• Journal of Dairy Science and Biotechnology
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• v.26 no.1
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• pp.27-36
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• 2008

This review was written to introduce updated data on the structure and function of the major milk proteins identified as allergens, the characterization of their epitopes in each allergenic milk proteins, and the reduction of milk protein allergenicity. Most mammalian milk protein, even protein present at low concentration, are potential allergens. Epitopes identified in milk proteins are both conformational(structured epitope) and sequential epitopes(linear epitope), throughout the protein molecules. Epitopes on casein and whey proteins are reported to be sequential epitope and conformational epitopes, respectively. Conformational epitopes on whey protein are changed into sequential epitope by heat denaturation during heat treatment. Several methods have been proposed to reduce allergenicity of milk proteins. Most ideal and acceptable method to make hypoallergenic milk or formula, so far, is the hydrolysis of allergenic milk proteins by enzymes that has substrate specificity, such as pepsin, trypsin, or chymotrypsin. Commercial formulas based on milk protein hydrolysate are available for therapeutic purpose, hypoantigenic formula for infants from families with a history of milk allergy and hypoallergenic formula for infants with existing allergic symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.5
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• pp.277-283
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• 2023

Purpose: Cow's milk protein allergy (CMPA) is a common condition in infants, but little is known about healthcare providers' clinical experience treating infants with CMPA. To address this gap, we analyzed prospectively collected data from healthcare providers (HCPs) who treated infants under six months old with suspected CMPA using hypoallergenic formulas. The study focused on a commercial extensively hydrolyzed formula containing Lactobacillus rhamnosus GG (ATCC53103) (eHF-LGG) or a commercial amino acid formula (AAF). Methods: In this secondary analysis of prospectively collected survey data, 52 HCPs treated 329 infants under six months old with suspected CMPA using hypoallergenic formulas. A series of two de-identified surveys per patient were collected by HCPs to assess short-term symptom relief in the patients and HCP's satisfaction with the management strategies. The initial survey was completed at the initiation of treatment of CMPA, and the second survey was completed at a follow-up visit. Results: The majority of HCPs (87%) in the study were general pediatricians, and most saw 2 to 10 CMPA patients weekly. Results showed that clinicians reported satisfaction with treatment in 95% of patients in the EHF cohort and 97% of patients in the AAF cohort and achieved expected clinical results in 93% and 97% of patients using eHF and AAF, respectively. Furthermore, few patients were switched from the hypoallergenic formula once initiated. Conclusion: The study provides new insights into HCP perspectives on treating infants with CMPA and supports using hypoallergenic formulas to manage this condition. However, additional prospective controlled studies are needed to confirm these initial findings.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.7-14
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• 2008

Special formulas are those in which one of the basic nutrients (usually the protein and/or carrbohydrate) has been changed to an alternative nutrient that an individual baby may better tolerate. The following are specialized formulas : Soy formulas, hypoallergenic formulas, Lactose free formulas, Premature baby formulas, Low phosphate formulas, Formulas for inborn errors of metabolism. Less is known about the long-term effects of feeding babies these special formulas and each formula has its unique properties and indications. The pediatrician must acquaint themselves with all commercially available infant formulas so as to provide the parent with reliable and unbiased information about them.

• Journal of Nutrition and Health
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• v.37 no.7
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• pp.540-549
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• 2004

Infants and children with food related Atopic Dermatitis (AD) need extra dietary efforts to maintain optimal nutrition due to food restriction to prevent allergy reactions. However, nutrition ignorance and food faddism make patients even more confused and practice desirable diet more difficult. The objective of this study was to report the AD patients' malnutrition cases in Korea. We report on 2 cases of severe nutritional deficiency caused by consuming macrobiotic diets which avoid processed foods and most animal foods, i.e. one of vegetarian diet. Case 1, a 12-month-old male child, was admitted with severe marasmus. Because of a history of AD, he was started on mixed grain porridge at 3 months without any breast milk or formula feeding. His caloric intake was 66% and protein intake was 69% of the recommended dietary allowance. Patient's height and weight was under 3th percentile. On admission the patient was unable to crawl or roll over. Case 2, a 9-month-old AD female patient, was diagnosed with kwashiorkor and rickets. She was also started on mixed grain porridge at 100 days due to AD. Her caloric intake has been satisfied recommended dietary allowance until 7 months, however, she conducted sauna bath therapy and reduced both energy and protein intake at 8 months. The amount of protein intake for case 2 was higher than recommended dietary allowance, but, sauna therapy and severe AD with intakes of low guality protein may increase patient's protein requirement resulting in kwashiorkor. Case 2 patient's height and weight was on 3th percentile. Both cases showed low intake of calcium, iron, zinc, vitamin A, vitamin E and especially very low intake of vitamin B$_{12}$ and vitamin D. Allergy tests for certain foods had not done prior to admission for both cases. They followed the dietary advise operated by macrobiotic diet internet site. In conclusion, AD infants' parents and caregivers should contact a pediatrician trained as a specialist in allergy for accurate diagnosis. For infant patients, breast or formula feeding including hypoallergenic formula should be continued until their one year of age. When certain foods need to be restricted or to follow special diets such as vegetarian diet, consultation with pediatrician and dietitian is needed.d.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.3
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• pp.263-275
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• 2022

Purpose: The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow's milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods: A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results: Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion: The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.

• Korean Journal of Food Science and Technology
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• v.26 no.5
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• pp.532-538
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• 1994

In order to investigate the lowering effects of in vitro enzymatic hydrolysis by the treatment of chymotrypsin, trypsin, pancreatin, or protease from Aspergillus oryzae on the antigenicity of whey protein(WPI) against rabbit anti ${\beta}-LG$ antiserum, competitive inhibition ELISA(cELISA) and passive cutaneous anaphylaxis(PCA) test using guinea pig were performed. The results of cELISA showed that the monovalent antigenicity of the whey protein hydrolysates(WPH) to the antiserum was decreased to $10^{-1.7}{\sim}10^{-4.1}$ and less by the hydrolysis. Especially, the antigenicity of OUP(hydrolysate by protease from Asp. oryzae with preteatment of pepsin) was found almost to be removed. By the heterologous PCA the polyvalent antigenicity of the WPH was decreased to $1/2{\sim}1/128$ and less. Especially, the polyvalent antigenicity of OUN(hydrolysate by protease from Asp. oryzae without preteatments) was found almost to be removed, although OUN did not have so high degree of hydrolysis(DH) or so low monovalent antigenicity (reduced to $10^{-3.2}$). Therefore, this result was assumed to come from effective destruction of antigenic determinants on ${\beta}-LG$ in WPI, not to produce polyvalent antigenic peptides that are closely associated with induction of allergy. This finding suggested that WPH prepared by the treatment of microorganic protease from Asp. oryzae would be a material for hypoallergenic infant formula due to the removal of the polyvalent antigenicity of ${\beta}-LG$, the major milk allergen in WPI.

• Neonatal Medicine
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• v.18 no.2
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• pp.204-210
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• 2011

Purpose: Feeding intolerance is common in very low birth weight infants(VLBWI); however, research on the etiology is limited. We investigated the incidence of allergic enterocolitis (AEC) as a cause of feeding intolerance and present the clinical characteristics of VLBWIs. Methods: The medical records of VLBWIs admitted to the neonatal intensive care unit of Samsung Medical Center between January 2009 and July 2010 were retrospectively analyzed. AEC was defined as patients who had feeding intolerance with eosinophila and who responded to hypoallergenic feeding intervention. Feeding intolerance symptoms included blood tinged stools, abdominal distension, residual feeding and regurgitation. Eosinophilia was defined as an eosinophil count ${\geq}$700 cells/$mm^3$. Patients with feeding intolerance were divided into the AEC or non-AEC group. Results: Of the 181 patients, 161 (88.9%) had a feeding intolerance, and 119 (65.7%) had eosinophilia. Seventeen infants were diagnosed with AEC. No difference in mean gestational age, birth weight, antibiotics duration, TPN duration, hospitalization, or symptom onset day was observed between patients with AEC and non-AEC patients. The percentage of eosinophilia was significantly higher in patients with AEC than in non-AEC patients. Two patients (12%) improved with restricted breast milk, 10 patients (59%) with extensively hydrolyzed formula and five patients (29%) with free amino acid-based formula. Conclusion: Our results suggest that AEC should be considered in VLBWIs who have clinical features of feeding intolerance and eosinophilia. An aggressive increase in feeding would be possible through feeding intervention in VLBWIs with feeding intolerance.