(image thanks to idesigniphone.com)
This paper is a nice confirmation out of Italy that there are all kinds of cow’s milk allergies, not just immediate reactions. These include IgG and IgA reactions, for which we can and do testing for.
They also correctly note that reactions can occur hours or many days after ingestion of the dairy product. It’s unusual for research papers to recognize this.
Study from National Institutes of Health:
The immunopathogenesis of cow’s milk protein allergy (CMPA).
authors: Vitaliti G, Cimino C, Coco A, Andrea Domenico P, Lionetti E.
ABSTRACT
The immunological mechanism that lead to the development of Cow Milk Proteins Allergy (CMPA) is not still clarified. There are different mechanisms that contribute to its pathogenesis.
The disease is caused by two main factors: IgE- and not-IgE- mechanisms. IgE-mediated reactions are based on simply immunological mechanisms that are better identified than not-IgE-mediated ones, and are based on pathways involving a humoral-immunity, with production of IgE and inflammatory processes triggered by different allergens. Nevertheless a high percentage of children and adults does not show circulating IgE, specific for cow’s milk proteins and their skin prick test and RAST result negative. This occurs for the development of a not-IgE-mediated allergic disease.
These reactions are characterized by a delayed set up, associated with the onset of symptoms after one hour or many days after the ingestion of cow’s milk proteins. For this reason, these reactions are classified as “delayed hypersensitivity”. However it is important to explain that the two reactions above described are not mutually exclusive and both are involved in different mechanisms. The development of both categories of CMAP is deeply linked to the ability of the host to develop a state of “mucosal tolerance”, defined as a decreased immune response towards foreign antigens.
In food allergy the fine balance between mucosal tolerance and hypersensitivity is regulated by the immune system. This complex system includes molecules with regulatory properties, such as Transforming Growth Factor Beta, IL-10 (TReg) and Natural Killers. Also CD4+CD25+Foxp3+ T cells are described as important mediators for maintaining peripheral tolerance and suppressing the T lymphocytes proliferation.
The purpose of this review is to highlight the immunological background determining the pathogenesis of CMAP and the development of “mucosal tolerance”, in order to clarify the immunological mechanism under the widespread of the disease.
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Image thanks to idesigniphone