Journal
WORLD ALLERGY ORGANIZATION JOURNAL
Volume 15, Issue 9, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.waojou.2022.100668
Keywords
Allergy; Cow's milk; Beta-lactoglobulin; Food allergy; Pasteurization
Categories
Funding
- Danube Allergy Research Cluster (DARC) by the Karl Landsteiner University, Krems, Austria [08]
- Swiss Messerli Foundation
- Austrian Science fund project within MCCA (Molecular, Cellular and Clinical Allergology) doctoral program of the Medical University Vienna [W1248-B30]
- Software AG Stiftung, Darmstadt, Germany
- The World Allergy Organization
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The immunopathogenesis of cow's milk protein allergy is affected by industrial processing, leading to structural changes and increased allergenicity of milk allergens. Unprocessed fresh milk contains tolerogenic factors that are impaired by industrial processing.
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 - alpha-lactalbumin, beta-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 alpha-lactalbumin and beta-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.
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