The clinical syndromes described in connection with cow's milk allergy and,
more generally, food allergy are numerous.
An asthma attack precipitated by wine was noted in 1679 by Thomas Willis
(33). Salter (1) observed sneezing, rhinorrhea, nasal congestion, coughing, and
wheezing after ingestion of certain foods;
The idea that what one eats influences how one feels and behaves is not new.
More than two thousand years ago, Titus Lucretius Carus (55 B.C.) coined the saying
"One man's meat is another man's poison."
Both for the clinician and the laboratory immunologist, the diagnosis of food
allergies is a frustrating exercise, due to the pathophysiological complexity of
food-induced adverse reactions on the one hand, and to the difficult interpretation
of single immunologic tests or techniques on the other.
The scope of the present chapter is to discuss technologic treatments leading to
a substantial reduction in the allergenicity of food proteins.
In this presentation the topic of food allergens is approached from an angle different
from that of comprehensive reviews.
An important adaptation of the gastrointestinal tract to the extrauterine environment
is its development of a mucosal barrier against the penetration of antigens
and antigenic fragments present in the intestinal lumen.
Mucosae represent (a) the main site of exposure of the immune system to environmental
antigens and (b) one of the major routes of penetration of infectious
agents into the body.
There has been considerable controversy concerning the possible pathogenetic
role of various IgG subclasses in the pathogenesis of allergic disease.
Persistent settling and waking difficulties, associated with disturbing behavior,
restlessness, and intense crying, are encountered in up to 20% of infants under 1
year of age (1).
Adverse reactions to food are a common finding (1,2). Although an association
between immediate hypersensitivity and the presence of specific IgE antibodies has
been established (3-5), in many patients no IgE antibodies to nutritive proteins
can be detected. In these individuals, adverse reaction to food might be related to
the presence of antibodies from other classes.
Among alimentary allergen sources, cow's milk and hen's egg most frequently
lead to hypersensitivity in children and give rise to allergic reactions.
With the increasing recognition of the clinical spectrum of food allergy in infancy,
there is a growing need for a means of dealing with this problem adequately.
It is a well-recognized fact that the risk of developing an immediate- or delayedtype
food allergic disease is higher in children than in adults.
Milk allergy, whose existence was known in ancient Greece, was the first of all
food allergies to be described in modern literature by Hamburger in 1901 (for review,
see ref. 1).
Although the fundamental immunology underlying allergic diseases is now being
elucidated, there are still few useful diagnostic tests.
The normal immune response of experimental animals to ingested antigens is
usually an increased mucosal immunity associated with an active suppression of
the systemic response (1-3).
This report describes a trial with a formula in which the protein fraction in the
form of demineralized whey from cow's milk has been subjected to physicochemical
treatment, as presented in the chapter by Jost (this volume), and has been tested
for hypoallergenicity in an animal model, as described in the chapter by Pahud et
al. (this volume).
Together with beta-lactoglobulin, the different types of casein are considered to
be responsible for most of the allergenicity of cow's milk proteins (1).
The dietetic treatment of food allergy is, in theory, extremely simple, since it
only involves (a) the identification of relevant food antigens and (b) the avoidance
of relevant food antigens.
The presence in a family of an infant or a child with immunologically mediated
adverse responses to food causes important feeding problems.
I should like to tell you about some of our results in studying the absorption of macromolecules.
The increasing use of animal milk for infant feeding during the nineteenth century
led to the first reports of allergy to cow's milk at the beginning of this century.
Food allergies, particularly cow's milk allergy, often appear to be familial, possibly
owing to a genetic tendency to respond with increased IgE production rather
than owing to inheritance of sensitivity of specific food allergens.
Food allergy is closely linked with children's age, and the condition might be
due to the degree of functional immaturity of the immune system or the digestive
Adverse reactions to foods and food constituents represent an increasing problem for the practicing allergist (1-4).