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42 Food Allergens 801
provide nutritional requirements of neonates. Human milk and
the milks of dairy animals, such as cows, goats, sheep and buf-
faloes, have been extensively studied. Humans are the only
known mammals that consume the milk of other mammals,
particularly from cows. In fact, cow’s milk and cow’s milk-
associated food have been deeply rooted as an important part
of the human diet, and the dairy industry plays a huge role in
supporting nutrition of humans and continues to be a backbone
of the agri-food sector in many countries.
In developed countries, bovine milk and milk-derived prod-
ucts contribute about 19% of total dietary protein intake and 73%
of calcium intake (Tome et al. 2004). However, for some people,
consumption of cow’s milk and cow’s milk-derived food has to
be avoided due to milk allergy. Recent studies have indicated
that prevalence and persistence of cow’s milk allergy (CMA) in
industrialised countries may be increasing. In North America,
incidence of CMA is estimated at 2.5% in children and about
1% in the adult population with a 75% outgrowing rate at the
age of 16 (Sicherer and Sampson 2010).
Milk Protein
Milk protein is a very complex mixture of molecules. Thanks to
advanced analytical techniques, over 200 types of proteins have
been identified in bovine milk (Ng-Kwai-Hang 2002). These
proteins can be arranged into five groups: caseins, whey proteins,
milk fat globule proteins, enzymes and minor miscellaneous
proteins. Caseins and whey proteins make up almost all of the
total milk protein composition, whereas the other 3 groups are
found in trace amounts (Table 42.1). Caseins can be separated
from the other proteins by acid precipitation at pH 4.6 to form
a coagulum. However, the ratio of casein and whey in the milk
varies among different species. In human milk, the ratio is 40:60,
in equine the ratio is 50:50 and in major dairy animals (cows,
goats, sheep and buffaloes) the ratio is 80:20.
Major Milk Allergens
β-Lactoglobulin (BLG, not found in human milk) and caseins,
α-s1-casein in particular, are regarded as the principal allergens
in cow’s milk (Kaminogawa and Totsuka 2003). A recent study
of 115 CMA Japanese children identified casein as a major milk
allergen with 107 (97.3%) children reacting positively to casein-
specific IgE, whereas 51 patients (46.6%) were positive to BLG-
specific IgE (Nakano et al. 2010). However, studies on large
populations show that a high proportion of CMA patients are
sensitised to multiple milk proteins, including proteins present
in very low quantities, such as bovine serum albumin (BSA), im-
munoglobulins and lactoferrin, suggesting that all milk proteins
could be potentially allergenic. Sensitisation to caseins, BLG,
andα-lactalbumin (ALA) appear to be closely linked. However,
sensitivity to BSA seems to be completely independent. Epitope
mapping of major milk allergens has revealed multiple aller-
genic epitopic regions within each protein (Busse et al. 2002,
Cocco et al. 2003).
Caseins
Casein (CN) forms the main fraction of milk proteins and is
subdivided into a number of families, includingα-S1-,α-S2-,
β-,κ- andγ-caseins.
Theα-S1-casein (α-S1-CN) is a single-chain phosphopro-
tein of 199 amino acid residues and represents about 40% of
total casein.α-S1-CN is characterised by a high content of
proline residues without disulfide bonds and the presence of
a small amount of secondary structure, such asα-helix orβ-
sheets. Several epitope regions ofα-S1-CN recognised by hu-
man IgE antibodies have been identified. These regions include
amino acid (aa) 19–30, aa86–103 and aa141–150 (Spuergin
et al. 1996), aa181–199 (Nakajima-Adachi et al. 1998) and nine
regions from amino acid residues 17 through 194 (Chatcha-
tee et al. 2001). Reasons for the differences in the dominant
Table 42.1.Characteristics of the Major Proteins in Human and Cow’s Milk
Proteins Human (mg/mL) Cow (mg/mL)
Molecular Weight (kDa) of
Cow’s Milk Proteins
Number of Amino
Acids in Cow’s Milk
Whole caseins
α-s1-Casein 0 11.6 23.6 199
α-s2-Casein 0 3 25.2 207
β-Casein 2.2 9.6 24 209
κ-Casein 0.4 3.6 19 169
γ-Casein 0 1.6 11.6–20.5
Whey proteins
β-Lactoglobulin 0 3 5.3 162
α-Lactalbumin 2.2 1.2 4.8 123
Immunoglobulins 0.8 0.6 < 150
Serum albumin 0.4 0.4 66.4 582
Lactoferrin 1.4 0.3 76.2 703
Other 1.3 0.6