title: Tolerability of donkey's milk in 92 highly-problematic cow's milk allergic children.
abstract: OBJECTIVE
  Not exclusively breastfed children with cow's milk allergy (CMA) require a formula or other alternative food, but past and present guidelines differ concerning the best choice. Our aim was to investigate the clinical tolerability, palatability and nutritional adequacy of donkey's milk (DM) in children with proven CMA. It was important to identify a CM replacement for these children, highly problematic from the feeding standpoint, in spite of their age.
  
  
  METHODS
  A prospective study was conducted on 92 children with CMA, diagnosed through a CM elimination diet, followed by double-blind, placebo-controlled food challenge (DBPCFC) unless contraindicated. Maternal milk was unavailable and current CM substitutes could not be used. Moreover, 89 percent were affected by multiple FA, and subjected to very restricted diets. Within 3 months after the last CM challenge, DBPCFC for DM was performed. CM or DM skin prick test and sIgE determination preceded the CM or DM challenge, respectively. Native electrophoresis and immunoblotting were used to identify CM and DM cross-reactive proteins. Z-scores of weight and length/stature for age were calculated at DM food challenge (T0) and during DM assumption.
  
  
  RESULTS
  83 children (90.2 percent) liked and tolerated DM, at challenge and during follow-up, with increased Z-score for weight and length/stature and improved nutritional parameters. Bovine beta-lactoglobulin was identified as the cross-reacting protein among the DM allergic patients.
  
  
  CONCLUSIONS
  DM was found to be a valid alternative foodstuff, in terms of clinical tolerability, palatability and nutritional adequacy, in subjects with CMA who were highly problematic from the feeding standpoint.
authors.affiliation: Department of Paediatric and Adolescence Science, Regina Margherita Children's Hospital, TurinPiazza Polonia 94, 10126 Turin, Italy. giovanna.monti@email.it
authors.forename: G
authors.initials: G
authors.lastname: Monti
authors.forename: S
authors.initials: S
authors.lastname: Viola
authors.forename: C
authors.initials: C
authors.lastname: Baro
authors.forename: F
authors.initials: F
authors.lastname: Cresi
authors.forename: P A
authors.initials: PA
authors.lastname: Tovo
authors.forename: G
authors.initials: G
authors.lastname: Moro
authors.forename: M P
authors.initials: MP
authors.lastname: Ferrero
authors.forename: A
authors.initials: A
authors.lastname: Conti
authors.forename: E
authors.initials: E
authors.lastname: Bertino
mesh_terms: D000818:Animals; D001724:Birth Weight; D001827:Body Height; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D018397:Equidae; D005260:Female; D006801:Humans; D015151:Immunoblotting; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000276:immunology*; D007782:Lactoglobulins / Q000097:blood / Q000276:immunology*; D008297:Male; D008892:Milk; D016269:Milk Hypersensitivity / Q000276:immunology / Q000517:prevention & control*; D008895:Milk, Human; D010919:Placebos; D011446:Prospective Studies; D012882:Skin Tests
chemical_list: D007782:Lactoglobulins; D010919:Placebos; D007073:Immunoglobulin E