• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.233-237
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• 2005

저자들은 분유 수유를 하던 1개월 된 영아가 토혈을 주소로 내원하여 시행한 내시경 검사에서 출혈성 위염으로 진단되어 고식적인 치료를 하였으나 토혈이 멎지 않고 발열이 동반되는 등 증상의 호전이 없었고 오히려 증상이 악화되어 우유 알레르기를 의심하였다. 금식시킨 후 증상이 호전되었고 우유를 가수분해 분유로 바꾼 후 출혈이 소실된 우유 알레르기로 인한 출혈성 위염 1예를 경험하였기에 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권1호
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• pp.1-5
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• 2014

The diagnosis and treatment of cow's milk protein allergy (CMPA) is still a challenge. A systematic literature search was performed using Embase, Medline, The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials for the diagnosis and treatment of cow's milk allergy (CMA). Since none of the symptoms of CMPA is specific and since there is no sensitive diagnostic test (except a challenge test), the diagnosis of CMPA remains difficult. A "symptom-based score" is useful in children with symptoms involving different organ systems. The recommended dietary treatment is an extensive cow milk based hydrolysate. Amino acid based formula is recommended in the most severe cases. However, soy infant formula and hydrolysates from other protein sources (rice) are gaining popularity, as they taste better and are cheaper than the extensive cow's milk based hydrolysates. Recent meta-analyses confirmed the safety of soy and estimate that not more than 10-15% of CMPA-infants become allergic to soy. An accurate diagnosis of CMA is still difficult. The revival of soy and the development of rice hydrolysates challenge the extensive cow's milk based extensive hydrolysates as first option and amino acid formula.

• Journal of Dairy Science and Biotechnology
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• 제31권1호
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• pp.67-73
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• 2013

Food allergy is defined as adverse reactions toward food mediated by aberrant immune mechanisms. Cow's milk allergy is one of the most common food allergies in childhood. This allergy is normally outgrown in the first year of life, however 15% of allergic children remain allergic. Cow's milk allergy seem to be associated with casein (${\alpha}_{s1}$-CN), ${\beta}$-lactoglobulin and whey protein. In addition to this, many other milk proteins are antigenic and capable of inducing immune responses. Various food processing affects the stability, structure and intermolecular interactions of cow milk proteins, as a result reduction the allergenic capacity. Heating, hydrolysis, chemical, proteolytic and other processes such as gamma-ray irradiation, high pressure, using probiotics treatments of milk to obtain hypoallergenic milk have been developed to reduce allergic reactions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권1호
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• pp.43-49
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• 2023

Purpose: The cow's milk-related-symptom-score (CoMiSS) tool was developed as an awareness tool for the assessment of cow's milk-related symptoms in infants or children. Fecal calprotectin (FC) is a noninvasive biomarker of gut inflammation that can be measured in serum and stool. This study aimed to investigate the relationship between FC levels and CoMiSS scores in infants with cow's milk protein allergy. Methods: Infants (aged 6-12 months) who were allergic to cow's milk protein were enrolled prospectively. Following completion of the CoMiSS scoring, the infants were divided into group 1 (positive CoMiSS scores ≥12) and group 2 (negative CoMiSS scores <12). FC was measured using immunoassay. Results: Of the 120 infants enrolled in this study, 60 (50.0%) had positive CoMiSS scores (group 1), while 60 (50.0%) had negative scores (group 2). The mean FC level was higher in the infants in group 1 than those in group 2 (2,934.57 ㎍/g vs. 955.13 ㎍/g; p<0.001). In addition, there was a positive correlation between FC and CoMiSS scores (R=0.168, p<0.0001). A FC level of 1,700 ㎍/g provided a sensitivity of 98.3%, specificity of 93.3%, and accuracy of 95.8% for the diagnosis of cow's milk protein allergy (CMPA). Conclusion: FC measurement may have a role in the assessing infants with CMPA.

• Clinical and Experimental Pediatrics
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• 제49권10호
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• pp.1061-1066
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• 2006

목 적 : 신생아에서 우유 알레르기가 의심되는 경우 우유 특이 IgE 항체 측정이 우유 알레르기 진단에 유용한지 알아보고자 하였다. 또한 추적관찰이 가능한 경우 우유 특이 IgE 항체 검사결과와 다른 알레르기 질환의 발현과의 연관성도 알아보고자 하였다. 방 법 : 생후 4주이내의 신생아로 우유 특이 IgE 항체 검사양성을 보인 87명을 대상으로 하였다. 대상 환아는 병력 청취와 진찰 소견에서 우유 알레르기가 의심되어 우유 단백 제거 요법을 시행하여 증세의 호전을 보이고 우유 특이 IgE 항체 검사에서 양성을 보인 환아로 하였다. 또한 이들 87명의 환아 중 추적관찰이 가능했던 40명을 대상으로 우유 특이 IgE 항체 검사결과와 알레르기 질환 발현과의 상관관계를 알아보았고 이들 항체와 알레르기 질환의 가족력과의 상관관계도 알아보았다. 결 과 : 대상 환아의 평균 나이는 $17.2{\pm}5.4$일 이었다. 우유 특이 IgE 항체 검사 결과 milk 양성은 87명이었고 casein 양성은 24명, ${\alpha}$-lactoalbuminn 양성은 38명, ${\beta}$-lactoglobulin 양성은 75명이었다. 6개월 이상의 추적관찰이 가능했던 환아는 40명(45.9%)이었고 부모가 알레르기 질환을 가진 경우는 10명(25%), 환아의 추적 관찰 결과 알레르기 질환을 가진 경우가 15명(37.5%)으로 천식 4명, 아토피 피부염 11명이었다. 추적관찰 결과 신생아기에 casein에 양성을 보인 경우 알레르기 질환의 발현과 연관성이 통계적으로 유의하게 높았다. 그러나 우유 특이 IgE 항체 양성과 알레르기 가족력과의 연관성은 통계적 유의성이 없었다. 결 론 : 신생아에서 IgE 매개성 및 혼합성 우유 알레르기가 의심되는 경우는 우유 제거 식이 요법과 우유 특이 IgE 항체 검사를 시행한다면 진단에 도움이 될 수 있다고 생각된다.

• Clinical and Experimental Pediatrics
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• 제62권5호
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• pp.149-154
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• 2019

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%-5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권4호
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• pp.392-402
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• 2021

Purpose: The present study assessed the role of an amino acid-based formula (AAF) in the growth of infants with cow's milk protein allergy (CMPA). Methods: Non-breastfed, term infants aged 0-6 months with symptoms suggestive of CMPA were recruited from 10 pediatric centers in China. After enrollment, infants were started on AAF for two weeks, followed by an open food challenge (OFC) with cow's milk-based formula (CMF). Infants with confirmed CMPA remained on AAF until 9 months of age, in conjunction with a cow's milk protein-free complementary diet. Body weight, length, and head circumference were measured at enrollment and 9 months of age. Measurements were converted to weight-for-age, length-for-age, and head circumference-for-age Z scores (WAZ, LAZ, HCAZ), based on the World Health Organization growth reference. Results: Of 254 infants (median age 16.1 weeks, 50.9% male), 218 (85.8%) were diagnosed with non-IgE-mediated CMPA, 33 (13.0%) tolerated CMF, and 3 (1.2%) did not complete the OFC. The mean WAZ decreased from 0.119 to -0.029 between birth and enrollment (p=0.067), with significant catch-up growth to 0.178 at 9 months of age (p=0.012) while being fed the AAF. There were no significant changes in LAZ (0.400 vs. 0.552; p=0.214) or HCAZ (-0.356 vs. -0.284; p=0.705) from the time of enrollment to age 9 months, suggesting normal linear and head growth velocity. Conclusion: The amino acid-based study formula, in conjunction with a cow's milk proteinfree complementary diet, supported normal growth till 9 months of age in a cohort of Chinese infants with challenge-confirmed non-IgE-mediated CMPA.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권1호
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• pp.22-26
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• 2017

Purpose: The diagnosis of cow's milk (CM) allergy is a challenge. The Cow's Milk-related-Symptom-Score ($CoMiSS^{TM}$) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the $CoMiSS^{TM}$ was evaluated in three clinical trials. Methods: Pooled analyses of the three studies were conducted based on regressing the results of the month-1 challenge test on the month-1 $CoMiSS^{TM}$, adjusting for baseline $CoMiSS^{TM}$ using a logistic regression model. In addition a logistic regression model was also fitted to the month-1 challenge test result with the change in $CoMiSS^{TM}$ from baseline as a predictor. Results: Results suggest that infants having a low $CoMiSS^{TM}$ (median, 5) after 1 month dietary treatment free from intact CM protein have a significant risk of having a positive challenge test (odds ratio, 0.83; 95% confidence interval, 0.75-0.93; p=0.002). Pooled data suggest that the change in $CoMiSS^{TM}$ from baseline to month-1 can predict CM related symptoms as a confirmed diagnosis according to the challenge test at month-1. However, in order to validate such a tool, infants without CM related symptoms would also need to be enrolled in a validation trial. A concern is that it may not be ethical to expose healthy infants to a therapeutic formula and a challenge test. Conclusion: Pooled data analysis emphasizes that the $CoMiSS^{TM}$ has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권2호
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• pp.154-162
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• 2020

Purpose: The Cow's Milk-related Symptom Score (CoMiSS^TM), which considers crying, regurgitation, stools, skin and respiratory symptoms, was developed as an awareness tool for evaluating cow's milk-related symptoms. The scoring ranges from 0 to 33. A score ≥12 was proposed as being likely cow's milk-related and suggestive of allergy to cow's milk. This study aimed to determine the age-related CoMiSS^TM values in presumed healthy infants in Poland. Methods: This was a cross-sectional study conducted in well-child clinics in two locations. Parents of the presumed healthy infants aged ≤6 months were approached during a routine checkup/vaccination visit. The exclusion criteria were as follows: presence of acute or chronic diseases, preterm delivery, treatment with therapeutic formula, and use of any food supplements (except vitamins) or medications. Results: Data from 226 infants were obtained (median age [Q1-Q3], 4 months [3-4]). The overall median (Q1-Q3) and mean (standard deviation) CoMiSS^TM values were 4 (2-7) and 4.7 (3.5), respectively. The 95th percentile was 11. Scores on some, albeit not all, components of the CoMiSS^TM significantly differed between age groups (crying, stools) or feeding type groups (stools and skin symptoms). Eleven children (4.9%) scored ≥12. Conclusion: This study adds to earlier age-related CoMiSS^TM data by providing CoMiSS^TM values in presumed healthy infants in Poland.

• 한국식품과학회지
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• 제33권4호
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• pp.501-505
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• 2001

대두 단백 제조유는 우유에 대해 알레르기를 일으키는 소아들에게 우유 알레르기를 치료하며 아토피의 예방을 위해 대체식품으로 1929년이래 사용되어 왔다. 그러나 대두 단백 제조유는 알레르기 반응을 유발시킬 수 있어서 이의 효용성에 대해서는 아직도 많은 논란이 지속되고 있다. 우리나라 식품 알레르기 환아에 대한 상황파악은 유럽이나 미국과 비교해 볼 때 아직도 잘 이루어지고 있지 않다. 본 연구의 목적은 국내 소아들의 우유 알레르기와 상관하여 대두 알레르기 발생 빈도 조사에 있다. 본 연구에서 임상적 증상을 나타내는 153명의 환아들 중에서 대두 또는 우유 단백질에 알레르기를 일으키는 환자가 각각 21% 또는 51.6%로 나타났다. 그리고 22명(14%)의 환아들은 우유와 대두 두가지 단백질에 모두 알레르기 증상을 나타내었다. 우유알레르기 환자의 경우는 27.8%의 소수 환아가 대두단백질에 알레르기 반응을 보여 주었으나, 대두 알레르기 환자는 대부분(68.8%)이 우유에 대한 알레르기 반응을 나타내는 것으로 확인되었다.