspects of CMPA diagnosis, prevention, oral food challenges, and treatment. The findings revealed that pediatricians generally agree on the use of extensively hydrolyzed formulas (eHFs) to prevent CMPA in high-risk atopic children, despite limited evidence supporting the widespread use of this practice. However, consensus was lacking regarding the utility of formulas with prebiotics and probiotics for expediting tolerance development. In most cases, pediatricians preferred eHFs for the nutritional management of CMPA, followed by hydrolyzed rice formulas (HRFs), with amino-acid-based formulas (AAFs) being the third option. Certain issues remained controversial among pediatricians, such as prevention methods, symptom assessment, and the role of probiotics. These variations in management approaches reflect the influence of clinician experience and area of expertise, underscoring the need for standardized guidelines in this field.
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Affiliation(s)
- Rafael Martín-Masot
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain (V.M.N.-L.)
| | - Juan José Díaz-Martín
- Pediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | | | - Víctor Manuel Navas-López
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain (V.M.N.-L.)
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15
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PARLAK Z, İLGÜN GÜREL D, SOYER Ö, ŞEKEREL BE, ŞAHİNER ÜM. Nutritional risks in children with food allergy. Turk J Med Sci 2023; 53:845-858. [PMID: 38031941 PMCID: PMC10765559 DOI: 10.55730/1300-0144.5648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/18/2023] [Accepted: 04/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.
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Affiliation(s)
- Zeynep PARLAK
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
- Department of Nutrition and Dietetics, Hacettepe İhsan Doğramacı Children’s Hospital, Hacettepe University, Ankara,
Turkiye
| | - Deniz İLGÜN GÜREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge SOYER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Bülent Enis ŞEKEREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ümit Murat ŞAHİNER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
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Yang J, Meng D, Wu Z, Chen J, Xue L. Modification and Solubility Enhancement of Rice Protein and Its Application in Food Processing: A Review. Molecules 2023; 28:molecules28104078. [PMID: 37241820 DOI: 10.3390/molecules28104078] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Rice protein is a high-quality plant-based protein source that is gluten-free, with high biological value and low allergenicity. However, the low solubility of rice protein not only affects its functional properties such as emulsification, gelling, and water-holding capacity but also greatly limits its applications in the food industry. Therefore, it is crucial to modify and improve the solubility of rice protein. In summary, this article discusses the underlying causes of the low solubility of rice protein, including the presence of high contents of hydrophobic amino acid residues, disulfide bonds, and intermolecular hydrogen bonds. Additionally, it covers the shortcomings of traditional modification methods and the latest compound improvement methods, compares various modification methods, and puts forward the best sustainable, economical, and environmentally friendly method. Finally, this article lists the uses of modified rice protein in dairy, meat, and baked goods, providing a reference for the extensive application of rice protein in the food industry.
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Affiliation(s)
- Jingjing Yang
- Tianjin Key Laboratory of Food Biotechnology, College of Biotechnology and Food Science, Tianjin University of Commerce, Tianjin 300134, China
| | - Dan Meng
- Tianjin Key Laboratory of Food Biotechnology, College of Biotechnology and Food Science, Tianjin University of Commerce, Tianjin 300134, China
| | - Zijian Wu
- Tianjin Key Laboratory of Food Biotechnology, College of Biotechnology and Food Science, Tianjin University of Commerce, Tianjin 300134, China
| | - Jinyu Chen
- Tianjin Key Laboratory of Food Biotechnology, College of Biotechnology and Food Science, Tianjin University of Commerce, Tianjin 300134, China
| | - Lu Xue
- Tianjin Key Laboratory of Food Biotechnology, College of Biotechnology and Food Science, Tianjin University of Commerce, Tianjin 300134, China
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17
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Chouraqui JP. Risk Assessment of Micronutrients Deficiency in Vegetarian or Vegan Children: Not So Obvious. Nutrients 2023; 15:2129. [PMID: 37432244 DOI: 10.3390/nu15092129] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
Vegetarian diets have gained in popularity worldwide and therefore an increasing number of children may be exposed to the resulting nutritional consequences. Among them, the risk of micronutrient shortfall is particularly of concern. This narrative review aims to assess and discuss the relevance of micronutrient deficiency risk based on the available data. It mainly draws attention to iron, zinc, iodine, and vitamins B12 and D intake. Diets that are more restrictive in animal source foods, such as vegan diets, have a greater likelihood of nutritional deficiencies. However, the actual risk of micronutrient deficiency in vegetarian children is relatively difficult to assert based on the limitations of evidence due to the lack of well-designed studies. The risk of vitamin B12 deficiency must be considered in newborns from vegan or macrobiotic mothers and children with the most restrictive diet, as well as the risk of iron, zinc, and iodine deficiency, possibly by performing the appropriate tests. A lacto-ovo-vegetarian diet exposes a low risk if it uses a very varied diet with a sufficient intake of dairy products. Vegan and macrobiotic diets should be avoided during pregnancy and childhood. There is a need for education and nutrition guidance and the need for supplementation should be assessed individually.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Paediatrics Department, University Hospital of Grenoble-Alpes (CHUGA), Quai Yermoloff, 38700 La Tronche, France
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18
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Malterre N, Bot F, O'Mahony JA. Formulation and Physical Stability of High Total Solids Lentil Protein-Stabilised Emulsions for Use in Plant Protein-Based Young Child Formulae. Foods 2023; 12:foods12091741. [PMID: 37174280 PMCID: PMC10178154 DOI: 10.3390/foods12091741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
The demand for high-quality plant protein products is increasing and the aim of this work was to evaluate the impact of increasing the total solids content on the formation and stability of lentil protein stabilised oil-in-water emulsions. A series of emulsions were formulated using different proportions of total solids: 23, 26, 29, 32, and 35% (w/v). The emulsions were formulated using three ingredients-lentil protein, sunflower oil, and maltodextrin-which made up 15.85, 27.43, and 56.72% (w/w) of the total solids, respectively. The changes in apparent viscosity, particle size distribution, and colour during thermal processing were evaluated, with the physical stability investigated using an analytical centrifuge. The apparent viscosity of the solutions increased with total solids content (25.6 to 130 mPa.s-1), as did redness colour intensity (a* value increased from 5.82 ± 0.12 to 7.70 ± 0.09). Thermal processing resulted in greater destabilisation for higher total solids samples, as evidenced by greater changes in particle size, along with decreased redness colour. These results bring a better understanding of high total solids plant protein emulsions and factors affecting their stability, which could be used for the development of cost-effective and sustainable processing solutions in the production of plant protein young child formulae.
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Affiliation(s)
- Nicolas Malterre
- School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland
| | - Francesca Bot
- Department of Food and Drug, University of Parma, 43100 Parma, Italy
| | - James A O'Mahony
- School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland
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19
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Byrne ME, Arranz E, Bot F, Gómez-Mascaraque LG, Tobin JT, O’Mahony JA, O’Callaghan TF. The Protein Composition and In Vitro Digestive Characteristics of Animal- versus Plant-Based Infant Nutritional Products. Foods 2023; 12:foods12071469. [PMID: 37048290 PMCID: PMC10094249 DOI: 10.3390/foods12071469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
The protein composition and digestive characteristics of four commercially available infant formulae (IF) manufactured using bovine (B-IF), caprine (C-IF), soy (S-IF), and rice (R-IF) as a protein source were examined in this study. Plant-based formulae had significantly higher crude protein and non-protein nitrogen (NPN) concentrations. Static in vitro gastrointestinal digestion of these formulae, and subsequent analysis of their digestates, revealed significantly higher proteolysis of B-IF at the end of gastrointestinal digestion compared to the other formulae, as indicated by the significantly higher concentration of free amine groups. Furthermore, differences in structure formation during the gastric phase of digestion were observed, with formation of a more continuous, firmer coagulum by C-IF, while R-IF demonstrated no curd formation likely due to the extensive hydrolysis of these proteins during manufacture. Differences in digestive characteristics between formulae manufactured from these different protein sources may influence the bio-accessibility and bioavailability of nutrients, warranting additional study.
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20
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Lajnaf R, Feki S, Ben Ameur S, Attia H, Kammoun T, Ayadi MA, Masmoudi H. Cows' milk alternatives for children with cows' milk protein allergy - Review of health benefits and risks of allergic reaction. Int Dairy J 2023. [DOI: 10.1016/j.idairyj.2023.105624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Morris E, Perumalla S, Stiers C, Gross K. Rice protein concentrate is a well-accepted, highly digestible protein source for adult cats. Front Vet Sci 2023; 10:1168659. [PMID: 37187925 PMCID: PMC10175793 DOI: 10.3389/fvets.2023.1168659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction The use of rice protein concentrate (RPC) as a protein source in cat food is uncommon. Therefore, this study aimed to determine the acceptability and digestibility of foods formulated to contain increasing levels of RPC to support its inclusion in foods for adult (non-gravid, non-lactating) cats. Methods Increasing levels of RPC (0, 7, 14, and 28%) were formulated into test foods fed to 24 cats in a Latin square design with 15-day periods and no washout between periods. Food intake and fecal scores were measured to determine the acceptability of test foods. Fecal output was measured on days 11-15. Food and fecal samples from day 15 of each period were analyzed for nutrient composition to calculate the macronutrient digestibility of the test foods. Analysis of variance and orthogonal contrasts were used to assess the effects of RPC inclusion on food intake, fecal output, fecal scores, and macronutrient digestibility. Results The results showed that as-fed (AF), dry matter (DM), and gross energy (GE) intake increased with increasing RPC levels (p > 0.05). Fecal output, both as-is and DM, was unaffected by RPC inclusion (p > 0.05); however, fecal scores increased linearly with increasing RPC inclusion (p < 0.001). Furthermore, true protein and apparent DM, GE, and carbohydrate (NFE) digestibility increased linearly with RPC inclusion (p < 0.05). Apparent fat digestibility was high for all test foods but was unaffected by RPC inclusion (p = 0.690). Discussion Overall, the inclusion of RPC was well-accepted, improved fecal characteristics, and increased the apparent and true macronutrient digestibility compared to the control. Therefore, this study demonstrated that RPC can serve as a high-quality and acceptable protein source for adult cats.
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Affiliation(s)
- Elizabeth Morris
- Hill’s Pet Nutrition, Inc., Topeka, KS, United States
- *Correspondence: Elizabeth Morris,
| | | | - Cheryl Stiers
- Hill’s Pet Nutrition, Inc., Topeka, KS, United States
| | - Kathy Gross
- Department of Animal Science & Industry Adjunct Faculty, Kansas State University, Manhattan, KS, United States
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Wright K, Feeney M, Yerlett N, Meyer R. Nutritional Management of Children with Food Allergies. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Purpose of the Review
The purpose of the review is to review the evidence for the nutritional management of paediatric food allergy and provide a practical approach for healthcare professionals working in this area.
Recent Findings
Dietary elimination remains the mainstay for management of food allergies in children. However, the elimination of food allergens increases the risk for growth faltering, micronutrient deficiencies and feeding difficulties. Breastmilk remains the ideal source of nutrition for infants, but when not available, the vast majority will tolerate an extensively hydrolysed formula, and rice hydrolysate has also been suggested as a suitable alternative. Only in severe cases, including anaphylaxis, eosinophilic oesophagitis and growth faltering, is an amino acid formula indicated. The early introduction of peanut and egg and avoiding the delay in the introduction of other allergens, when not already allergic, has been highlighted by recent studies.
Summary
Whilst the elimination of allergens increases the risk of developing poor growth, micronutrient deficiencies and feeding difficulties, optimal, early dietary input, including advice on active introduction of allergens and alternative feeds, ideally from a registered dietitian/nutritionist, may be prevent and improve outcomes.
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Hydrolyzed rice formula for dietary management of infants with cow's milk allergy. World Allergy Organ J 2022; 15:100717. [PMID: 36438193 PMCID: PMC9678766 DOI: 10.1016/j.waojou.2022.100717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Allergic diseases are increasing globally and are a significant public health challenge, especially in children. Cow's milk allergy (CMA) is one of the most common food allergies in early childhood. When CMA is diagnosed and exclusive breastfeeding is not possible, current guidelines recommend extensively hydrolyzed formulas (eHF) or amino acid-based formulas (AAF), depending on the diagnosis and severity of symptoms. Hydrolyzed rice formulas (HRF) are considered an alternative to eHF and AAF where available. Objectives & methods We aimed to understand how HRF are being used and their position in the management of CMA, and to generate consensus on indications for use. Two virtual roundtables of international healthcare experts in pediatric food allergy focused on HRF were convened in May and October 2021. Experts provided multiple perspectives due to different specialties, locations, healthcare settings, and availability of HRF. Following discussion of international CMA guidelines and HRF use, identification of challenges along the diagnosis and treatment pathway, and translation of guidelines into clinical practice, an expert consensus on the use of HRF for CMA was developed. This involved repeated voting followed by statement amendment to reach 100% agreement. This publication summarizes insights from these meetings. Results There was 100% agreement on all 8 statements: (1) While breastmilk is the best source of nutrition for infants with CMA, when breastfeeding is not possible, a hypoallergenic formula can be used; (2) Per definition, a HRF is cow's milk protein-free; (3) A minority of infants with immunoglobulin (Ig)E-mediated CMA react to eHF due to residual cow's milk protein; (4) More infants with non-IgE-mediated CMA than IgE-mediated CMA react to eHF likely due to residual cow's milk protein; (5) When a diagnostic elimination diet is indicated, HRF can be used; (6) A HRF can be recommended as a first-line option for CMA, where available, as outlined in the Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines; (7) HRFs have proven hypoallergenicity and are suitable for the dietary management of CMA; (8) HRFs have been shown to support growth in infants with CMA, similar to other hypoallergenic formulas. Participants recommend healthcare professionals take these statements as guidance to use HRF in clinical practice. Based on efficacy and growth evidence, the experts found HRF a suitable option for the dietary management of CMA. Conclusion HRF can be recommended as a first-line alternative to cow's milk-based eHF or AAF, where available, in the dietary management of CMA.
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Improving anti-hypertensive properties of plant-based alternatives to yogurt fortified with rice protein hydrolysate. Heliyon 2022; 8:e11087. [PMID: 36281384 PMCID: PMC9587324 DOI: 10.1016/j.heliyon.2022.e11087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/10/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
In recent years, an increasing demand of plant-based yogurt-like products for partially replacing milk products was related to both health and ethical needs. The objective of this study was to improve the functionality of yogurt-like products relevant for hypertension, using fortification with protein hydrolysate and lactic acid bacteria (LAB) fermentation of soy and Job’s tears beverages. Broken rice was hydrolysed by protease enzymes. Plant-based beverages and yogurt-like products with and without rice protein hydrolysate were prepared by LAB fermentation and evaluated by in-vitro assays for inhibition of free radical scavenging and angiotensin-converting enzyme (ACE) activity. Biochemical changes caused by lactic acid bacteria metabolism were characterized using chemical analysis and 1H NMR. The rice protein hydrolysate obtained using Alcalase® at pH 7.0 for 2 h at 60 °C showed the highest antioxidant activity and ACE inhibition. The ACE inhibition increased by 19.52% and 34.13% in Job’s tears and soy yogurt-like products with hydrolysate, respectively. A strongly significant correlation (R2 = 0.84) between o-phthalic dicarboxaldehyde (OPA) peptides and ACE inhibition was observed. These results indicated the promise of hydrolysate and LAB fermentation as a functional ingredient and process, respectively, for the food industry.
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25
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Yi C, Qiang N, Zhu H, Xiao Q, Li Z. Extrusion processing: A strategy for improving the functional components, physicochemical properties, and health benefits of whole grains. Food Res Int 2022; 160:111681. [DOI: 10.1016/j.foodres.2022.111681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/04/2022]
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Anania C, Martinelli I, Brindisi G, De Canditiis D, De Castro G, Zicari AM, Olivero F. Hydrolyzed Rice Formula: An Appropriate Choice for the Treatment of Cow's Milk Allergy. J Clin Med 2022; 11:4823. [PMID: 36013062 PMCID: PMC9410499 DOI: 10.3390/jcm11164823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Cow's milk allergy (CMA) is a common condition in the pediatric population. CMA can induce a diverse range of symptoms of variable intensity. It occurs mainly in the first year of life, and if the child is not breastfed, hypoallergenic formula is the dietary treatment. Extensively hydrolyzed cow's milk formulas (eHF) with documented hypo-allergenicity can be recommended as the first choice, while amino acid-based formulas (AAF) are recommended for patients with more severe symptoms. Hydrolyzed rice-based formulas (HRFs) are a suitable alternative for infants with CMA that cannot tolerate or do not like eHF and in infants with severe forms of CMA. In the present paper, we reviewed the nutritional composition of HRFs as well as studies regarding their efficacy and tolerance in children, and we provided an updated overview of the recent evidence on the use of HRFs in CMA. The available studies provide evidence that HRFs exhibit excellent efficacy and tolerance and seem to be adequate in providing normal growth in healthy children as well as in children with CMA.
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Affiliation(s)
- Caterina Anania
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Ivana Martinelli
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia Brindisi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Giovanna De Castro
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesca Olivero
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCSS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
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Singh BP, Bangar SP, Alblooshi M, Ajayi FF, Mudgil P, Maqsood S. Plant-derived proteins as a sustainable source of bioactive peptides: recent research updates on emerging production methods, bioactivities, and potential application. Crit Rev Food Sci Nutr 2022; 63:9539-9560. [PMID: 35521961 DOI: 10.1080/10408398.2022.2067120] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The development of novel protein sources to compensate for the expected future shortage of traditional animal proteins due to their high carbon footprint is a major contemporary challenge in the agri-food industry currently. Therefore, both industry and consumers are placing a greater emphasis on plant proteins as a sustainable source of protein to meet the growing nutritional demand of ever increasing population. In addition to being key alternatives, many plant-based foods have biological properties that make them potentially functional or health-promoting foods, particularly physiologically active peptides and proteins accounting for most of these properties. This review discusses the importance of plant-based protein as a viable and sustainable alternative to animal proteins. The current advances in plant protein isolation and production and characterization of bioactive hydrolysates and peptides from plant proteins are described comprehensively. Furthermore, the recent research on bioactivities and bioavailability of plant protein-derived bioactive peptides is reviewed briefly. The limitations of using bioactive peptides, regulatory criteria, and the possible future applications of plant protein-derived bioactive peptides are highlighted. This review may help understand plant proteins and their bioactive peptides and provide valuable suggestions for future research and applications in the food industry.
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Affiliation(s)
- Brij Pal Singh
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Sneh Punia Bangar
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, South Carolina, USA
| | - Munira Alblooshi
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Feyisola Fisayo Ajayi
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Priti Mudgil
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Sajid Maqsood
- Department of Food Science, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
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Alternatives to Cow’s Milk-Based Infant Formulas in the Prevention and Management of Cow’s Milk Allergy. Foods 2022; 11:foods11070926. [PMID: 35407012 PMCID: PMC8997926 DOI: 10.3390/foods11070926] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022] Open
Abstract
Cow’s milk-based infant formulas are the most common substitute to mother’s milk in infancy when breastfeeding is impossible or insufficient, as cow’s milk is a globally available source of mammalian proteins with high nutritional value. However, cow’s milk allergy (CMA) is the most prevalent type of food allergy among infants, affecting up to 3.8% of small children. Hypoallergenic infant formulas based on hydrolysed cow’s milk proteins are commercially available for the management of CMA. Yet, there is a growing demand for more options for infant feeding, both in general but especially for the prevention and management of CMA. Milk from other mammalian sources than the cow, such as goat, sheep, camel, donkey, and horse, has received some attention in the last decade due to the different protein composition profile and protein amino acid sequences, resulting in a potentially low cross-reactivity with cow’s milk proteins. Recently, proteins from plant sources, such as potato, lentil, chickpeas, quinoa, in addition to soy and rice, have gained increased interest due to their climate friendly and vegan status as well as potential lower allergenicity. In this review, we provide an overview of current and potential future infant formulas and their relevance in CMA prevention and management.
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29
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Highly stable fluorine-free foam by synergistically combining hydrolyzed rice protein and ferrous sulfate. Chem Eng Sci 2022. [DOI: 10.1016/j.ces.2021.117378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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30
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Yu X, Li F, Wang J, Lin Y, Zong R, Lu S. Effects of Fe (II) on stability of aqueous foam prepared by hydrolyzed rice protein in the presence of oil. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2021.117666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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31
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Wang N, Cui X, Duan Y, Yang S, Wang P, Saleh ASM, Xiao Z. Potential health benefits and food applications of rice bran protein: research advances and challenges. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.2013253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Na Wang
- College of Light Industry, Liaoning University, Shenyang, China
| | - Xiaotong Cui
- College of Food, Shenyang Agricultural University, Shenyang, Liaoning, China
| | - Yumin Duan
- College of Grain Science and Technology, Shenyang Normal University, Shenyang, Liaoning, China
| | - Shu Yang
- College of Life Science and Bioengineering, Shenyang University, Shenyang, Liaoning, China
| | - Peng Wang
- College of Grain Science and Technology, Shenyang Normal University, Shenyang, Liaoning, China
| | - Ahmed S. M. Saleh
- College of Grain Science and Technology, Shenyang Normal University, Shenyang, Liaoning, China
- Department of Food Science and Technology, Faculty of Agriculture, Assiut University, Assiut, Egypt
| | - Zhigang Xiao
- College of Food, Shenyang Agricultural University, Shenyang, Liaoning, China
- College of Grain Science and Technology, Shenyang Normal University, Shenyang, Liaoning, China
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Nunes L, Lima de Paula I, Cristianini M, Stephani R, Tavares GM. Aging of infant formulas containing proteins from different sources. Lebensm Wiss Technol 2021. [DOI: 10.1016/j.lwt.2021.112299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vegan Alternatives to Processed Cheese and Yogurt Launched in the European Market during 2020: A Nutritional Challenge? Foods 2021; 10:foods10112782. [PMID: 34829064 PMCID: PMC8619069 DOI: 10.3390/foods10112782] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/25/2023] Open
Abstract
Vegan alternatives to cheese (VAC) and yogurt (VAY) are fast-growing markets in Europe due to the increasing interest in plant-based alternatives to dairy products. This study aimed to take a closer look at the year 2020 and accordingly retrieved the nutritional information of dairy cheese and yogurt and their vegan counterparts for comparison. It was found that VAY (n = 182) provide more energy, total fats, and carbohydrates than dairy yogurt (n = 86), while saturated fatty acids (SFAs), sugars, and salt were not different between the two categories. Compared to dairy products (25.6%), 72.9% of the alternative products were declared low/no/reduced allergen, hence providing a larger spectrum of products to respond to consumers’ requirements. VAC (n = 114) showed high versatility of form compared to dairy (n = 115). Nutritionally, VAC have higher total fats, SFAs, and carbohydrates, but lower protein, salt, and sugar than dairy cheese. Food developers will continue to look for clean label solutions to improve the nutritional values of vegan products through the incorporation of natural ingredients, besides enhancing their taste and texture to appeal to flexitarians.
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Vandenplas Y, De Mulder N, De Greef E, Huysentruyt K. Plant-Based Formulas and Liquid Feedings for Infants and Toddlers. Nutrients 2021; 13:4026. [PMID: 34836284 PMCID: PMC8618919 DOI: 10.3390/nu13114026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/26/2022] Open
Abstract
Exclusive breastfeeding is the recommended feeding for all infants. Recent research has focused on the importance of balanced feeding during the first 1000 days, starting at conception with a balanced diet of the pregnant woman, up to the age of two years. The following step, a balanced diet after the age of two years is a challenge, as the dietary intake becomes more diversified. The role of young-child formula in this process is debated. This paper discusses the use of planted-based drinks, since they are a valuable and progressively more popular alternative for cow's milk, if nutritionally adapted to the requirements of toddlers. Plant-based drinks are per definition lactose free.
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Affiliation(s)
- Yvan Vandenplas
- Pediatric Gastroenterology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (N.D.M.); (E.D.G.); (K.H.)
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Vandenplas Y, Brough HA, Fiocchi A, Miqdady M, Munasir Z, Salvatore S, Thapar N, Venter C, Vieira MC, Meyer R. Current Guidelines and Future Strategies for the Management of Cow's Milk Allergy. J Asthma Allergy 2021; 14:1243-1256. [PMID: 34712052 PMCID: PMC8548055 DOI: 10.2147/jaa.s276992] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them. CONCLUSION A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.
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Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Helen A Brough
- Department Women and Children’s Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, UK
- Children’s Allergy Service, Evelina Children’s Hospital, Guy’s and St. Thomas’s NHS Foundation Trust, London, UK
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio, Rome, Italy
| | - Mohamad Miqdady
- Department of Pediatrics, Sheikh Khalifa Medical City, College of Medicine & Health Sciences, Khalifa University, Khalifa, United Arab Emirates
| | - Zakiudin Munasir
- Department of Child Health, Ciptomangunkusumo Hospital-Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Silvia Salvatore
- Pediatric Department, Hospital “F. Del Ponte”, University of Insubria, Varese, Italy
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - Carina Venter
- University of Colorado, Children’s Hospital Colorado, Denver, CO, USA
| | - Mario C Vieira
- Center for Pediatric Gastroenterology -Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
- Department Nutrition and Dietetics, University of Winchester, Winchester, UK
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Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow's Milk Allergy in the Middle East, North Africa, and Pakistan Region. Nutrients 2021; 13:nu13103429. [PMID: 34684427 PMCID: PMC8537404 DOI: 10.3390/nu13103429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Cow’s milk allergy (CMA) is the most common food allergy in early childhood, and its prevalence continues to rise. Exclusive breastfeeding is recommended for infants in the first 6 months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle East, North Africa, and Pakistan (MENAP) region. If the infant is affected by CMA, current guidelines recommend extensively hydrolyzed formulas (eHFs) or amino acid-based formulas (AAFs) in the case of severe symptoms, and hydrolyzed rice formulas (HRFs) where available. In recent years, HRFs have been proposed as a plant-based alternative to cow’s milk protein-based eHFs, and updates to current guidelines have been recommended. In 2014, a consensus statement and guidelines were published for the Middle East region on the prevention, diagnosis, and management of CMA. As new advances have been made in the extensively hydrolyzed hypoallergenic infant formula space, along with updated scientific evidence, a workshop of experts from the MENAP region focused on HRF was convened in 2021. This publication summarizes the insights from this meeting. During the consensus part of the meeting, a new approach was discussed and approved by all participants, and agreement was reached that HRF can be recommended as a first-line alternative to cow’s milk-based eHF in the dietary management of CMA.
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D’Auria E, Salvatore S, Acunzo M, Peroni D, Pendezza E, Di Profio E, Fiore G, Zuccotti GV, Verduci E. Hydrolysed Formulas in the Management of Cow's Milk Allergy: New Insights, Pitfalls and Tips. Nutrients 2021; 13:2762. [PMID: 34444922 PMCID: PMC8401609 DOI: 10.3390/nu13082762] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
An allergy to cow's milk requires the avoidance of cow's milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow's milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow's milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow's milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow's milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant's age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.
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Affiliation(s)
- Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Silvia Salvatore
- Department of Pediatrics, Ospedale “F. Del Ponte”, University of Insubria, 21100 Varese, Italy;
| | - Miriam Acunzo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
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Boukid F, Rosell CM, Rosene S, Bover-Cid S, Castellari M. Non-animal proteins as cutting-edge ingredients to reformulate animal-free foodstuffs: Present status and future perspectives. Crit Rev Food Sci Nutr 2021; 62:6390-6420. [PMID: 33775185 DOI: 10.1080/10408398.2021.1901649] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Consumer interest in protein rich diets is increasing, with more attention being paid to the protein source. Despite the occurrence of animal proteins in the human diet, non-animal proteins are gaining popularity around the world due to their health benefits, environmental sustainability, and ethical merit. These sources of protein qualify for vegan, vegetarian, and flexitarian diets. Non-animal proteins are versatile, derived mainly from cereals, vegetables, pulses, algae (seaweed and microalgae), fungi, and bacteria. This review's intent is to analyze the current and future direction of research and innovation in non-animal proteins, and to elucidate the extent (limitations and opportunities) of their applications in food and beverage industries. Prior knowledge provided relevant information on protein features (processing, structure, and techno-functionality) with particular focus on those derived from soy and wheat. In the current food landscape, beyond conventionally used plant sources, other plant proteins are gaining traction as alternative ingredients to formulate animal-free foodstuffs (e.g., meat alternatives, beverages, baked products, snack foods, and others). Microbial proteins derived from fungi and algae are also food ingredients of interest due to their high protein quantity and quality, however there is no commercial food application for bacterial protein yet. In the future, key points to consider are the importance of strain/variety selection, advances in extraction technologies, toxicity assessment, and how this source can be used to create food products for personalized nutrition.
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Affiliation(s)
- Fatma Boukid
- Institute of Agriculture and Food Research and Technology (IRTA), Food Safety and Functionality Programme, Monells, Catalonia, Spain
| | - Cristina M Rosell
- Institute of Agrochemistry and Food Technology (IATA-CSIC), Paterna, Valencia, Spain
| | - Sara Rosene
- General Mills, Golden Valley, Minnesota, USA
| | - Sara Bover-Cid
- Institute of Agriculture and Food Research and Technology (IRTA), Food Safety and Functionality Programme, Monells, Catalonia, Spain
| | - Massimo Castellari
- Institute of Agriculture and Food Research and Technology (IRTA), Food Safety and Functionality Programme, Monells, Catalonia, Spain
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European Food Safety Authority (EFSA), Arcella D, Cascio C, Gómez Ruiz JÁ. Chronic dietary exposure to inorganic arsenic. EFSA J 2021; 19:e06380. [PMID: 33537067 PMCID: PMC7845508 DOI: 10.2903/j.efsa.2021.6380] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Following an official request to EFSA from the European Commission, EFSA assessed the chronic dietary exposure to inorganic arsenic (iAs) in the European population. A total of 13,608 analytical results on iAs were considered in the current assessment (7,623 corresponding to drinking water and 5,985 to different types of food). Samples were collected across Europe between 2013 and 2018. The highest mean dietary exposure estimates at the lower bound (LB) were in toddlers (0.30 μg/kg body weight (bw) per day), and in both infants and toddlers (0.61 μg/kg bw per day) at the upper bound (UB). At the 95th percentile, the highest exposure estimates (LB-UB) were 0.58 and 1.20 μg/kg bw per day in toddlers and infants, respectively. In general, UB estimates were two to three times higher than LB estimates. The mean dietary exposure estimates (LB) were overall below the range of benchmark dose lower confidence limit (BMDL 01) values of 0.3-8 μg/kg bw per day established by the EFSA Panel on Contaminants in the Food Chain in 2009. However, for the 95th percentile dietary exposure (LB), the maximum estimates for infants, toddlers and other children were within this range of BMDL 01 values. Across the different age classes, the main contributors to the dietary exposure to iAs (LB) were 'Rice', 'Rice-based products', 'Grains and grain-based products (no rice)' and 'Drinking water'. Different ad hoc exposure scenarios (e.g. consumption of rice-based formulae) showed dietary exposure estimates in average and for high consumers close to or within the range of BMDL 01 values. The main uncertainties associated with the dietary exposure estimations refer to the impact of using the substitution method to treat the left-censored data (LB-UB differences), to the lack of information (consumption and occurrence) on some iAs-containing ingredients in specific food groups, and to the effect of food preparation on the iAs levels. Recommendations were addressed to improve future dietary exposure assessments to iAs.
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40
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Bocquet A, Briend A, Chouraqui JP, Darmaun D, Feillet F, Frelut ML, Guimber D, Hankard R, Lapillonne A, Peretti N, Roze JC, Simeoni U, Turck D, Dupont C. The new European regulatory framework for infant and follow-on formulas: Comments from the Committee of Nutrition of the French Society of Pediatrics (CN-SFP). Arch Pediatr 2020; 27:351-353. [PMID: 33023722 DOI: 10.1016/j.arcped.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France.
| | - A Briend
- Institut de recherche pour le développement, 13002 Marseille, France
| | - J-P Chouraqui
- Gastroentérologie et nutrition pédiatriques DMCP - CHUV, rue du Bugnon, 46, 1011 Lausanne, Switzerland
| | - D Darmaun
- Inra UMR1280, université Nantes-Atlantique, 44300 Nantes, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Cabinet de pédiatrie, 16, rue Septfonds, 81000 Albi, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Guimber
- Université de Lille, 59000 Lille, France
| | - R Hankard
- Inserm U 1069, université de Tours, 37000 Tours, France
| | - A Lapillonne
- Hôpital Necker-Enfants-Malades, université de Paris-Descartes, 75006 Paris, France
| | - N Peretti
- CaRMEN, hospices civils de Lyon, université de Lyon, 69000 Lyon, France
| | - J-C Roze
- Inra UMR1280, université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - D Turck
- LIRIC-Inserm U995, université de Lille 2, 59037 Lille, France
| | - C Dupont
- Hôpital Necker-Enfants-Malades, université de Paris-Descartes, 75006 Paris, France; Clinique Marcel Sembat, 92100 Boulogne-Billancourt, France
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Dupont C, Bocquet A, Tomé D, Bernard M, Campeotto F, Dumond P, Essex A, Frelut ML, Guénard-Bilbault L, Lack G, Linglart A, Payot F, Taieb A, Kalach N. Hydrolyzed Rice Protein-Based Formulas, a Vegetal Alternative in Cow's Milk Allergy. Nutrients 2020; 12:E2654. [PMID: 32878135 PMCID: PMC7551844 DOI: 10.3390/nu12092654] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 01/07/2023] Open
Abstract
Formulas adapted to infant feeding, although most of the time made from cow's milk proteins, can be made from hydrolyzed rice protein but they must be classified as "formulas for specific medical needs", according to European regulations. The nutritional quality of rice proteins is thus suitable to be used in infant formulas giving that it is supplemented by certain amino acids which can be lacking. Besides, hydrolysis is required to facilitate their water solubility and digestibility. Owing to a low allergenicity of rice and to the absence of the cross-allergy between milk proteins and rice proteins, these formulas are adapted to the diet of children with cow's milk protein allergy (CMPA), which explains their growing use in some countries. However, CMPA, an expanding disorder, has consequences for growth, bone mineralization, and often has an association with allergy to other foods, including cow's milk extensive hydrolysate, so that a surveillance of the adaption of hydrolyzed rice protein formulas (HRPF) to CMPA, the absence of unexpected side effects, and the appropriate response to its various health hazards seems mandatory. This paper analyses the health problem deriving from CMPA, the industrial development of hydrolyzed rice protein formulas, and the limited number of clinical studies, which confirms, at the moment, a good allergic tolerance and safety. The goal is to better advise heath care professionals on their use of HRPFs during CMPA.
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Affiliation(s)
- Christophe Dupont
- Pediatric Gastroenterology Department, Paris-Descartes University, 75006 Paris, France
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
- Marcel Sembat Clinic, 92100 Boulogne, France
| | - Alain Bocquet
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Medical and Pharmacy School, Franche-Comté University, 25000 Besançon, France
| | - Daniel Tomé
- UMR Nutrition Physiology and Ingestive Behavior, AgroParisTech, INRA, Paris-Saclay University, 75005 Paris, France;
| | | | - Florence Campeotto
- Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France;
| | - Pascale Dumond
- Pediatric Allergy Department, Children’s Hospital, University Hospital of Nancy, 54000 Vandoeuvre les Nancy, France;
| | - Anna Essex
- Sodilac Employee, Sodilac, 92000 Levallois, France;
| | - Marie-Laure Frelut
- Association Française de Pédiatrie Ambulatoire (French Association of Ambulatory Paediatrics), 33400 Talence, France; (A.B.); (M.-L.F.)
- Pediatric Practice, 16 Rue de Sept Fonds, 81000 Albi, France
| | | | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London WC2R ELS, UK;
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France;
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and ‘Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France
- APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | | | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, Bordeaux University Hospital, 33000 Bordeaux, France;
| | - Nicolas Kalach
- Department of Paediatrics, Saint Antoine Paediatric Hospital, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Catholic University of Lille, 59000 Lille, France;
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North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper: Plant-based Milks. J Pediatr Gastroenterol Nutr 2020; 71:276-281. [PMID: 32732790 DOI: 10.1097/mpg.0000000000002799] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Parents and caretakers are increasingly feeding infants and young children plant-based "milk" (PBM) alternatives to cow milk (CM). The US Food and Drug Administration currently defines "milk" and related milk products by the product source and the inherent nutrients provided by bovine milk. Substitution of a milk that does not provide a similar nutritional profile to CM can be deleterious to a child's nutritional status, growth, and development. Milk's contribution to the protein intake of young children is especially important. For almond or rice milk, an 8 oz serving provides only about 2% or 8%, respectively, of the protein equivalent found in a serving of CM. Adverse effects from the misuse of certain plant-based beverages have been well-documented and include failure to gain weight, decreased stature, kwashiorkor, electrolyte disorders, kidney stones, and severe nutrient deficiencies including iron deficiency anemia, rickets, and scurvy. Such adverse nutritional outcomes are largely preventable. It is the position of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Nutrition Committee, on behalf of the society, that only appropriate commercial infant formulas be used as alternatives to human milk in the first year of life. In young children beyond the first year of life requiring a dairy-free diet, commercial formula may be a preferable alternative to cow's milk, when such formula constitutes a substantial source of otherwise absent or reduced nutrients (eg, protein, calcium, vitamin D) in the child's restricted diet. Consumer education is required to clarify that PBMs do not represent an equivalent source of such nutrients. In this position paper, we provide specific recommendations for clinical care, labelling, and needed research relative to PBMs.
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Nutten S, Schuh S, Dutter T, Heine RG, Kuslys M. Design, quality, safety and efficacy of extensively hydrolyzed formula for management of cow's milk protein allergy: What are the challenges? ADVANCES IN FOOD AND NUTRITION RESEARCH 2020; 93:147-204. [PMID: 32711862 DOI: 10.1016/bs.afnr.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cow's milk protein allergy (CMPA) is one of the most common food allergies in infancy. Clinical food allergy guidelines recommend an extensively hydrolyzed formula (EHF) as the first-line treatment in nonbreastfed infants with CMPA. Designing and commercializing EHF poses both technical and regulatory challenges. Each manufacturing step, from sourcing of raw materials to release of the final product, needs to be managed in accordance with comprehensive quality systems. To avoid cross-contamination via externally sourced ingredients, suppliers should be carefully selected based on quality requirements. Strict zoning of the manufacturing areas according to contamination risk and air flow control are effective strategies to prevent accidental allergen contamination. Furthermore, dedicated manufacturing lines for hypoallergenic products are used to prevent potential cross-contamination from other products produced on the same line. The enzymatic hydrolysis, heat treatment and ultrafiltration used are specific to each manufacturer. Consequently, EHF are a heterogenous group of products with differences in the molecular weight profile of peptides, content of residual immunogenic cow's milk allergens, and residual in-vitro allergenicity. These differences are likely to affect clinical efficacy and safety. As not all commercialized EHF products have undergone formal testing in the laboratory and clinical trials, there is a need to develop guidelines for minimum technical and regulatory requirements for EHF products, including validated assays for ongoing quality control. Clinical trials assessing new EHF products for their hypoallergenicity and ability to support normal growth remain the definitive proof of efficacy and safety in infants and young children with CMPA.
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Affiliation(s)
| | - Susanne Schuh
- Nestlé Research and Development, Konolfingen, Switzerland
| | - Thibaut Dutter
- Nestlé Research and Development, Konolfingen, Switzerland
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Linhart B, Freidl R, Elisyutina O, Khaitov M, Karaulov A, Valenta R. Molecular Approaches for Diagnosis, Therapy and Prevention of Cow´s Milk Allergy. Nutrients 2019; 11:E1492. [PMID: 31261965 PMCID: PMC6683018 DOI: 10.3390/nu11071492] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open
Abstract
Cow´s milk is one of the most important and basic nutrients introduced early in life in our diet but can induce IgE-associated allergy. IgE-associated allergy to cow´s milk can cause severe allergic manifestations in the gut, skin and even in the respiratory tract and may lead to life-threatening anaphylactic shock due to the stability of certain cow´s milk allergens. Here, we provide an overview about the allergen molecules in cow´s milk and the advantages of the molecular diagnosis of IgE sensitization to cow´s milk by serology. In addition, we review current strategies for prevention and treatment of cow´s milk allergy and discuss how they could be improved in the future by innovative molecular approaches that are based on defined recombinant allergens, recombinant hypoallergenic allergen derivatives and synthetic peptides.
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Affiliation(s)
- Birgit Linhart
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria.
| | - Raphaela Freidl
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Elisyutina
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, 115478, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
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