Monday, June 25, 2007

Milk Soy Protein Intolerance (MSPI): The Great Goat's Milk Fallacy

Finding sources of fat and calcium is very difficult for moms breastfeeding MSPI kids. Many people (even lactation consultants and dietitians) suggested goats milk (and goat cheese and yogurt) as viable options. A chat with our allergist revealed that goat milk-based products are NOT safe for MSPI kids.

Bovine albumin (the protein that causes the irritation) and goat albumin have 97% structural homology. This means that the two proteins are almost identical and cause identical symptoms.

Enriched rice milk is a good source of calcium and can be used instead of milk in most recipes. I have yet to find alternatives for cheese and yogurt.

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JayMonster said...

Interesting in that I did not find one source that suggested that goat's milk was in fact a valid alternative.

However, most do state that it is an allergy that most kids outgrow quite quickly, so the milk and cheese, which are really based on milk fats really may not have a viable alternative until the child outgrows the allergy.

MT said...

How do you know it's the albumin and not the casein? "Whole Life Healthcare" (a vendor of specialty foods seemingly) refers to
"Genetic Casein Intolerance" and asserts that "all mammalian milk products contain the protein casein, however cow’s milk contains
approximately ten times the amount of casein than others."

MT said...

In fact, see here, where (amidst some complicating points) it reports " Immunoblotting and competitive enzyme-linked immunosorbent assays have identified a 30-kD glycinin from soybeans that cross-reacts with cow's milk caseins and is composed of 2 polypeptides (A5 and B3) linked by a disulphide bond. The protein's capacity to bind to the different antibodies relies on the B3 polypeptide. "

MT said...

Is MSPI maybe otherwise known as "Infantile food protein-induced enterocolitis syndrome (FPIES)"?

Here's a paper:

PEDIATRICS Vol. 111 No. 4 April 2003, pp. 829-835

Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins
Anna Nowak-Wegrzyn, MD*, Hugh A. Sampson, MD*, Robert A. Wood, MD{ddagger} and Scott H. Sicherer, MD

Background. Infantile food protein-induced enterocolitis syndrome (FPIES) is a severe, cell-mediated gastrointestinal food hypersensitivity typically provoked by cow’s milk or soy. Solid foods are rarely considered a cause.

Objective. To describe the clinical characteristics and natural history of FPIES provoked by solid foods.

Methods. Patients with FPIES induced by solid foods were identified and their clinical course compared with a control group with FPIES caused by cow’s milk and/or soy evaluated over the same time period.

Results. Fourteen infants with FPIES caused by grains (rice, oat, and barley), vegetables (sweet potato, squash, string beans, peas), or poultry (chicken and turkey) were identified. Symptoms were typical of classical FPIES with delayed (median: 2 hours) onset of vomiting, diarrhea, and lethargy/dehydration. Eleven infants (78%) reacted to >1 food protein, including 7 (50%) that reacted to >1 grain. Nine (64%) of all patients with solid food–FPIES also had cow’s milk and/or soy-FPIES. Initial presentation was severe in 79% of the patients, prompting sepsis evaluations (57%) and hospitalization (64%) for dehydration or shock. The diagnosis of FPIES was delayed, after a median of 2 reactions (range: 2–5). Thirty patients with typical cow’s milk- and/or soy-FPIES were identified for comparison. Overall, 48% of the 44 infants with FPIES were reactive to >1 food protein, and the risk for multiple food hypersensitivity approached 80% in the infants with solid food or soy-induced FPIES. None of the patients developed FPIES to maternally ingested foods while breastfeeding unless the causal food was fed directly to the infant.

Conclusions. Cereals, vegetables, and poultry meats, typically regarded as of low allergenic potential, must be considered in the evaluation of FPIES, particularly in infants previously diagnosed with FPIES to cow’s milk or soy, and as an initial cause in patients who have been exclusively breastfed. Infants with FPIES are at risk for multiple dietary protein hypersensitivities during an apparent period of immunologic susceptibility. Pediatricians should consider FPIES in the differential diagnosis of shock and sepsis.

Key Words: food protein-induced enterocolitis syndrome • milk-induced enterocolitis syndrome • soy-induced enterocolitis syndrome • oat-induced enterocolitis syndrome • rice-induced enterocolitis syndrome • food allergy • non-immunoglobulin E-mediated food hypersensitivity • rice allergy • oat allergy

MT said...

Also re: diagnosis of FPIES I noticed this:

"Atopy patch test for the diagnosis of food
protein-induced enterocolitis syndrome"

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy
patch test for the diagnosis of food protein-induced enterocolitis
Pediatr Allergy Immunol 2006: 17: 351–355.

MT said...

"How is FPIES Different From MSPI, MSPIES, MPIES, Etc.?

"MPIES (milk-protein induced enterocolitis syndrome) is FPIES to cow's milk only. MSPIES (milk- and soy-protein induced enterocolitis syndrome) is FPIES to milk and soy. Some doctors do create these subdivisions, while others declare that milk and soy are simply the two most common FPIES triggers and give the diagnosis of "FPIES to milk and/or soy.

"MSPI is milk and soy protein intolerance. Symptoms are those of allergic colitis and can include colic, vomiting, diarrhea and blood in stools. These reactions are not as severe or immediate as an FPIES reaction."