A male preterm infant with cow’s milk allergy to human milk fortifier showing only severe respiratory symptoms

Abstract

We report a male infant with a birthweight of 1,400 g at 29 weeks 2 days gestation diagnosed as having cow's milk allergy (CMA) due to human milk fortifier, who developed severe respiratory symptoms. The infant had no gastrointestinal symptoms ; rather, the initial symptoms were apnea attacks and wheezing with a prolonged expiratory phase that progressed to severe ventilatory insufficiency requiring mechanical ventilation. Aggravation of his general condition, which appeared to be due to sepsis, was improved by temporary starvation and respiratory care, but he relapsed on the resumption of enteral feeding of his mother's milk with a human milk fortifier. As a result, this event was interpreted as a positive oral food challenge test. The infant resumed complete breastfeeding without the fortifier and has not relapsed since. Examination of his serial cytokine profiles from residual serum revealed that although interleukin-5 was not increased, interferon (IFN)-γ was increased, suggesting some relation between the time course of IFNγ and the infant's eosinophil count. These findings may indicate that the involvement of IFNγ is one cause of the onset of this disease.

Fortification With Bovine Colostrum Enhances Antibacterial Activity of Human Milk

“…Relative to HM, bovine milk has a very different protein composition, including lower levels of whey proteins and the presence of β‐lactoglobulin, a unique bovine milk factor that causes food allergy 11 . Several clinical trials have reported increased incidence of NEC, mortality, and allergy in preterm infants fed bovine milk‐based formula or BMF 12–14 . The reason for these detrimental effects remains elusive, but it is possible that the harsh thermal‐processing conditions of BMF may destroy its bioactive components and generate compounds with inflammatory properties, including advanced glycation end‐products formed by reaction between reducing sugars and free amino acid groups of proteins 15 .…”

“… 11 Several clinical trials have reported increased incidence of NEC, mortality, and allergy in preterm infants fed bovine milk‐based formula or BMF. 12 , 13 , 14 The reason for these detrimental effects remains elusive, but it is possible that the harsh thermal‐processing conditions of BMF may destroy its bioactive components and generate compounds with inflammatory properties, including advanced glycation end‐products formed by reaction between reducing sugars and free amino acid groups of proteins. 15 Addition of BMF into HM also affects the final product properties, such as pH, osmolality, lipase activity, and antibacterial activity.…”