https://phaidra.vetmeduni.ac.at/o:2094 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update - III - Cow's milk allergens and mechanisms triggering immune activation Jensen, Sebastian A. Sebastian A. Jensen Medical University of Vienna / University of Veterinary Medicine Vienna WAO DRACMA guideline group WAO DRACMA guideline group Jensen-Jarolim, Erika Erika Jensen-Jarolim 0000-0003-4019-5765 Medical University of Vienna / University of Veterinary Medicine Vienna Venter, Carina Carina Venter University of Colorado Assa'ad, Amal H. Amal H. Assa'ad Cincinnati Children's Hospital Medical Center Takkinen, Kristiina Kristiina Takkinen VTT Technical Research Centre of Finland Ltd. Roth-Walter, Franziska Franziska Roth-Walter 0000-0001-5005-9228 Medical University of Vienna / University of Veterinary Medicine Vienna Pranger, Christina L. Christina L. Pranger 0000-0002-4232-5730 Medical University of Vienna / University of Veterinary Medicine Vienna Passanisi, Stefano Stefano Passanisi University of Messina Pali-Schöll, Isabella Isabella Pali-Schöll Cincinnati Children's Hospital Medical Center / Private Clinics Döbling Nowak-Wegrzyn, Anna Anna Nowak-Wegrzyn Hassenfeld Childrens' Hospital New York Jordakieva, Galateja Galateja Jordakieva Medical University of Vienna Baars, Ton Ton Baars Utrecht University Fiocchi, Alessandro Alessandro Fiocchi Bambino Gesù Children's Hospital Rome Elsevier text eng The immunopathogenesis of cow's milk protein allergy (CMPA) is based on different mechanisms related to immune recognition of protein epitopes, which are affected by industrial processing.The purpose of this WAO DRACMA paper is to: (i) give a comprehensive overview of milk protein allergens, (ii) to review their immunogenicity and allergenicity in the context of industrial processing, and (iii) to review the milk-related immune mechanisms triggering IgE-mediated immediate type hypersensitivity reactions, mixed reactions and non-IgE mediated hypersensitivities.The main cow's milk allergens - α-lactalbumin, β-lactoglobulin, serum albumin, caseins, bovine serum albumins, and others - may determine allergic reactions through a range of mechanisms. All marketed milk and milk products have undergone industrial processing that involves heating, filtration, and defatting. Milk processing results in structural changes of immunomodulatory proteins, leads to a loss of lipophilic compounds in the matrix, and hence to a higher allergenicity of industrially processed milk products. Thereby, the tolerogenic capacity of raw farm milk, associated with the whey proteins α-lactalbumin and β-lactoglobulin and their lipophilic ligands, is lost.The spectrum of immunopathogenic mechanisms underlying cow's milk allergy (CMA) is wide. Unprocessed, fresh cow's milk, like human breast milk, contains various tolerogenic factors that are impaired by industrial processing. Further studies focusing on the immunological consequences of milk processing are warranted to understand on a molecular basis to what extent processing procedures make single milk compounds into allergens. Bovine Beta-Lactoglobulin; Alpha-Lactalbumin; Food Allergy; Protein; Anaphylaxis; Casein; Children; Receptor; Infants; Dermatitis http://creativecommons.org/licenses/by/4.0/ https://phaidra.vetmeduni.ac.at/api/object/o:2094/download 10.1016/j.waojou.2022.100668 https://phaidra.vetmeduni.ac.at/o:605 application/pdf World Allergy Organization Journal 15(9) (2022) World Allergy Organization Journal 15 9 534.55 kB 2022