Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.

Lactose-Reduced Infant Formulas Are Over-Consumed Whereas Hypoallergenic Infant Formulas Are Not - When Compared to Medical Necessity

Objectives We aimed to report the macronutrient composition of powdered infant formula purchased from major US physical-location retailers from 2017 through 2019. We then compared the percentage of lactose-reduced and hypoallergenic powdered infant formula consumed with the estimated prevalence of infant conditions necessitating a lactose-reduced or hypoallergenic formula. We also compared the proportion of formula consumed that was lactose-reduced between WIC and non-WIC purchases. Methods Annual powdered infant formula volume and purchase data from all major brick-and-mortar stores in the United States (excluding Costco) from 2017 through 2019 was obtained from IRi (Information Resources Inc). Protein, carbohydrate, fat composition and scoop size for each formula was obtained from formula companies and equivalent liquid ounces (“formula consumed”) was calculated. Small can sizes of “standard” (intact and partially hydrolyzed protein) formulas served as proxies for WIC purchases. Proportions were compared to published medical prevalence by calculating a z-ratio, t-test. Results Average infant carbohydrate consumption consisted of 56.6% lactose, 37.7% glucose, and 5.7% sucrose. 21% of formula consumed contained sucrose. 55% of all formula and 47% of standard formula consumed was lactose-reduced, both higher than the estimated 7.5% prevalence of medical necessity (p < 0.0002). Lactose-reduced standard formula represented 51% of non-WIC sales which was greater than the 44% of WIC sales (p = 0.003). Protein consumption consisted of 5.0% soy protein, 74.1% intact dairy, 11.1% partially hydrolyzed dairy, 7.1% fully hydrolyzed protein, and 0.3% amino acid based. Hypoallergenic (fully hydrolyzed and amino acid-based) formula represented 7.4% of formula consumed, which did not differ from liberal estimates of cow's milk allergy prevalence (7.5%). Conclusions Estimated consumption of hypoallergenic formula in the US matches liberal estimates of medical necessity. However, a high proportion of formula-fed infants are consuming non-lactose-based carbohydrate; more than is medically warranted, necessitating further research into metabolic implications. Funding Sources None.

Nutritional status of infants with cow's milk allergy who consume breast milk vs. hypoallergenic formula

Background Infants with CMA are prone to suffer malnutrition because of the inability to absorb nutrients due to bowel inflammation. Breast milk and hypoallergenic formula is the best nutritional intake in CMA infants.Objective To compare the nutritional status of CMA infants who were consumed breast milk and hypoallergenic milk.Methods We conducted a cross-sectional study included a total of 63 CMA infants aged 3-6 months collected by consecutive sampling. Infant’s nutritional status measured by anthropometric exam were divided into well-nourished (-2 to 2 SD) or malnourished (<-2 or >2 SD). Type of milk consumption were asked directly to parents/caregivers through interviews.Results Most of our subject are well-nourished (75%). The number of CMA infants who were consumed breast milk or hypoallergenik milk is not a lot of difference, 51% vs 49%, respectively. There is no significant difference between the nutritional status of CMA infants who consumed breast milk and hypoallergenic milk (P=0.61).Conclusion because there were no differences between the nutritional status of CMA infants who consumed breast milk and hypoallergenic milk. Therefore it is recommended giving breast milk or hypoallergenic milk for the first 6 months of life to reduce cow’s milk protein exposure.