When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide

Cow’s milk protein allergy (CMPA) is common and costly. Clinical trials of infants with CMPA have shown that the use of an amino acid formula containing pre- and probiotics (synbiotics) (AAF-Syn) may lead to significant reductions in infections, medication prescriptions and hospital admissions, compared to AAF without synbiotics. These effects have not yet been confirmed in real-world practice. This retrospective matched cohort study examined clinical and healthcare data from The Health Improvement Network database, from 148 infants with CMPA (54% male, mean age at diagnosis 4.69 months), prescribed either AAF-Syn (probiotic Bifidobacterium breve M16-V and prebiotics, including chicory-derived oligo-fructose and long-chain inulin) or AAF. AAF-Syn was associated with fewer symptoms (−37%, p < 0.001), infections (−35%, p < 0.001), medication prescriptions (−19%, p < 0.001) and healthcare contacts (−18%, p = 0.15) vs. AAF. Infants prescribed AAF-Syn had a significantly higher probability of achieving asymptomatic management without hypoallergenic formula (HAF) (adjusted HR 3.70, 95% CI 1.97–6.95, p < 0.001), with a shorter clinical course of symptoms (median time to asymptomatic management without HAF 1.35 years vs. 1.95 years). AAF-Syn was associated with potential cost-savings of £452.18 per infant over the clinical course of symptoms. These findings may be attributable to the effect of the specific synbiotic on the gut microbiome. Further research is warranted to explore this. This real-world study provides evidence consistent with clinical trials that AAF-Syn may produce clinical and healthcare benefits with potential economic impact.

Download Full-text

Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13030935 ◽

2021 ◽

Vol 13 (3) ◽

pp. 935

Author(s):

Katy Sorensen ◽

Abbie L. Cawood ◽

Glenn R. Gibson ◽

Lisa H. Cooke ◽

Rebecca J. Stratton

Keyword(s):

Amino Acid ◽

Milk Protein ◽

Hospital Admissions ◽

Normal Growth ◽

Cow’S Milk ◽

Potential Cost ◽

Economic Implications ◽

Cow's Milk ◽

Cow’S Milk Protein ◽

Amino Acid Formula

Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four randomised controlled trials comparing an amino acid formula (AAF) with an AAF containing synbiotics (AAF-Syn) in infants with CMPA (mean age 8.6 months; 68% male, mean intervention 27.3 weeks, n = 410). AAF and AAF-Syn were equally effective in managing allergic symptoms and promoting normal growth. Compared to AAF, significantly fewer infants fed AAF-Syn had infections (OR 0.35 (95% CI 0.19–0.67), p = 0.001). Overall medication use, including antibacterials and antifectives, was lower among infants fed AAF-Syn. Significantly fewer infants had hospital admissions with AAF-Syn compared to AAF (8.8% vs. 20.2%, p = 0.036; 56% reduction), leading to potential cost savings per infant of £164.05–£338.77. AAF-Syn was associated with increased bifidobacteria (difference in means 31.75, 95% CI 26.04–37.45, p < 0.0001); reduced Eubacterium rectale and Clostridium coccoides (difference in means −19.06, 95% CI −23.15 to −14.97, p < 0.0001); and reduced microbial diversity (p < 0.05), similar to that described in healthy breastfed infants, and may be associated with the improved clinical outcomes described. This review provides evidence that suggests combining synbiotics with AAF produces clinical benefits with potential economic implications.

Download Full-text

Growth in Infants with Cow's Milk Protein Allergy Fed an Amino Acid-Based Formula

Pediatric Gastroenterology Hepatology & Nutrition ◽

10.5223/pghn.2021.24.4.392 ◽

2021 ◽

Vol 24 (4) ◽

pp. 392

Author(s):

Yvan Vandenplas ◽

Christophe Dupont ◽

Philippe Eigenmann ◽

Ralf G. Heine ◽

Arne Høst ◽

...

Keyword(s):

Amino Acid ◽

Milk Protein ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein

Download Full-text

PA35 TOLERANCE TO A NEW FREE AMINO ACID-BASED FORMULA IN CHILDREN WITH COW'S MILK PROTEIN ALLERGY

Digestive and Liver Disease ◽

10.1016/s1590-8658(09)60540-5 ◽

2009 ◽

Vol 41 ◽

pp. S235

Author(s):

S. Ruotolo ◽

R. Nocerino ◽

M. Tardi ◽

L. Cosenza ◽

G. Terrin ◽

...

Keyword(s):

Amino Acid ◽

Free Amino Acid ◽

Free Amino ◽

Milk Protein ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein

Download Full-text

Improved Tolerance to a New Amino Acid–Based Formula by Infants With Cow’s Milk Protein Allergy

Nutrition in Clinical Practice ◽

10.1177/0884533616639108 ◽

2016 ◽

Vol 31 (6) ◽

pp. 824-828

Author(s):

Pipop Jirapinyo ◽

Narumon Densupsoontorn ◽

Channagan Kangwanpornsiri ◽

Renu Wongarn ◽

Hathaichanok Tirapongporn ◽

...

Keyword(s):

Amino Acid ◽

Milk Protein ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein

Download Full-text

PA41 USE OF AN AMINO-ACID-BASED FORMULA IN THE TREATMENT OF COW'S MILK PROTEIN ALLERGY PRESENTING AS ALLERGIC PROCTOCOLITIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(10)60635-4 ◽

2010 ◽

Vol 42 ◽

pp. S357-S358

Author(s):

R. Francavilla ◽

R. Sardaro ◽

C. Fontana ◽

S. Fico ◽

F. Indio

Keyword(s):

Amino Acid ◽

Milk Protein ◽

Cow’S Milk ◽

Cow's Milk ◽

Cow’S Milk Protein ◽

Allergic Proctocolitis

Download Full-text

Evaluation of Efficacy and Safety of Longterm Feeding with Amino Acid-Based Formula in Infants with Cow’s Milk Protein Allergy: Results of the Open-Label Prospective Controlled Post-Registration Trial

Annals of the Russian academy of medical sciences ◽

10.15690/vramn757 ◽

2016 ◽

Vol 71 (6) ◽

Author(s):

G. A. Novik ◽

E. G. Khaleva ◽

N. V. Bychkova ◽

M. V. Zdanova

Keyword(s):

Amino Acid ◽

Milk Protein ◽

Cow’S Milk ◽

Efficacy And Safety ◽

Open Label ◽

Cow's Milk ◽

Registration Trial ◽

Cow’S Milk Protein ◽

One Year ◽

Successful Transfer

Background: The cow’s milk allergy (CMA) prevalence is 2−3% in children under one year. Approximately in 5% of cases transferring to extensively hydrolysed formula (eHF) doesn’t lead to disappearance of CMA symptoms. Aims: Evaluation of efficacy and safety of amino-acid formula (AAF) longterm feeding in children under one year and development of predictors of successful transfer from AAF to eHF. Materials and methods: In open-label prospective post-registration trial duration of 365 days were included 43 children aged from 3 to 12 months with CMA. CMA was based on Russian and international guidelines. When a patient was included in the trial, child received eHF for 4 weeks with the evaluation of the effect of elimination diet (ED): in case of absence of effect, for diagnostic purposes child feed with AAF for 2 weeks and upon receiving the effect, child continued to receive it for at least 6 months. Diet was considered effective if there were observed disappearance of clinical manifestations of CMA during of formula using. Results: Children fed with AAF gain weight and increased height statistically higher during the first 6 months, compared with children receiving eHF, but without subsequent difference in a year. After 4 weeks’ of AAF feeding, there was a significant decrease in SCORAD index from 46.84 (SD 4.164) to 2.52 (SD 2.204) (p=0.005); disappearance of gastrointestinal manifestations of CMA from 3 to 14 day. After 4 weeks, the 100% normalization of previously elevated faecal calprotectin (p0.05) was observed; and after 6months. ED, in 60% of children normalization of the index of activation of basophils with milk was observed. 38.7% of children were transferred to eHF in 6 months, 12.9% and 25.8% in 9 and 12 months respectively. Conclusions: Use of AAF for children with CMA is an effective and safe treatment without lengthening the period of elimination, which is necessary for the formation of tolerance to cow’s milk protein and has a positive impact on weight and height. Normalization of specific activation of basophils with milk could be considered as a predictor of successful transfer from AAF to eHF in children with CMA.

Download Full-text