Maternal soy protein isolate diet during lactation programs deleterious effects on hepatic lipid metabolism, atherogenic indices, and function of adrenal in adult rat offspring.

The benefits of consuming soy and its protein have been reported in many studies. However, its phytoestrogen content raises concerns about consumption during lactation and gestation We therefore examined the effects of soybean or soy protein isolate on the parameters-related cardiovascular pathophysiology in lactating mothers and their offsprings at weaning and adulthood. Lactating rats were divided: casein control (C); soy protein isolate (SPI); and soybean (S). At weaning, half of the litter received commercial ration up to 150 days. The levels of 17-ß-estradiol and superoxide dismutase were low in the S mothers. For the SPI mothers, we observed a reduction of thiobarbituric acid reactive substances (TBARS). At weaning, atherogenic indices [1 = total cholesterol (TC)/HDL; 2 = LDL/HDL; 3 = TC-HDL/HDL)] decreased in the S and SPI offsprings compared to the casein control group; TBARS and antioxidant enzymes increased in the S offspring, while reduced/oxidized glutathione ratio increased in the SPI offspring, indicating lower oxidative stress. In adulthood, the SPI offspring showed an increase in liver cholesterol and atherogenic index 1 and 3 (vs. C and S) and 2 (vs. S). In addition, we found a decrease in catecholamines in the adrenal medulla and an increase in caffeine-stimulated secretion, but tyrosine hydroxylase expression remained constant. Maternal consumption of SPI during lactation worsened atherogenic indices of the offsprings in adulthood, which was associated with increased liver cholesterol and decreased catecholamines in the adrenal medulla. Soy consumption had no consistent long-term effects on the evaluated parameters compared to casein consumption. The data suggest that the consumption of SPI during lactation should be done with caution.

AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW ABOUT NUTRITIONAL INTERVENTIONS.

OBJECTIVE: To identify and analyze the scientific evidence of nutritional interventions performed in children and adolescents with Autism Spectrum Disorder. DATA SOURCES: A systematic review was conducted in the MEDLINE, Cochrane Library, Embase, LILACS, Google Scholar, PubMed, PsycINFO and Periódicos CAPES databases, using a search strategy to identify studies published between January 2003 and March 2018, in Portuguese, English and Spanish. Were included studies that described nutritional interventions in children and adolescents with autism spectrum disorders and assessed autistic behavior and/or gastrointestinal symptoms. We excluded other review articles and studies that did not include a control group in the research design. The studies were reviewed for descriptive information, and the quality of evidence was assessed through the GRADE system. DATA SYNTHESIS: 18 studies were included in the review, being 16 randomized clinical trials, 1 case-control study and 1 open-label trial. As a result, the implementation of a gluten-free and casein-free diet was the most used intervention among the studies. Of the total, 10 studies showed a positive association of intervention with the evaluated results, while 8 did not find of a significant association. CONCLUSIONS: Although some authors report progress in the symptoms associated with autism in individuals with Autistic Spectrum Disorder undergoing nutritional interventions, there is little scientific evidence to support the use of nutritional supplements or dietary therapies in children and adolescents with autism.

Effect of the addition of sodium caseinate on the viability of cryopreserved buffalo semen / Efeito da adição de caseinato de sódio sobre a viabilidade do sêmen bubalino criopreservado

The use of cooled semen in artificial insemination operations results in higher pregnancy rates than the use of frozen semen. This result seems to be related to the more severe damage triggered by the freezing process than that observed during refrigeration. Due to its ability to bind to sperm-binding proteins and calcium ions, sodium caseinate has been studied as a substance capable of preventing early sperm capacitation, a significant cause of the decreased pregnancy rate resulting from the use of frozen semen. The first objective of this study was to evaluate whether a commercial egg yolk diluent developed for frozen bovine semen could be used for buffalo semen cryopreservation; the second objective was to investigate the effect of this diluent in combination with sodium caseinate during the procedures of buffalo sperm cryopreservation using flow cytometry and computer-assisted sperm analysis. In the first part of the study, comparing the results of spermatic kinetics and plasma and acrosomal membrane integrity, it was observed that the freezing process resulted in more cell damage than the cooling process. In the second part of the study, no effects of the addition of sodium caseinate to the egg yolk diluent were observed. From the results of the present study, it was possible to conclude that the egg yolk-based diluent was suitable for buffalo semen cryopreservation and that the addition of sodium caseinate did not decrease the harmful effects related to seminal cryopreservation.

O uso de sêmen resfriado em operações de inseminação artificial resulta em taxas de prenhez mais altas do que o uso de sêmen congelado. Esse resultado parece estar relacionado aos danos mais severos desencadeados pelo processo de congelação, quando comparado com o de refrigeração. Devido à sua capacidade de se ligar às proteínas ligadoras de espermatozoides e íons cálcio, o caseinato de sódio foi estudado quanto a sua capacidade de prevenir a capacitação espermática precoce, uma causa significativa de diminuição da taxa de prenhez com o uso de sêmen congelado. O primeiro objetivo deste estudo foi avaliar se um diluidor comercial a base de gema de ovo, destinado à congelação de sêmen bovino, poderia ser usado para a criopreservação de sêmen bubalino; o segundo objetivo foi investigar o efeito da adição do caseinato de sódio ao diluidor estudado durante os procedimentos de criopreservação de espermatozoides bubalinos. Foram empregadas a citometria de fluxo e a análise computadorizada do movimento espermático como métodos de avaliação seminal. Na primeira fase do estudo, comparando-se os resultados da cinética espermática e da integridade das membranas plasmática e acrossomal, observou-se que o processo de congelação promoveu mais danos celulares que o processo de resfriamento. Na segunda fase do estudo, não foram observados efeitos benéficos da adição de caseinato de sódio ao diluente empregado. A partir dos resultados do presente estudo, foi possível concluir que o diluente à base de gema de ovo foi adequado para a criopreservação do sêmen de bubalino e que a adição do caseinato de sódio não diminuiu os efeitos deletérios desencadeados pelo processo de criopreservação seminal.

Effect of the addition of sodium caseinate on the viability of cryopreserved buffalo semen / Efeito da adição de caseinato de sódio sobre a viabilidade do sêmen bubalino criopreservado

The use of cooled semen in artificial insemination operations results in higher pregnancy rates than the use of frozen semen. This result seems to be related to the more severe damage triggered by the freezing process than that observed during refrigeration. Due to its ability to bind to sperm-binding proteins and calcium ions, sodium caseinate has been studied as a substance capable of preventing early sperm capacitation, a significant cause of the decreased pregnancy rate resulting from the use of frozen semen. The first objective of this study was to evaluate whether a commercial egg yolk diluent developed for frozen bovine semen could be used for buffalo semen cryopreservation; the second objective was to investigate the effect of this diluent in combination with sodium caseinate during the procedures of buffalo sperm cryopreservation using flow cytometry and computer-assisted sperm analysis. In the first part of the study, comparing the results of spermatic kinetics and plasma and acrosomal membrane integrity, it was observed that the freezing process resulted in more cell damage than the cooling process. In the second part of the study, no effects of the addition of sodium caseinate to the egg yolk diluent were observed. From the results of the present study, it was possible to conclude that the egg yolk-based diluent was suitable for buffalo semen cryopreservation and that the addition of sodium caseinate did not decrease the harmful effects related to seminal cryopreservation.(AU)

O uso de sêmen resfriado em operações de inseminação artificial resulta em taxas de prenhez mais altas do que o uso de sêmen congelado. Esse resultado parece estar relacionado aos danos mais severos desencadeados pelo processo de congelação, quando comparado com o de refrigeração. Devido à sua capacidade de se ligar às proteínas ligadoras de espermatozoides e íons cálcio, o caseinato de sódio foi estudado quanto a sua capacidade de prevenir a capacitação espermática precoce, uma causa significativa de diminuição da taxa de prenhez com o uso de sêmen congelado. O primeiro objetivo deste estudo foi avaliar se um diluidor comercial a base de gema de ovo, destinado à congelação de sêmen bovino, poderia ser usado para a criopreservação de sêmen bubalino; o segundo objetivo foi investigar o efeito da adição do caseinato de sódio ao diluidor estudado durante os procedimentos de criopreservação de espermatozoides bubalinos. Foram empregadas a citometria de fluxo e a análise computadorizada do movimento espermático como métodos de avaliação seminal. Na primeira fase do estudo, comparando-se os resultados da cinética espermática e da integridade das membranas plasmática e acrossomal, observou-se que o processo de congelação promoveu mais danos celulares que o processo de resfriamento. Na segunda fase do estudo, não foram observados efeitos benéficos da adição de caseinato de sódio ao diluente empregado. A partir dos resultados do presente estudo, foi possível concluir que o diluente à base de gema de ovo foi adequado para a criopreservação do sêmen de bubalino e que a adição do caseinato de sódio não diminuiu os efeitos deletérios desencadeados pelo processo de criopreservação seminal.(AU)

Autism spectrum disorder: a systematic review about nutritional interventions / Transtorno do espectro autista: uma revisão sistemática sobre intervenções nutricionais

ABSTRACT Objective: To identify and analyze the scientific evidence of nutritional interventions performed in children and adolescents with Autism Spectrum Disorder. Data sources: A systematic review was conducted in the MEDLINE, Cochrane Library, Embase, LILACS, Google Scholar, PubMed, PsycINFO and Periódicos CAPES databases, using a search strategy to identify studies published between January 2003 and March 2018, in Portuguese, English and Spanish. Were included studies that described nutritional interventions in children and adolescents with autism spectrum disorders and assessed autistic behavior and/or gastrointestinal symptoms. We excluded other review articles and studies that did not include a control group in the research design. The studies were reviewed for descriptive information, and the quality of evidence was assessed through the GRADE system. Data synthesis: 18 studies were included in the review, being 16 randomized clinical trials, 1 case-control study and 1 open-label trial. As a result, the implementation of a gluten-free and casein-free diet was the most used intervention among the studies. Of the total, 10 studies showed a positive association of intervention with the evaluated results, while 8 did not find of a significant association. Conclusions: Although some authors report progress in the symptoms associated with autism in individuals with Autistic Spectrum Disorder undergoing nutritional interventions, there is little scientific evidence to support the use of nutritional supplements or dietary therapies in children and adolescents with autism.

RESUMO Objetivo: Identificar e analisar as evidências científicas de intervenções nutricionais realizadas em crianças e adolescentes com Transtorno do Espectro Autista. Fontes de dados: Realizou-se uma revisão sistemática nas bases de dados MEDLINE, Cochrane Library, Embase, LILACS, Google Acadêmico, PubMed, PsycINFO e Periódicos CAPES utilizando estratégia de busca abrangente para identificar estudos publicados entre janeiro de 2003 e março de 2018, em língua portuguesa, inglesa e espanhola. Foram incluídos estudos que descreveram intervenções nutricionais em crianças e adolescentes com Transtorno do Espectro Autista e avaliaram sintomas comportamentais e/ou sintomas gastrintestinais, sendo excluídos artigos de revisão e estudos que não incluíram um grupo controle em seu delineamento. Os estudos foram examinados para obter informações descritivas, e a qualidade de evidência foi avaliada por meio do Sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Síntese dos dados: Dezoito estudos foram incluídos na revisão (16 ensaios clínicos randomizados, um estudo de caso-controle e um ensaio clínico aberto). As intervenções e os resultados variaram, entretanto a implementação de uma dieta livre de glúten e caseína foi a intervenção mais utilizada entre os estudos. Do total, dez estudos encontraram associação positiva entre intervenção e resultados avaliados, enquanto oito não encontraram associação significativa. Conclusões: Embora alguns autores exponham progressos nos sintomas associados ao autismo em indivíduos com esse transtorno submetidos a intervenções nutricionais, há poucas evidências científicas para apoiar o uso destas em crianças e adolescentes com autismo.

[Lactose intolerance]. / Intolerancia a la lactosa.

The most common problem limiting milk consumption worldwide is lactose intolerance (LI), which is defined as the experience of gastrointestinal symptoms due to the intake of lactose-containing food. When symptoms ensue the intake of milk, the condition is referred as milk intolerance, and it may or may not be due to LI. The most common cause of LI is primary lactase deficiency which occurs in 30% of Mexican adults when one glass of milk is consumed (12-18 g of lactose). LI occurs in less than 15% of adults after the intake of this dose of lactose. Another cause of lactose intolerance is due to secondary lactase deficiency, which occurs because lactase is reduced due to diseases that affect the intestinal mucosa. Lactose intolerance can be eliminated or significantly reduced by elimination or reduction of the intake of milk and milk containing products. Recent studies demonstrate that when ß-casein-A1 contained in milk is hydrolyzed it produces ß-casomorphine-7 which is an opioid associated with milk intolerance.

Truths, Myths and Needs of Special Diets: Attention-Deficit/Hyperactivity Disorder, Autism, Non-Celiac Gluten Sensitivity, and Vegetarianism.

Different dietary approaches have been attempted for the treatment of attention-deficit/hyperactivity disorder and autism, but only three of them have been subjected to clinical trials: education in healthy nutritional habits, supplementation and elimination diets. On the other hand, for multiple reasons, the number of people who adopt vegetarian and gluten-free diets (GFD) increases daily. More recently, a new entity, non-celiac gluten sensitivity (NCGS), with a still evolving definition and clinical spectrum, has been described. Although, the benefits of GFD are clearly supported in this condition as well as in celiac disease, in the last two decades, GFD has expanded to a wider population. In this review, we will attempt to clarify, according to the existing evidence, which are the myths and facts of these diets.

Effect of a protein-free diet in the development of food allergy and oral tolerance in BALB/c mice.

The aim of the present study was to investigate the effect of a protein-free diet in the induction of food allergy and oral tolerance in BALB/c mice. The experimental model used was mice that were fed, since weaning up to adulthood, a balanced diet in which all dietary proteins were replaced by amino acid diet (Aa). The absence of dietary proteins did not prevent the development of food allergy to ovalbumin (OVA) in these mice. However, Aa-fed mice produced lower levels of IgE, secretory IgA and cytokines. In addition, when compared with mice from control group, Aa-fed mice had a milder aversive reaction to the allergen measured by consumption of OVA-containing solution and weight loss during food allergy development. In addition, mice that did not have dietary proteins in their diets were less susceptible to induction of oral tolerance. One single oral administration was not enough to suppress specific serum Ig and IgG1 levels in the Aa-fed group, although it was efficient to induce suppression in the control group. The present results indicate that the stimulation by dietary proteins alters both inflammatory reactivity and regulatory immune reactivity in mice probably due to their effect in the maturation of the immune system.

Whey protein supplementation increases methionine intake but not homocysteine plasma concentration in rats.

The purpose of this study was to examine the effects of whey protein supplementation on homocysteine (Hcy) metabolism and liver oxidative stress in rats. Twenty-four rats were divided into 3 groups (n = 8) to receive one of the following diets for 4 weeks: control diet (C), whey protein-composed diet (WP), and whey protein-supplemented diet (WPS). The C and WP diets consisted of AIN-93 with 20% casein and 20% whey protein as protein source, respectively. WPS was AIN-93 (20% casein) supplemented by the addition of 20% (w/w) whey protein. Four weeks of ingesting a WPS diet resulted in a significantly higher (P < 0.05) total protein and methionine intakes. Although a significant increase (P < 0.05) in the hepatic S-adenosylmethionine and S-adenosylhomocysteine levels occurred in WPS group compared with C and WP, no significant change was observed in plasma Hcy concentration between groups. Furthermore, the levels of lipid hydroperoxides and advanced oxidation protein products, known liver oxidative stress markers, were increased in the WPS group compared with the C group. In addition, no change in glutathione liver concentration was observed in any of the groups studied. In conclusion, whey protein supplementation increases methionine intake substantially; however, it does not change plasma Hcy concentrations. On the other hand, increased hepatic oxidative stress markers were observed in whey protein supplemented rats were probably due to high protein intake.

Preliminary study of a novel in-office bleaching therapy modified with a casein phosphopeptide-amorphous calcium phosphate.

Although in-office bleaching has been proven successful for bleaching teeth, controversy exists from morphological alterations in enamel morphology due to mineral loss and tooth sensitivity. This preliminary study aimed to evaluate the efficacy of a novel in-office tooth bleaching technique modified with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (MI paste-MI) and its effect on the enamel morphology and tooth sensitivity. Three patients received a 35% hydrogen peroxide (Whiteness HP-HP) dental bleaching system. HP was prepared and applied on the teeth on one of the hemiarches, whilst teeth on the other hemiarch were bleached with a mixture of HP and MI. Tooth color, epoxy resin replicas, and sensitivity levels were evaluated in the upper incisors. The results were analyzed descriptively. Right and left incisors showed similar color change after bleaching. Incisors bleached with the mixture of HP and MI presented unaltered enamel surfaces and lower sensitivity levels. The currently tested tooth bleaching technique did not reduce the gel effectiveness while decreasing hypersensitivity levels and protecting the enamel against surface alterations caused by the high-concentration bleaching peroxide tested. The concomitant use of MI Paste and high-concentration hydrogen peroxide might be a successful method for decreasing tooth sensitivity and limiting changes in the enamel morphology during in-office bleaching.

[Case report: allergy to cow's milk protein]. / Alergia a la proteina de leche de vaca.

GOAL: Milk-based formulas can induce cow's milk protein allergy (CMPA) in infants. This article discusses two cases of severe CMPA in infants exposed to casein-based formulas. CASES: Case N°1: A 7 day old boy developed diarrhea with no improvement despite several courses of antibiotic and switching to formula without lactose. At 2 months of age he had a hemoglobin 8.6 mg/dL, IgE = 17.8 IU/ml (normal <1.5 UI/ml) and a CD4/CD8 ratio = 0.16 (normal 1.5 ­ 2.5). Upper endoscopy biopsies showed duodenal atrophy. He received a casein hydrolysate formula with decreased fecal flow but continued diarrhea. At 3 months of life he was changed to an amino acid formula with cessation of diarrhea in < 48 hours, resumption of normal growth and normalization of duodenal histology. Case N°2: A 10 month old boy had a 6-day history of vomiting, diarrhea and edema. His albumin was 2.35 mg/dL. An upper endoscopy biopsy showed severe duodenal atrophy. He received a casein hydrolysate with good tolerance and resolution of the edema. At 26 months of age, and endoscopic duodenal biopsy showed regeneration of the mucosa. CONCLUSION: The CMPA is a frequent diagnosis in young infants that can be confused with infection. An early diagnosis is key to a positive outcome.

Evaluation of biological and biochemical quality of whey protein.

Nutritional and biochemical properties of noncommercial whey protein have been described since 1950. However, comparisons between commercial whey protein for human consumption and casein are rarely found. The aim of this study was to compare biological quality of a commercial whey protein with casein and its effect on biochemical parameters of rats. Thirty-two weanling Fisher rats were divided into three groups and given the following diets: casein group, standard diet (AOAC); whey protein group, modified AOAC diet with whey protein instead of casein; and casein:whey group, modified AOAC diet with 70%:30% casein:whey. A protein-free group was used for determination of endogenous nitrogen losses. Net protein ratio, protein efficiency ratio, and true digestibility were determined, and blood was collected for biochemical analysis. When compared with casein, whey protein showed significant differences for all biological parameters evaluated, as well as for albumin, total protein, total cholesterol, and glucose concentrations. Replacing 30% of casein with whey protein did not affect these parameters. A positive relation among whey protein, high-density lipoprotein-cholesterol, and paraoxonase activity was found. Hepatic or renal dysfunctions were not observed. In conclusion, in comparison with casein, commercial whey protein had higher values of biological parameters, and biochemical evaluation revealed it improved glycemic homeostasis, lipid status, and paraoxonase activity in rats.

Low-carbohydrate and high-fat diets on the promotion of hepatic steatosis in rats.

AIM: The present work looked for to evaluate in rats the impact of different diets (high-lipid and high-lipid+high-protein) on liver, verifying the occurrence of oxidative stress and steatosis. METHODS: The animals were treated with the respective diets (Group HLS: high-lipid diet with 50% of saturated fat; Group HPLS: high-lipid and high-protein diet with 50% of saturated fat and 40% of protein; Group Control: control diet AIN-93) for 28 days. After this period the animals were sacrificed for hepatic determinations of MDA, reduced GSH, vitamin E, steatosis and glycemia. RESULTS: The results showed higher glycemia in the group HPLS, high concentration of MDA and GSH in the group Control and decreased hepatic vitamin E concentration in the groups that received the high-lipid diets. The hepatic fat was higher in the groups HPLS and HLS in relation to the Group Control, however HPLS presenting high level of fat concentration, showing similar results as the steatosis. CONCLUSION: the fat increase in the diet promoted increase of the oxidative stress, evidenced by the decrease in the hepatic concentration of vitamin E, showing its antioxidant role against the probable generated free radicals, the ones which possibly exercised a role in the steatosis occurrence.

Tratamientos biológicos del autismo y dietas de eliminación / Biological treatments of autism, elimination diets: a critical review

This paper presents some critical considerations regarding the growing adoption, by families, of alternative treatments and diets for the treatment of various disorders like autism in children. Research does not seem to support such practices, with the exception of the relationship between timesoral and vaccines, neurological and cardiac disorders. Issues to consider are pointed out in the need to opt for biological treatments, and the need for families and research teams to work together for the purpose of clarifying such procedures.

El objetivo de este trabajo es presentar consideraciones críticas en relación a la creciente adopción, por parte de las familias de niños con trastornos del desarrollo, de tratamientos alternativos y dietas para reducir los síntomas de diversas alteraciones tales como el autismo, SDAH y otros. Las investigaciones no parecen apoyar tales prácticas, a excepción de la creciente evidencia de la relación entre el timerosal de las vacunas y afecciones cardíacas y neurológicas. Se señalan los elementos a tener en cuenta para optar por los tratamientos biológicos y dietas, junto con insistir en la necesidad de mancomunar esfuerzos entre familias y equipos de investigación para desarrollar estudios que clarifiquen los efectos de tales procedimientos.

Estudio de la lisina como aminoácido utilizado en la fortificación de alimentos: en ratas de experimentación / Lisine study how aminoacid utilizing in the food fortification: in rats of experimentation

Estudios previos, realizados por Hevia y colaboradores en 1980, mostraron que en ratas la adición de 5 por ciento de L-lisina una dieta en base a caseína producía, a los 15 días, una disminución en la velocidad de crecimiento de los animales y una acumulación marcada de lípidos en el hígado, principalmente de triglicéridos y colesterol. Debido a que la lisina es un aminoácido esencial utilizado en la fortificación de alimentos, el presente trabajo determinó si el consumo de concentraciones de lisina similares a las utilizadas en la fortificación de alimentos para consumo humano, las cuales abarcan un rango comprendido entre 0,1 y 0,25 gramos por cada 100 gramos de alimento, producen alteraciones similares a las antes mencionadas. Para ello se utilizaron ratas en crecimiento de la cepa "Sprague-dawley", las cuales fueron sometidas a diferentes tratamientos a base de dietas conteniendo 15 por ciento de proteína proveniente de la caseína-maíz (2:1) y suplementadas con 0,1; 0,25 y 5 por ciento de L-lisina durante 15, 45 o 60 días. Los resultados mostraron que, a los 15 días de tratamiento, el grupo de animales alimentados con 15 por ciento de caseína y 5 por ciento de lisina presentó además de una marcada reducción en la velocidad de crecimiento, un hígado graso caracterizado principalmente por una acumulación severa de triglicéridos y colesterol. Similares resultados se obtuvieron con el grupo de animales sometidos a una dieta en base a 15 por ciento de proteína proveniente de la mezcla caseína-maíz suplementada con 5 por ciento de L-lisina, aunque la acumulación de lípidos hepáticos fue de menor magnitud. Por otra parte, a diferencia de los resultados obtenidos de los grupos antes mencionados, aquellos que consumieron concentraciones menores de lisina dietaria, no presentaron alteraciones en el metabolismo lipídico a los 15 días de tratamiento, observándose además un crecimiento acelerado y significativamente mayor al obtenido por los grupos que no consumieron lisina. Al prolongar el tiempo de tratamiento hasta 45 días se observó por una parte, la reservación del hígado graso ocasionado por el consumo de 5 por ciento de lisina dietaria y un incremento significativo en los lípidos circulares, principalmente de triglicéridos y colesterol y, por otra parte, un aumento progresivo de la concentración de lípidos hepáticos en aquellos grupos alimentarios con cantidades menores de lisina en la dieta

Immunologic changes associated with the development of tolerance in children with cow milk allergy.

The purpose of this study was to determine whether cow milk-specific antibody responses correlated with the development of clinical tolerance in cow milk-allergic children. Double-blind, placebo-controlled food challenges were performed annually in 29 patients with cow milk allergy. Clinical reactivity was lost in 11 (38%) of 29 patients. The median age for all patients at the time of diagnosis by these food challenges was 3 years; more than 80% of patients in each group had atopic dermatitis as part of their presenting symptoms. Casein-specific and beta-lactoglobulin-specific IgE, IgG, IgG1, and IgG4 antibody concentrations were analyzed in all patients at regular intervals. In the patients becoming clinically tolerant to cow milk, the IgE-specific antibody concentrations and IgE/IgG-specific ratios for both milk proteins were lower initially and decreased significantly with time, in comparison with those in the group who retained clinical sensitivity. The concentrations of IgG1- and IgG4-specific antibody to casein and the IgE/IgG1 and IgE/IgG4 ratios for both casein and beta-lactoglobulin were significantly less in the patients losing clinical reactivity. No differences in the IgG-specific concentrations were observed in either group at any of the evaluation times noted above. Monitoring similar casein-specific and beta-lactoglobulin-specific IgE concentrations and IgE/IgG ratios may help predict which patients will ultimately lose their clinical reactivity to cow milk.

Safety of casein hydrolysate formula in children with cow milk allergy.

The purpose of this study was to determine whether a new casein hydrolysate infant formula, Alimentum, could be administered safely to children with cow milk hypersensitivity. The formula was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and with a sensitive enzyme-linked inhibition immunoassay, and it was judged to be safe for clinical trials in children allergic to cow milk. Twenty-five such children underwent double-blind placebo-controlled oral food challenges with 10 gm of powdered cow milk and casein hydrolysate formula. All children were highly atopic and had positive skin prick reactions to cow milk. No patient reacted to placebo during a double-blind, placebo-controlled food challenge. Two patients lost their allergy to cow milk and did not react during the challenge; the remaining patients reacted with a variety of cutaneous, respiratory, and gastrointestinal symptoms within 15 to 90 minutes of challenge. All children tolerated the blinded challenge to the casein hydrolysate and were fed the hydrolysate openly without difficulty. We conclude that this casein hydrolysate is generally safe to feed to children with immediate hypersensitivity to cow milk. We recommend that all infant formulas promoted as "hypoallergenic" be tested in milk-allergic patients to assess their allergenic potential, in addition to standard nutritional evaluation and animal testing for antigenicity.