Инновации диетотерапии аллергии к белкам коровьего молока: обогащение высокогидролизованных смесей олигосахаридами грудного молока

Захарова И.Н., Османов И.М., Бережная И.В., Дмитриева Д.К., Скоробогатова Е.В., Гостюхина А.Д. Инновации диетотерапии аллергии к белкам коровьего молока: обогащение высокогидролизованных смесей олигосахаридами грудного молока. Педиатрия. Consilium Medicum. 2022;2:122–127.
DOI: 10.26442/26586630.2022.2.201745

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Zakharova IN, Osmanov IM, Berezhnaya IV, Dmitrieva DK, Skorobogatova EV, Gostiukhina AD. Innovations in the dietary therapy of cow's milk protein allergy: enrichment of highly hydrolyzed infant formulas with human milk oligosaccharides: A review. Pediatrics. Consilium Medicum. 2022;2:122–127.
DOI: 10.26442/26586630.2022.2.201745

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Аннотация

Одной из самых частых причин развития пищевой аллергии у детей в настоящее время являются белки коровьего молока (БКМ). Диагностика аллергии к БКМ (АБКМ) может быть затруднена, учитывая патоморфизм клинических проявлений, а также как IgE-, так и не-IgE-опосредованные варианты патологии.
При выборе диетотерапии для детей с симптомами АБКМ требуется полный отказ от любых молочных продуктов и, следовательно, подбор полноценной замены для поддержания адекватного по составу, действию и калорийности питания рациона. Использование высокогидролизованных и аминокислотных смесей в питании детей с АБКМ является предпочтительным, поскольку современные гидролизованные смеси высокоэффективны, а добавление в них олигосахаридов грудного молока оказывает дополнительное влияние на формирование оральной толерантности.

Ключевые слова: аллергия к белкам коровьего молока, дети первого года жизни, высокогидролизованная смесь, олигосахариды грудного молока

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The prevalence of food allergies has been increasing over the past 30 years. One of the most common causes of food allergies in children today is an allergy to cow's milk proteins (ACMP). Diagnosis of the ACMP can often be difficult, given the pathomorphism of the manifestations. Both in the diagnosis and in the treatment of children with manifestations of ACMP, a rejection of any dairy products and, consequently, the selection of a complete substitute to maintain a diet adequate in composition, action and caloric content is required. The use of highly hydrolyzed and amino acid formulas in the nutrition of children with ACMP is preferable, given the current opportunities that bring adapted formulas closer to the composition of breast milk, using breast milk oligosaccharides to support the development of early oral tolerance.

Keywords: cow's milk protein allergy, first year of life, extensively hydrolyzed formula, breast milk oligosaccharides

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Список литературы

1. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. 2011;127(3):594‑602. DOI:10.1016/j.jaci.2010.11.044
2. Giannetti A, Toschi Vespasiani G, Ricci G, et al. Cow's Milk Protein Allergy as a Model of Food Allergies. Nutrients. 2021;13(5):1525. DOI:10.3390/nu13051525
3. Verduci E, D'Elios S, Cerrato L, et al. Cow's Milk Substitutes for Children: Nutritional Aspects of Milk from Different Mammalian Species, Special Formula and Plant-Based Beverages. Nutrients. 2019;11(8):1739. DOI:10.3390/nu11081739
4. Wal JM. Bovine milk allergenicity. Ann Allergy Asthma Immunol. 2004;93(5 Suppl. 3):S2-11. DOI:10.1016/s1081-1206(10)61726-7
5. Séverin S, Wenshui X. Milk biologically active components as nutraceuticals: review. Crit Rev Food Sci Nutr. 2005;45(7-8):645-56. DOI:10.1080/10408690490911756
6. Hochwallner H, Schulmeister U, Swoboda I, et al. Cow's milk allergy: from allergens to new forms of diagnosis, therapy and prevention. Methods. 2014;66(1):22-33. DOI:10.1016/j.ymeth.2013.08.005
7. Fiocchi A, Schünemann HJ, Brozek J, et al. Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report. J Allergy Clin Immunol. 2010;126(6):1119-28.e12. DOI:10.1016/j.jaci.2010.10.011
8. Fiocchi A, Bognanni A, Brożek J, et al. Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions. World Allergy Organ J. 2022;15(1):100609. DOI:10.1016/j.waojou.2021.100609
9. Boyce JA, Assa’a A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: Summary of the NIAID-sponsored expert panel report. Nutrition. 2011;27(2):253-67. DOI:10.1016/j.nut.2010.12.001
10. Venter C, Arshad SH. Epidemiology of food allergy. Pediatr Clin N Am.2011;58(2):327-49. DOI:10.1016/j.pcl.2011.02.011
11. Flom JD, Sicherer SH. Epidemiology of Cow's Milk Allergy. Nutrients.2019;11(5):1051. DOI:10.3390/nu11051051
12. Connor F, Salvatore S, D'Auria E, et al. Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review. Nutrients. 2022;14(6):1317. DOI:10.3390/nu14061317
13. Warner JO. The Early Life Origins of Asthma and Related Allergic Disorders. Arch Dis Child. 2004;89(2):97-102. DOI:10.1136/adc.2002.013029
14. Adel-Patient K, Bernard H, Fenaille F, et al. Prevention of Allergy to a Major Cow’s Milk Allergen by Breastfeeding in Mice Depends on Maternal Immune Status and Oral Exposure During Lactation. Front Immunol. 2020;11:1545. DOI:10.3389/fimmu.2020.01545
15. Lack G. Update on Risk Factors for Food Allergy. J Allergy Clin Immunol. 2012;129(5):1187-97. DOI:10.1016/j.jaci.2012.02.036
16. Muehlhoff E, Bennett A, McMahon D, et al. Milk and Dairy Products in Human Nutrition (2013). Dairy Technol. 2014;67(2):303-4. DOI:10.1111/1471-0307.12124
17. Klemola T, Vanto T, Juntunen-Backman K, et al. Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy: A prospective, randomized study with a follow-up to the age of 2 years. J Pediatrics. 2002;140(2):219-24. DOI:10.1067/mpd.2002.121935
18. Vandenplas Y, De Greef E, Hauser B, Paradice Study Group. Safety and tolerance of a new extensively hydrolyzed rice protein-based formula in the management of infants with cow’s milk protein allergy. Eur J Pediatr. 2014;173(9):1209-16. DOI:10.1007/s00431-014-2308-4
19. Bocquet A, Dupont C, Chouraqui J-P, et al. Efficacy and Safety of Hydrolyzed Rice-Protein Formulas for the Treatment of Cow’s Milk Protein Allergy. Arch Pediatr. 2019;26(4):238-46. DOI:10.1016/j.arcped.2019.03.001
20. Greer FR, Sicherer SH, Burks AW. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics. 2008;121(1):183‑91. DOI:10.1542/peds.2007-3022
21. Tanabe S. Analysis of Food Allergen Structures and Development of Foods for Allergic Patients. Biosci Biotechnol Biochem. 2008;72(3):649-59. DOI:10.1271/bbb.70708
22. Luyt D, Ball H, Makwana N, et al. Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) BSACI Guideline for the Diagnosis and Management of Cow’s Milk Allergy. Clin Exp Allergy. 2014;44(5):642-72. DOI:10.1111/cea.12302
23. Evans M, Truby H, Boneh A. The Relationship between Dietary Intake, Growth and Body Composition in Phenylketonuria. Mol Genet Metab. 2017;122(1‑2):36‑42. DOI:10.1016/j.ymgme.2017.07.007
24. Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI Food Allergy and Anaphylaxis Guidelines: Diagnosis and Management of Food Allergy. Allergy. 2014;69(8):1008-25. DOI:10.1111/all.12429
25. Høst A. Cow’s Milk Protein Allergy and Intolerance in Infancy. Some Clinical, Epidemiological and Immunological Aspects. Pediatr Allergy Immunol. 1994;5(5 Suppl.):1-36. DOI:10.1111/j.1399-3038.1994.tb00352.x
26. Rzehak P, Sausenthaler S, Koletzko S, et al. Long-Term Effects of Hydrolyzed Protein Infant Formulas on Growth--Extended Follow-up to 10 y of Age: Results from the German Infant Nutritional Intervention (GINI) Study. Am J Clin Nutr. 2011;94(6 Suppl.):1803-7. DOI:10.3945/ajcn.110.000679
27. Korhonen H, Pihlanto A. Food-Derived Bioactive Peptides – Opportunities for Designing Future Foods. Curr Pharm Des. 2003;9:1297-308. DOI:10.2174/1381612033454892
28. Kiewiet MBG, Gros M, van Neerven RJJ, et al. Immunomodulating Properties of Protein Hydrolysates for Application in Cow’s Milk Allergy. Pediatr Allergy Immunol. 2015;26(3):206-17. DOI:10.1111/pai.12354
29. Nowak-Wegrzyn A, Czerkies L, Reyes K, et al. Confirmed Hypoallergenicity of a Novel Whey-Based Extensively Hydrolyzed Infant Formula Containing Two Human Milk Oligosaccharides. Nutrients. 2019;11(7):1447. DOI:10.3390/nu11071447
30. Ballard O, Morrow AL. Human milk composition: Nutrients and bioactive factors. Pediatr Clin N Am. 2013;60(1):49-74. DOI:10.1016/j.pcl.2012.10.002
31. Petschacher B, Nidetzky B. Biotechnological production of fucosylated human milk oligosaccharides: Prokaryotic fucosyltransferases and their use in biocatalytic cascades or whole cell conversion systems. J Biotechnol. 2016;235:61-83. DOI:10.1016/j.jbiotec.2016.03.052
32. Xiao L, van De Worp WR, Stassen R, et al. Human milk oligosaccharides promote immune tolerance via direct interactions with human dendritic cells. Eur J Immunol. 2019;49(7):1001-14. DOI:10.1002/eji.201847971
33. Vandenplas Y, Żołnowska M, Berni Canani R, et al. Effects of an Extensively Hydrolyzed Formula Supplemented with Two Human Milk Oligosaccharides on Growth, Tolerability, Safety and Infection Risk in Infants with Cow's Milk Protein Allergy: A Randomized, Multi-Center Trial. Nutrients. 2022;14(3):530. DOI:10.3390/nu14030530
34. Järvinen KM, Martin H, Oyoshi MK. Immunomodulatory effects of breast milk on food allergy. Ann Allergy Asthma Immunol. 2019;123(2):133-43. DOI:10.1016/j.anai.2019.04.022

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Авторы

И.Н. Захарова*1, И.М. Османов2,3, И.В. Бережная1, Д.К. Дмитриева1, Е.В. Скоробогатова2, А.Д. Гостюхина1

1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия;
3 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
* zakharova-rmapo@yandex.ru

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Irina N. Zakharova*1, Ismail M. Osmanov2,3, Irina V. Berezhnaya1, Diana K. Dmitrieva1, Ekaterina V. Skorobogatova2, Anastasiia D. Gostiukhina1

1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 Bashlyaeva Children's City Clinical Hospital, Moscow, Russia;
3 Pirogov Russian National Research Medical University, Moscow, Russia

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