Epigenetic Effects in Children With Cow's Milk Allergy Treated With Different Formulas

NCT ID: NCT04184700

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-10

Study Completion Date

2024-08-31

Brief Summary

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Lactobacillus GG (LGG) is able to exert long lasting effects in children with atopic disorders. Nutramigen LGG accelerates tolerance acquisition in infants with cow's milk allergy. The mechanisms of these effects are still largely undefined. The effect of LGG could be related at least in part by the immunoregulatory role played by LGG. This probiotic can balance the generation of cytokines possibly involved in IgE- or non-IgE-mediated cow's milk allergy Interleulkin (IL)-4, IL-5, IL-10, IFN-γ , TGF-β, and TNF-Υ), which can contribute to modulation of inflammatory processes. The investigators have demonstrated that children with IgE-mediated CMA produce significantly higher level of IL-4 and IL-13 in response to cow's milk protein, and that tolerance is associated with a marked reduction of IL-13 production and a concomitant increased frequency of IFN-γ releasing cells. Epigenetics studies the heritable (and potentially reversible) changes of the genome inherited from one cell generation to the next which alter gene expression but do not involve changes in primary DNA sequences, highlighting the complexity of the inter-relationship between genetics and nutrition. There are three distinct, but closely interacting, epigenetic mechanisms (histone acetylation, DNA methylation, and non-coding microRNAs) that are responsible for modifying the expression of critical genes associated with physiologic and pathologic processes. The profile of epigenetic modifications associated with Th lineage commitment, coupled with the sensitivity of the early developmental period, has led to speculation that factors that disrupt these pathways may increase the risk of allergic diseases. Specifically, effects on DNA methylation and endogenous histone deacetylase inhibitors acting on specific pathways (Th1 and T regulatory cell differentiation) may favour Th2-associated allergic differentiation. MicroRNAs are another structural components of an epigenetic mechanism of post-transcriptional regulation of messenger RNA translation. It has been recently identified a specific Th2-associated microRNA (miR-21) that is critical for the regulation of Th cell polarization. It has been previously demonstrated an inverse DNA methylation pattern of cytokines involved in Th2 response (IL-4, IL-5) compared with cytokines involved in Th1 response (IL-10, INF- y) in children with CMA acquiring oral tolerance, with the most pronounced effects in those treated with Nutramigen LGG.

Detailed Description

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Conditions

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Cow Milk Allergy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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EHCF + LGG

Extensively hydrolyzed casein formula plus Lactobacillus rhamnosus GG

Group Type EXPERIMENTAL

EHCF+LGG

Intervention Type DIETARY_SUPPLEMENT

Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG

RHF

Extensively hydrolyzed rice formula

Group Type ACTIVE_COMPARATOR

RHF

Intervention Type DIETARY_SUPPLEMENT

Rice hydrolysed formula

EHWF

Extensively hydrolyzed protein formula

Group Type ACTIVE_COMPARATOR

EHWF

Intervention Type DIETARY_SUPPLEMENT

extensively hydrolysed whey formula

AAF

Amino acid based formula

Group Type ACTIVE_COMPARATOR

AAF

Intervention Type DIETARY_SUPPLEMENT

amino acid based formula

SF

Soy formula

Group Type ACTIVE_COMPARATOR

SF

Intervention Type DIETARY_SUPPLEMENT

Soy formula

Interventions

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EHCF+LGG

Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG

Intervention Type DIETARY_SUPPLEMENT

RHF

Rice hydrolysed formula

Intervention Type DIETARY_SUPPLEMENT

SF

Soy formula

Intervention Type DIETARY_SUPPLEMENT

EHWF

extensively hydrolysed whey formula

Intervention Type DIETARY_SUPPLEMENT

AAF

amino acid based formula

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* children with cow's milk allergy

Exclusion Criteria

* Concomitant chronic systemic diseases,
* congenital cardiac defects,
* active tuberculosis,
* autoimmune diseases,
* immunodeficiency,
* chronic inflammatory bowel diseases,
* celiac disease,
* cystic fibrosis,
* metabolic diseases,
* malignancy,
* chronic pulmonary diseases,
* malformations of the gastrointestinal tract,
* suspected eosinophilic esophagitis or eosinophilic enterocolitis,
* suspected food-protein-induced enterocolitis syndrome,
* suspected cow's milk protein-induced anaphylaxis,
* still on exclusion diet with one of the study formulas or with another dietary regimen because of cow's milk allergy,
* other food allergies.
Minimum Eligible Age

6 Months

Maximum Eligible Age

12 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Federico II University

OTHER

Sponsor Role lead

Responsible Party

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Roberto Berni Canani, MD, PhD

Full professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Pediatric Office

Naples, , Italy

Site Status

Countries

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Italy

Other Identifiers

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28n15

Identifier Type: -

Identifier Source: org_study_id