Food Proteins in Human Breast Milk and Probability of IgE-Mediated Allergic Reaction in Children During Breastfeeding: A Systematic Review

TY - JOUR

T1 - Food Proteins in Human Breast Milk and Probability of IgE-Mediated Allergic Reaction in Children During Breastfeeding

T2 - A Systematic Review

AU - Gamirova, Aysylu

AU - Berbenyuk, Anna

AU - Levina, Daria

AU - Peshko, Dmitrii

AU - Simpson, Melanie R.

AU - Azad, Meghan B.

AU - Järvinen, Kirsi M.

AU - Brough, Helen A.

AU - Genuneit, Jon

AU - Greenhawt, Matthew

AU - Verhasselt, Valerie

AU - Peroni, Diego G.

AU - Perkin, Michael R.

AU - Warner, John O.

AU - Palmer, Debra J.

AU - Boyle, Robert J.

AU - Munblit, Daniel

N1 - Funding Information: Conflicts of interest: J. O. Warner was employed (2014-2019) by Imperial College through the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for NW London. The views expressed are those of the author(s) and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. He has received bursaries for lectures and scientific advice from Airsonett, Danone/Nutricia, and Friesland-Campina. R. J. Boyle received consultancy fees from Cochrane, DBV technologies, and Prota Therapeutics, and expert witness fees for acting in cases about anaphylaxis and infant formula claims. D. Levina provided phone consultations on child health–related matters at Nestle hotline. M. Greenhawt has received support from the Agency for Health care Research and Quality; is an expert panel and coordinating committee member of the composition National Institute of Allergy and Infectious Diseases–sponsored Guidelines for Peanut Allergy Prevention; has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory board attendance at boards for Aimmune Therapeutics , DBV Technologies and Sanofi / Genzyme , Genentech , GlaxoSmithKline , Novartis , Nutricia, Kaléo Pharmaceutical, Nestlé, Aquestive Therapeutics, Allergy Therapeutics, AllerGenis, Aravax, Prota Therapeutics and has been paid for legal testimony in cases related to Therapeutics, Pfizer , US World Meds, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, Aimmune Therapeutics , DBV Technologies, BEFORE Brands, multiple state allergy and food anaphylaxis societies, the American College of Allergy, Asthma and Immunology, the European Academy of Allergy, and Clinical Immunology; is an associate editor for the Annals of Allergy, Asthma & Immunology; and is a member of the Joint Taskforce on Allergy Practice Parameters. J. Genuneit has been the project manager of research grants from Danone to both Ulm University and Leipzig University in relation to studies of the composition of breast milk. H. A. Brough declares speaker honoraria from DBV Technologies and Sanofi. M. B. Azad holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease and is a fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She regularly speaks at conferences and workshops on infant nutrition, some sponsored by Medela , the Institute for the Advancement of Breastfeeding & Lactation Education, and Prolacta Biosciences. She has contributed to online courses on breast milk and the infant microbiome produced by Microbiome Courses. She serves in a volunteer capacity as Secretary to the International Society for Research on Human Milk and Lactation and as a member of the National Academy of Sciences, Engineering and Medicine Committee on Scanning New Evidence on the Nutrient Content of Human Milk. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. K. M. Järvinen reports research funding for related work from the NIH and unrelated funding from Aimmune Therapeutics , Food Allergy Research and Education , and Janssen Research and Development; consulting fees from Merck and DBV Technologies; and royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: Conflicts of interest: J. O. Warner was employed (2014-2019) by Imperial College through the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for NW London. The views expressed are those of the author(s) and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health. He has received bursaries for lectures and scientific advice from Airsonett, Danone/Nutricia, and Friesland-Campina. R. J. Boyle received consultancy fees from Cochrane, DBV technologies, and Prota Therapeutics, and expert witness fees for acting in cases about anaphylaxis and infant formula claims. D. Levina provided phone consultations on child health?related matters at Nestle hotline. M. Greenhawt has received support from the Agency for Health care Research and Quality; is an expert panel and coordinating committee member of the composition National Institute of Allergy and Infectious Diseases?sponsored Guidelines for Peanut Allergy Prevention; has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory board attendance at boards for Aimmune Therapeutics, DBV Technologies and Sanofi/Genzyme, Genentech, GlaxoSmithKline, Novartis, Nutricia, Kal?o Pharmaceutical, Nestl?, Aquestive Therapeutics, Allergy Therapeutics, AllerGenis, Aravax, Prota Therapeutics and has been paid for legal testimony in cases related to Therapeutics, Pfizer, US World Meds, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, Aimmune Therapeutics, DBV Technologies, BEFORE Brands, multiple state allergy and food anaphylaxis societies, the American College of Allergy, Asthma and Immunology, the European Academy of Allergy, and Clinical Immunology; is an associate editor for the Annals of Allergy, Asthma & Immunology; and is a member of the Joint Taskforce on Allergy Practice Parameters. J. Genuneit has been the project manager of research grants from Danone to both Ulm University and Leipzig University in relation to studies of the composition of breast milk. H. A. Brough declares speaker honoraria from DBV Technologies and Sanofi. M. B. Azad holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease and is a fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She regularly speaks at conferences and workshops on infant nutrition, some sponsored by Medela, the Institute for the Advancement of Breastfeeding & Lactation Education, and Prolacta Biosciences. She has contributed to online courses on breast milk and the infant microbiome produced by Microbiome Courses. She serves in a volunteer capacity as Secretary to the International Society for Research on Human Milk and Lactation and as a member of the National Academy of Sciences, Engineering and Medicine Committee on Scanning New Evidence on the Nutrient Content of Human Milk. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. K. M. J?rvinen reports research funding for related work from the NIH and unrelated funding from Aimmune Therapeutics, Food Allergy Research and Education, and Janssen Research and Development; consulting fees from Merck and DBV Technologies; and royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest. No funding was received for this work. Publisher Copyright: © 2022 American Academy of Allergy, Asthma & Immunology

PY - 2022/5

Y1 - 2022/5

N2 - Background: Previous reports suggested that food proteins present in human milk (HM) may trigger symptoms in allergic children during breastfeeding, but existing evidence has never been reviewed systematically. Objective: To assess the probability of food proteins in HM to trigger allergic reactions in infants with IgE-mediated food allergy. Methods: Electronic bibliographic databases (MEDLINE, EMBASE) were systematically searched from inception to November 3, 2021. The data regarding the levels of food proteins detected in HM were extracted and compared with data from the Voluntary Incidental Trace Allergen Labelling (VITAL 3.0) guide to assess the probability of food-allergic individuals to experience immediate type allergic reactions on ingesting HM. Results: A total of 32 studies were identified. Fourteen studies assessed excretion of cow's milk proteins into HM, 9 egg, 4 peanut, and 2 wheat; 3 measured levels of cow's milk and egg proteins simultaneously. We found that levels of all food proteins across the studies were much lower than the eliciting dose for 1% of allergic individuals (ED01) in most of the samples. The probability of an IgE-mediated allergic reaction in a food-allergic infant breastfed by a woman consuming the relevant food can be estimated as ≤1:1000 for cow's milk, egg, peanut, and wheat. Conclusions: To our knowledge, this is the first systematic review that assesses and summarizes evidence on food proteins in HM and potential for IgE-mediated allergic reactions. Our data suggest that the probability of IgE-mediated allergic reactions to food proteins in HM is low.

AB - Background: Previous reports suggested that food proteins present in human milk (HM) may trigger symptoms in allergic children during breastfeeding, but existing evidence has never been reviewed systematically. Objective: To assess the probability of food proteins in HM to trigger allergic reactions in infants with IgE-mediated food allergy. Methods: Electronic bibliographic databases (MEDLINE, EMBASE) were systematically searched from inception to November 3, 2021. The data regarding the levels of food proteins detected in HM were extracted and compared with data from the Voluntary Incidental Trace Allergen Labelling (VITAL 3.0) guide to assess the probability of food-allergic individuals to experience immediate type allergic reactions on ingesting HM. Results: A total of 32 studies were identified. Fourteen studies assessed excretion of cow's milk proteins into HM, 9 egg, 4 peanut, and 2 wheat; 3 measured levels of cow's milk and egg proteins simultaneously. We found that levels of all food proteins across the studies were much lower than the eliciting dose for 1% of allergic individuals (ED01) in most of the samples. The probability of an IgE-mediated allergic reaction in a food-allergic infant breastfed by a woman consuming the relevant food can be estimated as ≤1:1000 for cow's milk, egg, peanut, and wheat. Conclusions: To our knowledge, this is the first systematic review that assesses and summarizes evidence on food proteins in HM and potential for IgE-mediated allergic reactions. Our data suggest that the probability of IgE-mediated allergic reactions to food proteins in HM is low.

KW - Allergens

KW - Allergy

KW - Breast milk

KW - Breastfeeding

KW - Child

KW - Cow's milk

KW - Egg

KW - Food allergy

KW - Food proteins

KW - Gliadin

KW - Human milk

KW - Infant

KW - Peanut

UR - http://www.scopus.com/inward/record.url?scp=85124996939&partnerID=8YFLogxK

U2 - 10.1016/j.jaip.2022.01.028

DO - 10.1016/j.jaip.2022.01.028

M3 - Article

C2 - 35123103

AN - SCOPUS:85124996939

SN - 2213-2198

VL - 10

SP - 1312-1324.e8

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

IS - 5

ER -