Allergy to goat and sheep milk without allergy to cows’ milk

Cows’ milk allergy occurs in 2% to 6% of the infant population, being the most frequent cause of food allergy. Many of these infants cannot tolerate goats’ or sheeps’ milk either (Bellioni-Businjco et al, 1999). Conversely, the goat’s or sheep’s milk allergies that are not associated with allergic cross-reactivity to cow’s milk are rare.

Until 2000 a dozen observations of caprine and ovine milk without allergy to bovine milk have been described (Wüthrich and Johansson,1995; Calvani and Allessandri, 1998; Umpiérrez et al, 1999). Since 2000 more frequent observations have been reported (Orlando and Breton-Bouveyron, 2000; Lamblin et al, 2001; Munoz-Martin et al, 2004; Restany, 2004; Martins, 2005; Attou et al, 2005; Tavarez et al, 2007; Boissieu et Dupont, 2008) and significative series have been described: 18 observations by Paty et al (2003), 31 by Bidat et al (2003) and 28 by Ah-Leung et al (2006). Recently Vitte and Bongrand (2008) reported a fatal ewe’s milk-induced anaphylaxis on a 8 years old boy.

Generally chidren had severe allergic reactions, including anaphylaxis, a few minutes after consumption of goats’ or sheeps’ milk products but tolerated cows’ milk products. Clinical observations, skin prick testing and immunoglobulin IgE-binding studies confirmed the diagnosis of goat’s or sheeps’ milk allergy without associated cows’ milk allergy.

The characteristics of goat’s or sheep’s milk allergy differ from those of cow’s milk allergy because it affects older children and appears later (around 6 years). However, Umpiérrez et al (1999) reported on a two years old girl who experienced allergic reactions after eating goat cheese and after touching goat and sheep cheese, but not after consuming cow milk. In the series of Bidat (2003) 19% of the children regularly consumed goats’ milk while previously allergic to cows’ milk.

The major allergenic proteins in cow’s milk are ß-lactoglobulin, a-lactalbumin, serum albumin and caseins (Räsänen et al, 1992). However, it has been suggested that caseins may be the main allergen both in children (Kohno et al, 1994) and adults (Stöger et al, 1993). In their series of infants with goat’s or sheep’s milk allergy, Ah-Leung et al (2006) demonstrated by enzyme allergosorbent tests that the casein fractions and not the whey proteins were involved. Cow’s milk caseins were not at all or poorly recognized by the patient’s IgE, while aS1-, aS2- and ß-caseins from goat’s or sheep’s milk were recognized with high specificity and affinity. Unlike what is observed in cow’s milk allergy, k-casein was not recognized by the IgE antibodies. A similar predominant role of caseins has been observed by Umpiérrez et al (1999). However, Tavares et al (2007) reported that a non-casein 14 kDa protein (probably a-lactalbunin) was involved for a 27 years old female patient exhibiting goats’ milk allergy not associated to cows’ milk allergy.

Due to severity of the anaphylactic reaction of patients with allergy to caprine and ovine milk, Boissieu and Dupont (2008) recommend to avoid eating cheese made from caprine or ovine milk (Feta, Roquefort, Ossau Iraty, Etorky etc.) and cheese not stored at home (restaurant, buffet, friends etc.). Care must be taken to present cheese made from bovine milk and cheese made from caprine or ovine cheese in separate plates to avoid the frequently observed cross-contaminations. Moreover, allergic patients must be circunspect with many foods which can contain goat’s or sheep’s dairy proteins such as pizza, toasted cheese, Moussaka etc.

In this new context, the agroalimentary industry must now implement analytical methods to detect goat’s or sheep’s milk in bovine dairy products and in agro-alimentary products with added milk proteins. Most of the published analytical methods have been developed for the detection of bovine milk in the more expensive caprine or ovine milks. The detection limits are around 1% contamination since a lower percentage is not of economical interest. Now, the detection of potentially allergenic goat’s milk or sheep’s milk in cow’s milk must be more sensitive, down to 10-100 ppm, in order to guarantee the allergenic safety of the cow milk dairy products.

References

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