Cow’s milk allergy is associated with changes in urinary organic acid concentrations

Abstract

Cow's milk allergy (CMA) is the most common form of food allergy affecting 2.5% of children, but the diagnosis is often difficult. Both intestinal microbiota and barrier function seem to be disturbed in patients with food allergies, and administration of probiotics has been shown to normalize intestinal microbiota and alleviate symptoms. We hypothesized that the differences in intestinal metabolic activity and permeability could lead to detectable changes in the end-products of metabolism in patients with CMA. This could offer new diagnostic possibilities. The urinary concentrations of 37 organic acids were studied by a mass spectrometry-based method in 35 infants aged under 1 yr with atopic eczema, 16 of them having CMA diagnosed with a double-blind placebo-controlled food challenge test. The control group consisted of the remaining 19 infants with only atopic eczema. In a second study, Lactobacillus rhamnosus GG (LGG) or placebo was administered to the infants with CMA for 4 wk and the urinary organic acids were analysed again. CMA patients and patients with only atopic eczema had statistically significant differences in urinary concentrations of hydroxybutyrate (p<0.001); adipate and isocitrate (p<0.01 for both); homovanillate, suberate, tartarate, 3-indoleacetate and 5-hydroxyindoleacetate (p<0.05 for all). These concentrations did not change significantly following LGG administration to the CMA patients, but a trend towards the control group was seen. Thus, CMA is associated with changes in some urinary organic acid levels. These differences between atopic infants with and without CMA could be investigated as a novel approach for CMA diagnosis.

Current insights into cow's milk allergy in children: Microbiome, metabolome, and immune response—A systematic review

“…16,24,26 In addition to GM modifications, CMA children were reported to have decreased total SCFAs 14,16 and altered amino acids and nucleotide levels. 14,23 These findings are consistent with a recent review on the metabolic changes in children with IgE-mediated food allergies, 41 and these metabolome changes appear to be restored with interventions. Increased SCFAs and balanced amino acids were reported after treatment with LGG or lactose-supplemented EHF.…”

Food allergy and anaphylaxis in pediatrics: update 2010‐2012

“…CM avoidance resulted in an increase in the proportion of lactobacilli and in a decrease in the proportion of enterobacteria and bifidobacteria. In another study , infants with CM allergy showed a different urinary metabolic profile compared with infants without FA, which may reflect differences in intestinal microbiota. The concentrations of urinary organic acids did not significantly change after 4 weeks of administration of Lactobacillus rhamnosus compared with placebo.…”

“…Early colonization of the infant's gut is thought to protect against the development of allergic disease. Studies have characterized the commensal flora of infants with and without FA and tested the manipulation of the gut microflora through the administration of pre-and/or probiotics (6)(7)(8). Thompson-Chagoyan et al (6) reported that CM-allergic infants had higher total bacteria and anaerobic counts and lower yeast counts than healthy infants.…”

Glycolysis in Patients with Age-Related Macular Degeneration

“…Measurement of urinary metabolites was performed with gas chromatography/mass spectrometry (GC/MS) by US BioTek Laboratories (Seattle, WA) according to the company's published method [18]. The subjects were not allowed to eat or drink on the morning of the test day.…”