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Clin Exp Allergy. 2014 Jan;44(1):69-78. doi: 10.1111/cea.12228.

Role of maternal elimination diets and human milk IgA in the development of cow's milk allergy in the infants.

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Division of Allergy and Immunology & Center for Immunology and Microbial Diseases, Albany Medical College, Albany; Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Icahn School of Medicine at Mount Sinai, New York.



The role of maternal avoidance diets in the prevention of food allergies is currently under debate. Little is known regarding the effects of such diets on human milk (HM) composition or induction of infant humoral responses.


To assess the association of maternal cow's milk (CM) avoidance during breastfeeding with specific IgA levels in HM and development of cow's milk allergy (CMA) in infants.


We utilized HM and infant serum samples from a prospective birth cohort of 145 dyads. Maternal serum and HM samples were assessed for casein and beta-lactoglobulin (BLG)-specific IgA and IgG by ELISA; 21 mothers prophylactically initiated a strict maternal CM avoidance diet due to a sibling's history of food allergy and 16 due to atopic eczema or regurgitation/vomiting seen in their infants within the first 3 months of life. Infants' sera were assessed for casein and BLG-specific IgG, IgA and IgE; CMA was confirmed by an oral food challenge. The impact of HM on BLG uptake was assessed in transcytosis assays utilizing Caco-2 intestinal epithelial cell line.


Mothers avoiding CM had lower casein- and BLG-specific IgA in HM than mothers with no CM restriction (P = 0.019 and P = 0.047). Their infants had lower serum casein- and BLG-specific IgG(1) (P = 0.025 and P < 0.001) and BLG-specific IgG(4) levels (P = 0.037), and their casein- and BLG-specific IgA levels were less often detectable than those with no CM elimination diet (P = 0.003 and P = 0.007). Lower CM-specific IgG4 and IgA levels in turn were associated with infant CMA. Transcytosis of BLG was impaired by HM with high, but not low levels of specific IgA.


Maternal CM avoidance was associated with lower levels of mucosal-specific IgA levels and the development of CMA in infants.


HM IgA may play a role in preventing excessive, uncontrolled food antigen uptake in the gut lumen and thereby in the prevention of CMA.


IgA; avoidance; breast milk; breastfeeding; cow's milk; cow's milk allergy; epithelium; human milk; infants; restriction diet; secretory IgA

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