Kuhmilchspezifische humorale und zelluläre Immunantwort bei Säuglingen mit hohem Atopierisiko unter Ernährung mit einer Molke-Hydrolysatnahrung

 

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Zusammenfassung

Hintergrund: Hypoallergene (HA) Säuglingsnahrungen sind zur Atopieprophylaxe bei Säuglingen mit hohem Atopierisiko bestimmt, wenn diese nicht gestillt werden können. Kuhmilch-oder Fremdprotein-basierte Nahrungen rufen beim Säugling eine antigenspezifische Immunantwort aus. Das Ziel unserer Studie war, die spezifische Immunantwort von Säuglingen mit hohem Atopierisiko zu erheben, die entweder mit einer neuen Nahrung (Kuhmilchmolke-Hydrolysat) ernährt oder voll gestillt wurden. Patienten und Methoden: Bei 94 Säuglingen mit hohem Atopierisiko (44 voll gestillt, 50 HA-ernährt) wurden mit 6 Lebensmonaten Plasma-Konzentrationen von kuhmilchspezifischen IgE-Antikörpern bestimmt. Darüber hinaus wurden zu dem selben Zeitpunkt kuhmilchspezifische IgG-Antikörper (26 voll gestillte, 30 HA-ernährte), sowie Beta-Laktoglobulin (BLG)-spezifische Proliferationen von mononuklearen Zellen aus peripherem Blut (41 voll gestillte, 47 HA-ernährte Säuglinge) untersucht. Spezifische IgE- sowie IgG-Antikörper wurden mittels Enzym-Immunoassay (Alastat) bestimmt. Die antigenspezifische Zell-Proliferation nach 6-tägiger Stimulierung mit BLG wurde mittels tritiummarkierten Thymidin-Einbautests gemessen. Ergebnisse: In der voll gestillten Gruppe hatten zwei Säuglinge, in der HA-Gruppe ein Säugling positive IgE-Milchantikörper (> 0,35 kU/L). Die milchspezifische IgG-Konzentration war bei HA-Ernährten nicht signifikant höher als bei voll gestillten Säuglingen. Keine signifikanten Unterschiede wurden in den Proliferationen auf BLG zwischen den beiden Gruppen gefunden. Schlussfolgerungen: Die untersuchte extensiv hydrolysierte Kuhmilchmolke-basierte HA-Nahrung unterschied sich in den nachgeprüften Eigenschaften Antigenität, Allergenität, Immunogenität nicht signifikant von der Muttermilch bei Säuglingen mit erhöhtem Atopierisiko im Alter von 6 Monaten.

Abstract

Background: Hypoallergenic infant formulas (HAF) were developed for atopy prevention in infants with high risk of atopy if these cannot be breastfed. HAF mount an antigen-specific immune response in infants. The aim of the study was to analyse the immune response in infants fed with a new infant formula based on a whey hydrolysate (HAF) and to compare it with that of exclusively breastfed controls. Patients and Methods: Plasma concentrations of cow milk-specific IgE were analysed in 94 infants with high risk of atopy, 44 were exclusively breastfed, 50 were fed with HAF. In addition, cow milk-specific IgG antibodies (26 breastfed, 30 fed with HAF) as well as proliferation of periph-eral blood mononuclear cells to bovine beta-lactoglobulin (BLG) (41 breastfed, 47 fed with HAF) were tested. Specific IgE and IgG antibodies were determined using enzymoimmunometric assay (Alastat). Cellular proliferation was measured using tritiated thymidine incorporation assay after 6 day stimulation with BLG. Results: Elevated IgE to cow milk antibodies (>0,35 kU/L) were detected in two infants from the breastfed group and in one from the HAF-fed group. The plasma concentrations of milk specific IgG antibodies in HAF-fed infants were insignificantly higher than those in breastfed ones. No significant difference was found in bovine BLG-specific cell proliferation between both groups. Conclusion: Concerning the properties investigated like antigenicity, allergenicity and immunogenicity, the extensively hydrolysed whey based hypoallergenic formula does not significantly differ from mother milk in 6 month-old infants with an increased atopy risk.

Literatur

• 1 Aggett P J, Haschke F, Heine W, Hernell O, Koletzko B, Rey J. et al . Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition [see comments].  Acta Paediatr. 1993;  82 (3) 314-319
  PubMedGoogle Scholar
• 2 Axelsson I, Jakobsson I, Lindberg T, Benediktsson B. Bovine beta-lactoglobulin in the human milk. A longitudinal study during the whole lactation period.  Acta Paediatr Scand. 1986;  75 (5) 702-707
  PubMedGoogle Scholar
• 3 Businco L, Dreborg S, Einarsson R, Giampietro P G, Host A, Keller K M. et al . Hydrolysed cow’s milk formulae. Allergenicity and use in treatment and prevention. An ESPACI position paper. European Society of Pediatric Allergy and Clinical Immunology [see comments].  Pediatr Allergy Immunol. 1993;  4 (3) 101-111
  PubMedGoogle Scholar
• 4 Cordle C T, Mahmoud M I, Moore V. Immunogenicity evaluation of protein hydrolysates for hypoallergenic infant formulae.  J Pediatr Gastroenterol Nutr. 1991;  13 (3) 270-276
  PubMedGoogle Scholar
• 5 Fritsche R, Pahud J J, Pecquet S, Pfeifer A. Induction of systemic immunologic tolerance to beta-lactoglobulin by oral administration of a whey protein hydrolysate.  J Allergy Clin Immunol. 1997;  100 (2) 266-273
  PubMedGoogle Scholar
• 6 Giampietro P G, Kjellman N I, Oldaeus G, Wouters-Wesseling W, Businco L. Hypoallergenicity of an extensively hydrolyzed whey formula.  Pediatr Allergy Immunol. 2001;  12 (2) 83-86
  CrossrefPubMedGoogle Scholar
• 7 Halken S, Hansen K S, Jacobsen H P, Estmann A, Faelling A E, Hansen L G. et al . Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study.  Pediatr Allergy Immunol. 2000;  11 (3) 149-161
  CrossrefPubMedGoogle Scholar
• 8 Halken S, Host A. Prevention of allergic disease. Exposure to food allergens and dietetic intervention.  Pediatr Allergy Immunol. 1996;  7 (9 Suppl) 102-107
  PubMedGoogle Scholar
• 9 Halken S, Host A, Hansen L G, Osterballe O. Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. A prospective study of 159 „high-risk” infants.  Allergy. 1992;  47 (5) 545-553
  PubMedGoogle Scholar
• 10 Halken S, Host A, Hansen L G, Osterballe O. Preventive effect of feeding high-risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula. A prospective, randomized, comparative clinical study.  Pediatr Allergy Immunol. 1993;  4 (4) 173-181
  PubMedGoogle Scholar
• 11 Host A, Husby S, Hansen L G, Osterballe O. Bovine beta-lactoglobulin in human milk from atopic and non-atopic mothers. Relationship to maternal intake of homogenized and unhomogenized milk.  Clin Exp Allergy. 1990;  20 (4) 383-387
  PubMedGoogle Scholar
• 12 Isolauri E, Tahvanainen A, Peltola T, Arvola T. Breast-feeding of allergic infants [see comments].  J Pediatr. 1999;  134 (1) 27-32
  PubMedGoogle Scholar
• 13 Jakobsson I, Lindberg T, Benediktsson B, Hansson B G. Dietary bovine beta-lactoglobulin is transferred to human milk.  Acta Paediatr Scand. 1985;  74 (3) 342-345
  PubMedGoogle Scholar
• 14 Jarvinen K M, Makinen K S, Suomalainen H. Cow’s milk challenge through human milk evokes immune responses in infants with cow’s milk allergy.  J Pediatr. 1999;  135 (4) 506-512
  PubMedGoogle Scholar
• 15 Meeuwisse G W. Immunological considerations on breast vs. formula feeding.  Klin Padiatr. 1985;  197 (4) 322-325
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Nentwich I, Michkova E, Nevoral J, Urbanek R, Szepfalusi Z. Cow’s milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula.  Allergy. 2001;  56 (12) 1144-1156
  PubMedGoogle Scholar
• 17 Oldaeus G, Bjorksten B, Jenmalm M C, Kjellman N I. Cow’s milk IgE and IgG antibody responses to cow’s milk formulas.  Allergy. 1999;  54 (4) 352-357
  CrossrefPubMedGoogle Scholar
• 18 Pecquet S, Bovetto L, Maynard F, Fritsche R. Peptides obtained by tryptic hydrolysis of bovine beta-lactoglobulin induce specific oral tolerance in mice.  J Allergy Clin Immunol. 2000;  105 (3) 514-521
  CrossrefPubMedGoogle Scholar
• 19 Saarinen K M, Vaarala O, Klemetti P, Savilahti E. Transforming growth factor-beta1 in mothers’ colostrum and immune responses to cows’ milk proteins in infants with cows’ milk allergy.  J Allergy Clin Immunol. 1999;  104 (5) 1093-1098
  PubMedGoogle Scholar
• 20 Saito S, Yoshida M, Ichijo M, Ishizaka S, Tsujii T. Transforming growth factor-beta (TGF-beta) in human milk.  Clin Exp Immunol. 1993;  94 (1) 220-224
  PubMedGoogle Scholar
• 21 Stavnezer J. Regulation of antibody production and class switching by TGF-beta.  J Immunol. 1995;  155 (4) 1647-1651
  PubMedGoogle Scholar
• 22 Szepfalusi Z, Nentwich I, Jost E, Gerstmayr M, Ebner C, Frischer T. et al . Cord blood mononuclear cells and milk-specific T-cell clones are tools to evaluate the residual immunogenicity of hydrolyzed milk formulas.  J Allergy Clin Immunol. 1998;  101 (4 Pt 1) 514-520
  CrossrefPubMedGoogle Scholar
• 23 Tainio V M, Savilahti E, Arjomaa P, Salmenpera L, Perheentupa J, Siimes M A. Plasma antibodies to cow’s milk are increased by early weaning and consumption of unmodified milk, but production of plasma IgA and IgM cow’s milk antibodies is stimulated even during exclusive breast-feeding.  Acta Paediatr Scand. 1988;  77 (6) 807-811
  PubMedGoogle Scholar
• 24 Vaarala O, Saukkonen T, Savilahti E, Klemola T, Akerblom H K. Development of immune response to cow’s milk proteins in infants receiving cow’s milk or hydrolyzed formula.  J Allergy Clin Immunol. 1995;  96 (6 Pt 1) 917-923
  PubMedGoogle Scholar
• 25 Wahn U, Wahl R, Rugo E. Comparison of the residual allergenic activity of six different hydrolyzed protein formulas.  J Pediatr. 1992;  121) (5 Pt 2) S80-S84
  PubMedGoogle Scholar
• 26 Zeiger R S, Heller S. The development and prediction of atopy in high-risk children: Follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol 1995: 1179-1190
  Google Scholar

MUDr. Ivo Nentwich Ph.D 

Masaryk-Universität in Brünn, Medizinische Fakultät

Joštova 10

CZ-662 43 Brno

Tschechien

Email: inentw@med.muni.cz