Cow’s milk protein allergy damages not only the baby’s health but also the mother’s health
Main Article Content
Keywords
allergic proctocolitis, infant, milk allergy, mother’s health, nutrition
Abstract
The aim of this study was to evaluate the nutritional status, especially calcium deficiency, of breastfeeding mothers of infants diagnosed with cow’s milk food protein-induced allergic proctocolitis (FPIAP) on an elimination diet and to investigate the relationship between daily calcium intake and body composition of these mothers. Our prospective cohort study included 86 patients with cow’s milk protein allergy (CMPA) and their mothers on an elimination diet. The mother’s body fat, muscle, and water percentages were measured with the Bioelectrical Impedance Method (Tanita MC-580). All mothers were administered a diet containing an average of 2000 kcal (kilocalorie), 1000 mg of calcium, and 400 units per day of vitamin D. The final measurements were repeated 1 month later and the results of the first and second assessments were compared. The mean age of the patients included in the study was 3.8 ± 1.8 months, and the M/F (male to female) ratio was 18/17. In all, 54.3% of the patients had only CMPA, while 45.7% had multiple food allergies, including milk. A comparison of the mother’s body measurements before and after the diet showed a significant decrease in fat but with an increase in calcium levels. In contrast, muscle and water ratios did not change (p < 0.001, p = 0.332, p = 0.189). Despite the recommendation of a 2000 kcal per day diet, the second evaluation found that calorie, fat, and protein ratios were significantly reduced (p = < 0.001, p = 0.011, p = 0.009, p < 0.05, respectively). The metabolic health of breastfeeding mothers who follow an elimination diet for CMPA is affected even with dietician support.
References
2 Fiocchi A, Schünemann HJ, Brozek J, Restani P, Beyer K, Troncone R, et al. Diagnosis and rationale for action against cow’s milk allergy (DRACMA): A summary report. J Allergy Clin Immunol. 2010;126(6):1119–28. 10.1016/j.jaci.2010.10.011
3 Mennini M, Fiocchi AG, Cafarotti A, Montesano M, Mauro A, Villa MP, et al. Food protein-induced allergic proctocolitis in infants: Literature review and proposal of a management protocol. World Allergy Organ J. 2020;13(10):100471. 10.1016/j.waojou.2020.100471
4 Agata H, Kondo N, Fukutomi O, Shinoda S, Orii T. Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens. J Allergy Clin Immunol. 1993;91(2):668–79. 10.1016/0091-6749(93)90273-i
5 Papachristou E, Voutsina M, Vagianou K, Papadopoulos N, Xepapadaki P, Yannakoulia M. Dietary intake, diet diversity, and weight status of children with food allergy. J Acad Nutr Diet. 2024;124(12):1606–13. 10.1016/j.jand.2024.05.019
6 Coppola S, Carucci L, Oglio F, Di Sarra C, Ozen G, Berni Canani R. Nutritional strategies for the prevention and management of cow’s milk allergy in the pediatric age. Nutrients. 2023:15(15):3328. 10.3390/nu15153328
7 Sackesen C, Buyuktiryaki B, Gokce T, Gogebakan E, Gundogdu BS, Eltan SB, et al. The association of milk and multiple food avoidance with growth parameters in infants and children. Ann Allergy Asthma Immunol. 2024;132(6):745–51. 10.1016/j.anai.2024.02.023
8 Jardim-Botelho A, Martins TG, Motta-Franco J, Meyer R, Vieira SCF, Protásio BF, et al. Growth and nutritional biomarkers in Brazilian infants with cow’s milk allergy at diagnosis and 18-month follow-up: A prospective cohort study. Pediatr Gastroenterol Hepatol Nutr. 2023;26(6):355. 10.5223/pghn.2023.26.6.355
9 Zhang F, Ye J, Zhu X, Wang L, Gao P, Shu G, et al. Anti-obesity effects of dietary calcium: The evidence and possible mechanisms. Int J Mol Sci. 2019;20(12):3072. 10.3390/ijms20123072
10 Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non-IgE-mediated gastrointestinal food allergy. J Allergy Clin Immunol. 2015;135(5):1114–24. 10.1016/j.jaci.2015.03.025
11 Rashmi R, Umapathy S, Alhajlah O, Almutairi F, Aslam SM. Design and development of portable body composition analyzer for children. Diagnostics (Basel). 2024;14(23):2658. 10.3390/diagnostics14232658
12 Buyuktiryaki B, Celik IK, Erdem SB, Capanoglu M, Civelek E, Guc B, et al. Risk factors influencing tolerance and clinical features of food protein-induced allergic proctocolitis. J Pediatr Gastroenterol Nutr. 2020;70(5):574–9. 10.1097/MPG.0000000000002629
13 Meyer R, Chebar Lozinsky A, Fleischer DM, Vieira MC, Du Toit G, Vandenplas Y, et al. Diagnosis and management of non-IgE gastrointestinal allergies in breastfed infants—An EAACI Position Paper. Allergy. 2020;75(1):14–32. 10.1111/all.13947
14 Meyer R, Groetch M, Santos A, Venter C. The evolution of nutritional care in children with food allergies–With a focus on cow’s milk allergy. J Hum Nutr Diet. 2025;38(1):e13391. 10.1111/jhn.13391
15 Meyer R. Nutritional disorders resulting from food allergy in children. Pediatr Allergy Immunol. 2018;29(7):689–704. 10.1111/pai.12960
16 Pavić I, Kolaček S. Growth of children with food allergy. Horm Res Paediatr. 2017;88(1):91–100. 10.1159/000462973
17 Skypala IJ, McKenzie R. Nutritional issues in food allergy. Clin Rev Allergy Immunol. 2019;57(2):166–78. 10.1007/s12016-018-8688-x
18 Durban R, Groetch M, Meyer R, Collins SC, Elverson W, Friebert A, et al. Dietary management of food allergy. Immunol Allergy Clin North Am. 2021;41(2):233–70. 10.1016/j.iac.2021.01.009
19 Venter C, Agostoni C, Arshad SH, Ben-Abdallah M, Du Toit G, Fleischer DM, et al. Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology. Pediatr Allergy Immunol. 2020;31(8):889–912. 10.1111/pai.13303
20 Rajani PS, Martin H, Groetch M, Järvinen KM. Presentation and management of food allergy in breastfed infants and risks of maternal elimination diets. J Allergy Clin Immunol Pract. 2020;8(1):52–67. 10.1016/j.jaip.2019.11.007
21 Høst A, Husby S, Østerballe OLE. A prospective study of cow’s milk allergy in exclusively breast-fed infants: incidence, pathogenetic role of early inadvertent exposure to cow’s milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr. 1988;77(5):663–70. 10.1111/j.1651-2227.1988.tb10727.x
22 McWilliam V, Netting MJ, Volders E, Palmer DJ, Ansotegui I, Arasi S, et al. World Allergy Organization (WAO) diagnosis and rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines update: Breastfeeding a baby with cow’s milk allergy. World Allergy Organ J. 2023;16(11):100830. 10.1016/j.waojou.2023.100830
23 Adams J, Voutilainen H, Ullner PM, Järvinen KM. The safety of maternal elimination diets in breastfeeding mothers with food-allergic infants. Breastfeed Med. 2014;9(10):555–6. 10.1089/bfm.2014.0118
24 Zhang F, Ye J, Zhu X, Wang L, Gao P, Shu G, et al. Anti-obesity effects of dietary calcium: The evidence and possible mechanisms. Int J Mol Sci. 2019;20(12):3072. 10.3390/ijms20123072
25 Torres-Costoso A, Martínez-Vizcaíno V, Fernández-Rodríguez R, Sequí-Dominguez I, Reina-Gutiérrez S, Núñez de Arenas-Arroyo S, et al. Dietary calcium intake and fat mass in Spanish young adults: The role of muscle strength. Nutrients. 2021;13(12):4498. 10.3390/nu13124498
26 Ismail MS, Al Qahiz M. Can dietary calcium consumption be beneficial in body weight loss regimen. Merit Res J Med Sci. 2016;4::282–9.
27 Perez-Escamilla R, Bermudez O, Buccini GS, Kumanyika S, Lutter CK, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018;361:k2252. 10.1136/bmj.k2252
28 Wosje K, Kalkwarf H. Lactation,weaning, and calcium suplementation: Effects on body composition in postpartum women. Am J Clin Nutr. 2004,80(2):423–9. 10.1093/ajcn/80.2.423
