NDLI: Anaphylaxis to cow's milk formula containing short-chain galacto-oligosaccharide.

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Anaphylaxis to cow's milk formula containing short-chain galacto-oligosaccharide.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Chiang, Wen Chin Huang, Chiung-Hui Llanora, Genevieve V. Gerez, Irvin Goh, Si Hui Shek, Lynette P. C. Nauta, Alma J. Van Doorn, Wilhelmina A. Bindels, Jacques Ulfman, Laurien H. Knipping, Karen Delsing, Dianne J. Knol, Edward F. Lee, Bee Wah
Description	Country affiliation: Singapore Author Affiliation: Chiang WC ( Department of Paediatrics, KK Woman's and Children's Hospital, Singapore. Chiang.Wen.Chin@kkh.com.sg)
Abstract	BACKGROUND: On the basis of the proven prebiotic effects of oligosaccharides in cow's milk formula (CMF) in infants, CMFs are supplemented with oligosaccharides. OBJECTIVE: We present a series of 5 cases of cow's milk-tolerant but atopic patients with a history of respiratory allergies. All had anaphylaxis after the ingestion of CMF supplemented with short-chain galacto-oligosaccharide (scGOS). The allergen trigger was investigated. METHODS: Clinical histories were collated. Skin prick tests (SPTs) and basophil activation tests (BATs) were carried out with the eliciting CMF that triggered anaphylaxis, with or without supplemented prebiotics (scGOS) and with scGOS fractions containing oligosaccharides of different chain lengths. RESULTS: The median age of presentation was 6 years (range, 5-38 years). Anaphylaxis occurred within 30 minutes of the first known exposure to CMF supplemented with prebiotics in all patients. Only 1 patient was subjected to oral challenge, which resulted in an anaphylactic reaction. All patients demonstrated IgE sensitization through SPTs and BATs to scGOS and fractions of scGOS containing 3 sugar units or greater but not to cow's milk or long-chain fructo-oligosaccharide. Eight child control subjects tolerant to regular ingestion of scGOS-supplemented CMF and 1 adult volunteer were found to have negative results to scGOS through SPTs and BATs. In addition, in vitro BATs with donor basophils sensitized with sera from 2 of the 3 reported cases showed reactions to scGOS. The scGOS-induced basophil activation was inhibited in the presence of wortmannin, a phosphatidylinositol 3-kinase inhibitor. CONCLUSIONS: This study describes an unusual form of IgE-mediated anaphylaxis triggered by low-molecular-weight oligosaccharides in scGOS. The primary sensitizer for this phenomenon requires further investigation.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
Journal	Journal of Allergy and Clinical Immunology
Issue Number	6
Volume Number	130
Language	English
Publisher	Elsevier
Publisher Date	2012-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Anaphylaxis Diagnosis Food, Formulated Adverse Effects Milk Hypersensitivity Oligosaccharides Immunology Respiratory Hypersensitivity Adolescent Animals Basophil Degranulation Test Child, Preschool Dietary Supplements Immunoglobulin E Blood Skin Tests Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article Case study
Subject	Immunology and Allergy Immunology

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