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  Substance Info: (and synonyms)
Milk - alpha-lactalbumin / nBos d 4

Background Info:

See: Milk (Cow's) and Milk (Whey).
Alpha lactalbumin is one of the major cow's milk allergens.

 

Adverse Reactions:

IMMUNE REACTIONS


[ 1 / 13 ]

Two exclusively breastfed infants, aged 3 and 4 months, with severe atopic dermatitis are reported. Both had direct specific IgE against cow's milk proteins (lactoferrin, serum albumin, beta-casein, and alpha-lactalbumin) and homologous milk proteins of their mother. After complete regression of the symptoms had occurred, a mild worsening of eczematous lesions was observed in both after re-introduction of CMP into the maternal diet, and total regression was again observed 2 weeks after maternal re-elimination of CMP. Direct CMP challenge with a generalized erythematous rash appeared after 10 minutes, followed in one case by sneezing and laryngeal edema. (Bertino 2000 ref.13577 7)

Reference:
Bertino E, Coscia A, Martano C, Fabris C, Monti G, Conti A. IgE cross-reactivity between human and cow's milk proteins in atopic breast-fed infants. J Pediatr 2000;136(3):421-423



[ 2 / 13 ]

Serum antibodies to cows' milk, beta-lactoglobulin, alpha-lactalbumin, bovine serum albumin and ovalbumin were measured in 30 children with acute diarrhoea in the acute phase and 1 month after recovery. IgG anti-beta-lactoglobulin titres for the study group increased 1 month after recovery compared to the titres during the acute phase (P = 0.02). Antibody concentration for the other antigens studied did not rise. Four children developed positive IgE antibodies to one or more of the allergens after the diarrhoeal episode, although the titres were very low. None showed evidence of allergy to cows' milk or egg during the year-long follow-up. (Ahmed 1998 ref.2922 9)

Reference:
Ahmed T, Sumazaki R, Shin K, Nagai Y, et al. Humoral immune and clinical responses to food antigens following acute diarrhoea in children. J Paediatr Child Health 1998;34(3):229-32



[ 3 / 13 ]

Cord blood mononuclear cells from 39 neonates were incubated with cow's milk proteins (alpha-lactalbumin, beta-lactoglobulin, casein, alpha-casein, beta-casein, kappa-casein, bovine serum albumin) for 7 days, and proliferation was assessed. A pronounced proliferation of cells stimulated with alpha-lactalbumin, beta-lactoglobulin and alpha-casein was found. The recognition of allergen by cord blood cells indicates that allergen priming must occur prenatally. The relevance for subsequent sensitization is unclear. (Szepfalusi 1997 ref.6470 7)

Reference:
Szepfalusi Z, Nentwich I, Gerstmayr M, Jost E, Todoran L, Gratzl R, et al. Prenatal allergen contact with milk proteins. Clin Exp Allergy 1997;27(1):28-35



[ 4 / 13 ]

A daily dose of less than 70 mg a-lactalbumin by intake of a "milk-free" cereal flour containing lactose caused repeated episodes of vomiting and diarrhea in a 22 months old child. This study reports on a baby food, which, although guaranteed free of cow's milk protein, caused failure to thrive and diarrhea, vomiting, and coughing fits in a 22-month-old child. Specific IgE was elevated to 100 kU/l for cow's milk and to 15.3 kU/l for alpha-lactalbumin (2.5 kU/l for casein, 0.7 kU/l for beta-lactoglobulin). The presence of alpha-lactalbumin in "food-quality" lactose used in this flour, at a dose of 1-5 micrograms/g, was found. The daily intake of alpha-lactalbumin was found to be less than 70 micrograms. This exquisite clinical sensitization was attributed to the intestinal hyperpermeability (IH) which favors the access of milk allergen to the blood, leading to an ever-growing state of hypersensitivity. Food products containing lactose of "food quality" may contain enough residual milk protein to cause symptoms in highly sensitive subjects. (Fremont 1996 ref.1410 6)

Reference:
Frémont S, Kanny G, Bieber S, Nicolas JP, Moneret-Vautrin DA. Identification of a masked allergen, alpha-lactalbumin, in baby-food cereal flour guaranteed free of cow's milk protein. Allergy 1996;51(10):749-54



[ 5 / 13 ]

34 adult patients (aged from 16 to 58 years) with IgE-mediated reactions to cow milk and cheese were evaluated. Women represented 91.2% of the study group and 39% of them suffered from the first symptoms during or soon after a pregnancy. 47% of the patients were nonatopic and showed a monovalent sensitization to cow milk proteins. RAST results (score > or = 2) found the predominant allergen to be casein with a sensitization frequency of 71%, whereas sensitization to whey proteins (alpha-lactalbumin and beta-lactoglobulin) in this adult group was rare. The main organ manifestations of CMA in adults were the respiratory tract and the skin, with gastrointestinal and cardiovascular symptoms occurring less often than in children.
Symptoms of the respiratory tract (ranging from rhinitis to coughing, dyspnoea with expiratory stridor in combination with or without conjunctivitis) in 91.2% of the cases as well as symptoms of the skin (generalized or localized urticaria and/or angioedema) in 79.4% were predominant in adult patients. Gastrointestinal manifestations (diarrhea, vomiting, colic) were less frequent (42.4%). 35.3% of the patients complained of local oropharyngeal itching up to contact urticaria prior to generalized symptoms. Cardiovascular symptoms (mainly tachycardia) were reported by 11 patients (34.4%); only 4 of them showed a single episode of a syncope after ingestion of a milk product.
Furthermore, 4 women suffered from contact urticaria of the skin after handling cheese or after treating their babies with a CMP-containing baby powder. Inhalation of 'Fissan' baby powder (containing hydrolyzed casein) and of CMP-containing vapors during cooking led to an asthma attack in 2 cases. 3 patients described additional temperature dysregulation with severe shivering, 2 patients observed a swelling of lymph nodes after ingestion of CMP products and in 1 case angioedematous swellings did not only involve lips and eye lids but also led to a genital swelling with urinary stasis.
Lesions of atopic eczema which partly improved on a CMP elimination diet were observed in 3 cases.
Only 28% of CMA adults could enjoy an unlimited symptom-free intake of milk products after 4 years of disease. Compared with the existing studies on CMA in children, the results suggest that allergies to cow milk proteins in adults are less frequent and tend to persist longer. (Stoger 1993 ref.1346 7)

Reference:
Stoger P, Wüthrich B. Type I allergy to cow milk proteins in adults. A retrospective study of 34 adult milk- and cheese-allergic patients. Int Arch Allergy Immunol 1993;102(4):399-407



[ 6 / 13 ]

Hypersensitivity reaction in an infant fed hydrolyzed lactalbumin. (Businco 1991 ref.16615 3)

Reference:
Businco L, Cantani A. Hypersensitivity reaction in an infant fed hydrolyzed lactalbumin. J Pediatr Gastroenterol Nutr 1991 Nov;13(4):429.



[ 7 / 13 ]

Following introduction of milk protein formula feedings, a 6-month-old male developed profuse, watery diarrhea progressing to shock, requiring cardiopulmonary resuscitation. Reinstitution of enteral feedings with a formula containing hydrolyzed lactalbumin (Travasorb STD) resulted in recurrence of diarrhea with fever. Twenty-three months later, while admitted for evaluation of hypophosphatemic rickets, immunologic testing using the lymphocyte migration inhibition factor (LIF) test demonstrated positive reactions, especially to alpha-lactalbumin (56% inhibition) and whole cow's milk (22%, normal of less than 20% inhibition). Skin tests revealed sensitivity to cow's milk and eggs. Soy formula also produced diarrhea and bloody stools. Protein hydrolysate formulas, touted as hypoallergenic diets, are useful in infants with intolerance to milk protein. This is the first documented case of an immunological reaction to the hydrolyzed whey protein, lactalbumin. (Heyman 1990 ref.16621 7)

Reference:
Heyman MB, Stoker TW, Rudolph CD, Frick OL. Hypersensitivity reaction in an infant fed hydrolyzed lactalbumin contained in a semielemental formula. J Pediatr Gastroenterol Nutr 1990 Feb;10(2):253-6.



[ 8 / 13 ]

A study of 25 milk-allergic patients with a variety of allergic symptoms showed a-lactalbumin-specific IgE antibodies in 67% of the sera and beta-lactoglobulin-specific IgE antibodies in 33% of the sera. (Rolfsen 1987 ref.20114 7)

Reference:
Rolfsen W, Tibell M, Yman L. Cow’s milk proteins as allergens and antigens. Allergol Immunolog Clinica (Madr) 1987;2:213.



[ 9 / 13 ]

Allergic reactions. 33% of 25 milk-allergic patients had specific IgE to beta-lactoglobulin and 67% to alpha lactalbumin. (Rolfsen 1987 ref.388 89)

Reference:
Rolfsen W, Tibell M, Yman L. Cow's milk proteins as allergens and antigens. Allergol Immunolog Clinica 1987;2:282 (abstr)



[ 10 / 13 ]

Open skin challenge test with whole milk and its large and small molecular fractions was performed on intact skin of children with atopic dermatitis and suspicion of milk allergy. Of the 51 children challenged with milk 35 reacted within minutes with contact urticaria. The large molecular (m.w. greater than 10,000 d) fraction gave an urticarial reaction as often as whole milk, whereas the small molecular fraction gave only a few positive reactions. These were obviously caused by alpha-lactalbumin which was present only in small amounts in the small molecular fraction. These findings indicate that immediate contact allergy to relevant food allergens can be very common in children with atopic dermatitis and that the large molecular antigens readily penetrate children's skin. (Salo 1986 ref.16626 0)

Reference:
Salo OP, Makinen-Kiljunen S, Juntunen K. Milk causes a rapid urticarial reaction on the skin of children with atopic dermatitis and milk allergy. Acta Derm Venereol 1986;66(5):438-42.



[ 11 / 13 ]

IgE's specifically directed against alpha-lactalbumin, beta-lactoglobulin and casein were evaluated in the sera of 164 children aged between 8 days and 3 years, suspected of intolerance to cow's milk. Intolerance was detected in 107 out of 180 sera tested, with at least one of the RAST's being positive. The two specific allergens most frequently involved were alpha-lactalbumin and beta-lactoglobulin. However, these proved curiously less sensitive than the "total allergen". A highly significant positive correlation was found between total IgE's and positivity of the four RAST's. (Basuyau 1983 ref.16627 4)

Reference:
Basuyau JP, Mallet E, Brunelle P, de Menibus CH. Intolerance to cow's milk. Study of specific immunoglobulin E. [French] Presse Med 1983 Sep 24;12(33):2041-3.



[ 12 / 13 ]

40% of eczema patients were found to be positive to apple. 12/25 eczema patients (48%) had IgE antibodies to alpha-lactalbumin. (Hoffman 1975 ref.219 34)

Reference:
Hoffman D, Yamamoto F. Specific IgE antibodies in atopic eczema. J Clin Allergy Clin Immunol 1975;55:256-267



[ 13 / 13 ]

For Cow's milk proteins, see, among other:
Milk - cow's
Milk - casein
Milk - alpha-lactalbumin
Milk - beta-lactoglobulin
Milk - lactoferrin / Bovine Lactoferrin
Bovine Serum Albumin (BSA)
Beef

Reference:
Editor Comment Editorial comment, common knowledge, or still to add - -




Non-Immune reactions


[ 1 ]

A link between allergy to milk and infantile autism with high levels of IgA antigen-specific antibodies for casein, lactalbumin and beta-lactoglobulin, and IgG and IgM for casein is reported. In a cow's milk free diet in 36 autistic patients, a marked improvement in the behavioural symptoms of patients after a period of 8 weeks was found as well as high levels of IgA antigen specific antibodies for casein, lactalbumin and beta-lactoglobulin and IgG and IgM for casein was found. (Lucarelli 1995 ref.714 38)

Reference:
Lucarelli S, Frediani T, Zingoni AM, Ferruzzi F, Giardini O, et al. Food allergy and infantile autism. Panminerva Medica 1995;37(3):137-41




Occupational reactions


[ 1 ]

Occupational asthma and rhinoconjunctivitis from inhalation of dried cow's milk caused by sensitization to alpha-lactalbumin. A chocolate candy worker was diagnosed as having occupational asthma and rhinoconjunctivitis. Positive conjunctival and bronchial challenge tests with lactalbumin showed that this protein was the pathogenetic agent. Skin prick test and RAST were positive. (Bernaola 1994 ref.1333 5)

Reference:
Bernaola G, Echechipia S, Urrutia I, Fernandez E, Audicana M, Fernandez de Corres L. Occupational asthma and rhinoconjunctivitis from inhalation of dried cow's milk caused by sensitization to alpha-lactalbumin. Allergy 1994;49(3):189-91




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