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Presence of functional, autoreactive human milk‐specific IgE in infants with cow's milk allergy
Author(s) -
Järvinen K. M.,
Geller L.,
Bencharitiwong R.,
Sampson H. A.
Publication year - 2012
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/j.1365-2222.2011.03864.x
Subject(s) - cow's milk allergy , immunoglobulin e , allergy , milk allergy , immunology , cow milk , medicine , biology , food science , food allergy , antibody
Summary Background Occasionally, exclusively breastfed infants with cow's milk allergy ( CMA ) remain symptomatic despite strict maternal milk avoidance. Objective To determine whether or not persistence of symptoms could be due to sensitization against endogenous human milk proteins with a high degree of similarity to bovine allergens. Methods Ten peptides representing known bovine milk IgE ‐binding epitopes [α‐lactalbumin ( ALA ), β‐ and κ‐casein] and the corresponding, highly homologous human milk peptides were labelled with sera from 15 breastfed infants with CMA , aged 3 weeks to 12 months, and peptide (epitope)‐specific IgE antibodies were assessed. Nine of the 15 breastfed infants became asymptomatic during strict maternal avoidance of milk and other major food allergens; six infants remained symptomatic until weaned. Ten older children, aged 5–15 years, with CMA were also assessed. The functional capacity of specific IgE antibodies was assessed by measuring β‐hexosaminidase release from rat basophilic leukaemia cells passively sensitized and stimulated with human and bovine ALA . Results A minimum of one human milk peptide was recognized by IgE antibodies from 9 of 15 (60%) milk‐allergic infants, and the majority of older children with CMA . Genuine sensitization to human milk peptides in the absence of IgE to bovine milk was occasionally seen. There was a trend towards specific IgE being detected to more human milk peptides in those infants who did not respond to the maternal milk elimination diet than in those who did ( P = 0.099). Functional IgE antibody to human ALA was only detected in infants not responding to the maternal diet. Conclusions and Clinical Relevance Endogenous human milk epitopes are recognized by specific IgE from the majority of infants and children with CMA . Such autoreactive, human milk‐specific IgE antibodies appear to have functional properties in vitro . Their role in provoking allergic symptoms in infants exclusively breastfed by mothers strictly avoiding dietary milk remains unclear.