Penggunaan Susu

formula soy untuk

Alergi Susu Sapi
HARSOYO NOTOATMOJO
FK UNDIP/RSUP Dr. KARIADI
 PENDAHULUAN
Alergi Susu Sapi :
Reaksi immunologik thd protein susu
terjadi Alergi protein susu sapi.
( mis. Intoleransi laktosa)
Vandenplas Y, Brueton M, Dupont C, Hill D,
I solauri et al Arch Dis Child 2007;92:902-
908
Terdapat hubungan dgn hypersensitivity
type I (IgE or non-IgE mediated)
 Alergi Makanan
Problem International

Israel:
Egg
3.9 Milk Singapore:
% Sesame seeds SeaBirdsnest
USA:
food
Milk
Egg
Egg
Milk
Peanuts
Tree nuts France: Australia:
Seafood Egg Milk
Peanuts Italy: Egg
Milk Milk Peanuts
Mustard Egg Sesame
Seafood seeds
Big 8 Foods: milk, egg, peanut, soy, wheat, tree nuts, fish, shellfish
 Mechanisms of allergic reactions
to milk protein

Crittenden RG, Bennett LE. Cows Milk Allergy : A Complex Disorder. Journal of
the American College of Nutrition, vol. 24, No. 6, 2005
 Epidemiologi Risiko Alergi Makanan
Alergi Makanan dan Penyakit Atopi lain:
AD adalah manifestasi pertama dari atopic march
AD umur beberapa bulan
FA pada umur 1-3 tahun
33-81% pada bayi dan anak muda AD with AD
mempunyai FA

AD berhubungan dengan alergi telur,

susu dan kacang tanah1
Study of 2184 infants2

1Lack G, et al. N Engl J Med 2003;348:977-85

2Hill DJ, et al. Clin Exp Allergy 2008;38:161-8
ATOPY
 Alergi Susu Sapi (CMA)
Prevalensi : Bayi 2-3%
CMA berkembang pada beberapa bulan pertama
kehidupan
Permulaan Cepat vs. Lambat
Mis. Anaphylaxis vs. Manifestasi Kulit/percernaan
Sistem Imun hypersensitivitas makanan
IgE vs. Non-IgE
CMA yang berhubungan reaksi yang berat: 15%
pada anak-anak

Rona RJ. J Allergy Clin Immunol 2007;120:638

Boyano-Martinez. J Allergy Clin Immunol 2009;123:88
 Allergenisitas protein
Makanan

Glycoprotein :
Berat Molekular 10 60 kDa
Resisten terhadap denaturasi
Epitop

Joint statement of ESPACI on hypoallergenic formulas and ESPGHAN. Dietary

products used in infants for treatment and prevention of food allergy. Arch Dis
12/3/2017
Child 1999;81 9
Keseimbangan Th1 dan Th2

Normal Alergi
Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, et al. Guidelines for the
diagnosis and management of cows milk protein allergy in infants. Arch Dis Child
2007;92:902-908
Schouten B. Cows milk allergy : immune modulation by dietary intervention
 Protein Susu sapi
Protein Molecular Weight Content (%)
Caseins
alpha(s1)-casein 23,000; 199 residues, 17 proline 32
residues

alpha(s2)-casein 25,000; 207 residues, 10 prolines 8

-casein 24,000; 209 residues, 35 prolines 32
kappa-casein 19,000; 169 residues, 20 prolines 8
80
Whey proteins 12
-Lactoglobulins 18,000; 162 residues 4
alpha-Lactalbumins 14,000; 123 residues 3
Immunoglobulins 1
Serum albumin 20
Crittenden and Bennett, J Am Coll Nutr 2005;24:582S-591S
 Algorithm for the diagnosis and management of CMPA in
exclusively breast-fed infant

Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, et al. Guidelines for the diagnosis and
management of cows milk protein allergy in infants. Arch Dis Child 2007;92:902-908
 Algorithm for the diagnosis and management of CMPA in formula-fed
infant

Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, et al. Guidelines for the diagnosis and
management of cows milk protein allergy in infants. Arch Dis Child 2007;92:902-908
 Technologies to Reduce the
Allergenicity of a Protein
Heating

Enzymatic
hydrolysis

Ultrafiltration

The lower the chain length and the smaller the molecular
mass, the lower is the residual allergenicity of a protein /
peptide
Protein Hydrolysates:
Different Types

intact protein pHF eHF Amino acids

Allergenicity
 Hydrolysed formulae
Partially hydrolysed formulae (pHF)
218% peptides above 6000 Dalton.

extensively hydrolysed formulae (eHF),

95% of peptides have a molecular weight below 1500
Dalton
< 0.5% of the remaining peptide is above 6000 Dalton

Amino acid based formula

100% amino acids
Extensively hydrolyzed
VS amino-acids based
 TATA LAKSANA

Nutrisi

1. Prinsip utama menghindari segala bentuk produk susu

sapi, dengan memberikan nutrisi yang seimbang

2. Pemberian ASI Eksklusif

3. Pada bayi yang mengkonsumsi susu formula,

disarankan pemberiansusu hipoalergenik
 Tata Laksana (lanj.)
4. Hindari makanan padat yang mengandung
protein susu sapi pada pemberian makanan
tambahan
5. Pemberian susu kedelai jika susu formula
terhidrolisat ekstensif tidak tersedia
6. Pemberian susu mamalia lain tidak
diperbolehkan pada bayi dibawah usia 1
tahun.
26