Specialty Infant Formulas for Milk Allergy: Current Choices and Unmet Needs
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Purpose of Review
Literature on the different options for the management of cow’s milk allergy (CMA) was reviewed. Literature was searched using databases to find original papers and reviews on this topic.
Amino acid based infant formula (AAF) is the most effective dietary treatment of CMA. However, because of the high cost, guidelines recommend extensively hydrolyzed formula (eHF) with a clinical proof of efficacy as the first choice option. In many parts of the world, rice hydrolysates are an alternative option. Soy infant formula can sometimes still be considered, in the absence of more suitable products. Yet, about 10 to 15% of infants allergic to cow milk will also react to soy. Thickened eHF and AAF may be helpful in infants presenting also with troublesome regurgitation. Partially hydrolyzed formula or infant formula with intact protein from other animals is no option. Finally, oral immune therapy is indicated in some children with persistent CMA.
eHF remains the first option for the treatment of most patients with CMA. Recent data on induction of oral tolerance in CMA infants are interesting and deserve further research.
KeywordsCow milk (protein) allergy Extensively hydrolyzed formula Amino acid formula
Compliance with Ethical Standards
Conflict of Interest
Y Vandenplas has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott Nutrition, Biocodex, CHR Hansen, Danone, Nestle Health Science, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition, Schär, United Pharmaceuticals, Wyeth. S Nutten is a Nestec Ltd. employee.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 6.Spergel JM. Nonimmunoglobulin e-mediated immune reactions to foods. Allergy, Asthma Clin Immunol. 2006;2:78–85.Google Scholar
- 12.• Kiewiet MB, Gros M, van Neerven RJ, Faas MM, de Vos P. Immunomodulating properties of protein hydrolysates for application in cow’s milk allergy. Pediatr Allergy Immunol. 2015;26:206–17 The effects of extensive protein hydrolysates on the immune system. This paper highlights the differences between hydrolysates.CrossRefGoogle Scholar
- 14.• Gonzalez Ballesteros LF, Ma NS, Gordon RJ, Ward L, Backeljauw P, Wasserman H, et al. Unexpected widespread hypophosphatemia and bone disease associated with elemental formula use in infants and children. Bone. 2017;97:287–92 The nutritional properties of formulas for the treatment of cow milk allergy differ, and because of differences in bioavailablity some may be related to nutritional deficiencies.CrossRefGoogle Scholar
- 17.Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183–91.CrossRefGoogle Scholar
- 21.• Niggemann B, Nies H, Renz H, Herz U, Wahn U. Sensitizing capacity and residual allergenicity of hydrolyzed cow’s milk formulae: results from a murine model. Int Arch Allergy Immunol. 2001;125:316–21 The differences between hydrolysates are highlighted. Each hydrolysate has different properties.CrossRefGoogle Scholar
- 29.Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66:516–54.CrossRefGoogle Scholar
- 47.• Miceli Sopo S, Greco M, Monaco S, Bianchi A, Cuomo B, Liotti L, et al. Matrix effect on baked milk tolerance in children with IgE cow milk allergy. Allergol Immunopathol (Madr). 2016;44:517–23 Tolerance to milk protein depends on teh way the milk is presented: tolerances to cooked/baked milk may be larger than tolerance to liquid milk.CrossRefGoogle Scholar
- 53.Berni Canani R, Di Costanzo M, Bedogni G, Amoroso A, Cosenza L, Di Scala C, et al. Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow’s milk allergy: 3-year randomized controlled trial. J Allergy Clin Immunol. 2017;139:1906–1913.e4.CrossRefGoogle Scholar
- 58.• Tordesillas L, Berin MC. Mechanisms of oral tolerance. Clin Rev Allergy Immunol. 2018. https://doi.org/10.1007/s12016-018-8680-5Interesting review on the induction of tolerance.
- 75.Berni Canani R, Nocerino R, Terrin G, Coruzzo A, Cosenza L, Leone L, et al. Effect of extensively hydrolyzed casein formula supplemented with Lactobacillus GG on tolerance acquisition in infants with cow’s milk allergy: a randomized trial. J Allergy Clin Immunol. 2012;129:580–2.CrossRefGoogle Scholar