Abstract
Background: The immunopathogenesis of cow's milk protein allergy (CMPA) is based on different mechanisms related to immune recognition of protein epitopes, which are affected by industrial processing. Purpose: The purpose of this WAO DRACMA paper is to: (i) give a comprehensive overview of milk protein allergens, (ii) to review their immunogenicity and allergenicity in the context of industrial processing, and (iii) to review the milk-related immune mechanisms triggering IgE-mediated immediate type hypersensitivity reactions, mixed reactions and non-IgE mediated hypersensitivities. Results: The main cow's milk allergens – α-lactalbumin, β-lactoglobulin, serum albumin, caseins, bovine serum albumins, and others – may determine allergic reactions through a range of mechanisms. All marketed milk and milk products have undergone industrial processing that involves heating, filtration, and defatting. Milk processing results in structural changes of immunomodulatory proteins, leads to a loss of lipophilic compounds in the matrix, and hence to a higher allergenicity of industrially processed milk products. Thereby, the tolerogenic capacity of raw farm milk, associated with the whey proteins α-lactalbumin and β-lactoglobulin and their lipophilic ligands, is lost. Conclusion: The spectrum of immunopathogenic mechanisms underlying cow's milk allergy (CMA) is wide. Unprocessed, fresh cow's milk, like human breast milk, contains various tolerogenic factors that are impaired by industrial processing. Further studies focusing on the immunological consequences of milk processing are warranted to understand on a molecular basis to what extent processing procedures make single milk compounds into allergens.
Original language | English |
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Article number | 100668 |
Number of pages | 19 |
Journal | World Allergy Organization Journal |
Volume | 15 |
Issue number | 9 |
DOIs | |
Publication status | Published - Sept 2022 |
MoE publication type | A1 Journal article-refereed |
Funding
SAJ, FRW and EJJ were supported by the Danube Allergy Research Cluster (DARC), project #08 by the Karl Landsteiner University, Krems, Austria. EJJ, CLP and IPS were supported by the Swiss Messerli Foundation. CLP was supported Austrian Science fund project W1248-B30 to EJJ within MCCA (Molecular, Cellular and Clinical Allergology) doctoral program of the Medical University Vienna; TB is funded by the Software AG Stiftung, Darmstadt, Germany. There was no external source of funding obtained for this study. EJJ and FRW declare inventorship on EP2894478 (“Lipocalins for AIT”), owned by Biomedical International R + D, Vienna, Austria, of whom EJJ is shareholder. TB performs limited paid consulting on dairy farms and presentations at workshops for raw milk producers; CV reports grants from Reckitt, personal fees from Reckitt, personal fees from Danone, personal fees from Abbott, personal fees from Nestle Nutrition Institute, personal fees from Sifter, outside the submitted work. The other authors declare that they have no competing interests.
Keywords
- Allergy
- Beta-lactoglobulin
- Cow's milk
- Food allergy
- Pasteurization