Role of maternal elimination diets and human milk IgA in the development of cow's milk allergy in the infants
Article first published online: 20 DEC 2013
© 2013 John Wiley & Sons Ltd
Clinical & Experimental Allergy
Volume 44, Issue 1, pages 69–78, January 2014
How to Cite
Clinical & Experimental Allergy, 2014 (44) 69–78., , , , , , and ,
- Issue published online: 20 DEC 2013
- Article first published online: 20 DEC 2013
- Accepted manuscript online: 28 OCT 2013 11:20AM EST
- Manuscript Accepted: 24 OCT 2013
- Manuscript Revised: 14 OCT 2013
- Manuscript Received: 13 AUG 2013
- National Institute of Allergy and Infectious Diseases. Grant Number: K08 AI091655
- NIH. Grant Numbers: RR026134, AI44236, AI066738, AI093577
- breast milk;
- cow's milk;
- cow's milk allergy;
- human milk;
- restriction diet;
- secretory IgA
The role of maternal avoidance diets in the prevention of food allergies is currently under debate. Little is known regarding the effects of such diets on human milk (HM) composition or induction of infant humoral responses.
To assess the association of maternal cow's milk (CM) avoidance during breastfeeding with specific IgA levels in HM and development of cow's milk allergy (CMA) in infants.
We utilized HM and infant serum samples from a prospective birth cohort of 145 dyads. Maternal serum and HM samples were assessed for casein and beta-lactoglobulin (BLG)-specific IgA and IgG by ELISA; 21 mothers prophylactically initiated a strict maternal CM avoidance diet due to a sibling's history of food allergy and 16 due to atopic eczema or regurgitation/vomiting seen in their infants within the first 3 months of life. Infants' sera were assessed for casein and BLG-specific IgG, IgA and IgE; CMA was confirmed by an oral food challenge. The impact of HM on BLG uptake was assessed in transcytosis assays utilizing Caco-2 intestinal epithelial cell line.
Mothers avoiding CM had lower casein- and BLG-specific IgA in HM than mothers with no CM restriction (P = 0.019 and P = 0.047). Their infants had lower serum casein- and BLG-specific IgG1 (P = 0.025 and P < 0.001) and BLG-specific IgG4 levels (P = 0.037), and their casein- and BLG-specific IgA levels were less often detectable than those with no CM elimination diet (P = 0.003 and P = 0.007). Lower CM-specific IgG4 and IgA levels in turn were associated with infant CMA. Transcytosis of BLG was impaired by HM with high, but not low levels of specific IgA.
Maternal CM avoidance was associated with lower levels of mucosal-specific IgA levels and the development of CMA in infants.
HM IgA may play a role in preventing excessive, uncontrolled food antigen uptake in the gut lumen and thereby in the prevention of CMA.