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 en 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 1552099 10.1016/j.waojou.2022.100668 2023-09-08T12:33:45.689Z 44 yes 46 Sebastian A. Jensen Medical University of Vienna / University of Veterinary Medicine Vienna Alessandro Fiocchi Bambino Gesù Children's Hospital Rome person Ton Baars Utrecht University person Galateja Jordakieva Medical University of Vienna person Anna Nowak-Wegrzyn Hassenfeld Childrens' Hospital New York person Isabella Pali-Schöll Cincinnati Children's Hospital Medical Center / Private Clinics Döbling person Stefano Passanisi University of Messina person Christina L. Pranger Medical University of Vienna / University of Veterinary Medicine Vienna person 0000-0002-4232-5730 Franziska Roth-Walter Medical University of Vienna / University of Veterinary Medicine Vienna person 0000-0001-5005-9228 Kristiina Takkinen VTT Technical Research Centre of Finland Ltd. person Amal H. Assa'ad Cincinnati Children's Hospital Medical Center person Carina Venter University of Colorado person Erika Jensen-Jarolim Medical University of Vienna / University of Veterinary Medicine Vienna person 0000-0003-4019-5765 WAO DRACMA guideline group person application/pdf 547376 https://phaidra.vetmeduni.ac.at/o:2094 no yes 16 70 1552253 World Allergy Organization Journal 19 15 9 Elsevier 2022