Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity—Thinking about Cow’s Milk Allergy and Beyond

Children with medical complexities, such as multi-system disorders and/or neurological impairments, often experience feeding difficulties and need enteral nutrition. They frequently have impaired motility and digestive–absorbing functions related to their underlying condition. If a cow’s milk allergy (CMA) occurs as a comorbidity, it is often misdiagnosed, due to the symptoms’ overlap. Many of the commercialized mixtures intended for enteral nutrition are composed of partially hydrolyzed cow’s milk proteins, which are not suitable for the treatment of CMA; thus, the exclusion of a concomitant CMA is mandatory in these patients for obtaining symptoms relief. In this review, we focus on the use of elemental and semi-elemental formulas in children with neurological diseases and in preterm infants as clinical “models” of medical complexity. In children with neurodisabilities, when gastrointestinal symptoms persist despite the use of specific enteral formula, or in cases of respiratory and/or dermatological symptoms, CMA should always be considered. If diagnosis is confirmed, only an extensively hydrolyzed or amino-acid based formula, or, as an alternative, extensively hydrolyzed nutritionally adequate formulas derived from rice or soy, should be used. Currently, enteral formulas tailored to the specific needs of preterm infants and children with neurological impairment presenting concomitant CMA have not been marketed yet. For the proper monitoring of the health status of patients with medical complexity, multidisciplinary evaluation and involvement of the nutritional team should be promoted.

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IgE-Mediated Cow’s Milk Allergy in Iranian Infants and Children: Predictive Factors of Early Tolerance

Iranian Journal of Pediatrics ◽

10.5812/ijp.55937 ◽

2018 ◽

Vol 28 (1) ◽

Author(s):

Mohammad Hossein Eslamian ◽

Mozhgan Moghtaderi ◽

Mohammad Gharagozlou

Keyword(s):

Predictive Factors ◽

Infants And Children ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Ige Mediated

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Cow's Milk Allergy in Infants and Children

Journal of Nutritional Medicine ◽

10.3109/13590849109084116 ◽

1991 ◽

Vol 2 (2) ◽

pp. 201-201

Author(s):

Norman W. Clein

Keyword(s):

Infants And Children ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

In Infants And Children

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Development of Food Allergies with Special Reference to Cow's Milk Allergy

PEDIATRICS ◽

10.1542/peds.75.1.177 ◽

1985 ◽

Vol 75 (1) ◽

pp. 177-181

Author(s):

Tony Foucard

Keyword(s):

Wide Spectrum ◽

Gastrointestinal Symptoms ◽

Cow’S Milk Allergy ◽

Food Allergies ◽

Cow’S Milk ◽

Gradual Change ◽

Milk Allergy ◽

Early Introduction ◽

Cow's Milk ◽

Cow's Milk Allergy

Using strict criteria, the incidence of cow's milk sensitivity is probably 1% to 2% during the first 2 years of life. Although there is a wide spectrum of sensitivity symptoms caused by cow's milk, two major groups of infants are discernible. One group consists of infants who react to small amounts of cow's milk within a few minutes up to one hour, usually with gastrointestinal symptoms or urticaria. These infants are often atopic and have positive findings on skin prick tests and radioallergosorbent test (RAST) reactions to cow's milk allergens. The other group consists of children whose reaction to cow's milk occurs one hour or longer after intake of cow's milk or cow's milk-based formula. These reactions are usually not immunoglobulin (Ig)E-mediated and different immune and nonimmune mechanisms probably cause the symptoms. The risk of developing cow's milk sensitivity seems to be influenced by the atopic constitution of the infant and the age at which cow's milk is introduced. Early exposure to cow's milk increases the risk, not only of adverse reactions to this milk but also of developing allergies to other foods. It is suggested that early introduction of cow's milk may enhance the risk of future respiratory allergies. Allergists are still not in agreement as to whether the weaning process should be rapid or should consist of a gradual change from breast milk to cow's milk in order to minimize the risk of cow's milk allergy.

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