Hypoallergenic formula and eczema

Parents who are atopic often ask us how they can prevent troublesome symptoms, particularly eczema, in their babies. We would, of course, recommend exclusive breastfeeding, but if mothers choose to wean off the breast for any reason, what formula should we recommend? Some preliminary evidence suggests that hypoallergenic formula, with oligosaccharide prebiotic supplementation, might be beneficial.

A study funded by a formula-manufacturing company set out to investigate this, clearly with an eye to producing a formula aimed at these babies (PATCH study; Boyle R, et al. Allergy 2016. doi:10.1111/all.12848). They randomised 860 infants with a family history of allergic disease to receive either the intervention feed, a partially-hydrolysed whey formula with oligosaccharides, or a control standard formula, if the mothers chose to introduce formula before 18 weeks. Ten centres in Australia, Singapore, England and Ireland were involved.

They found no difference in the primary outcome, eczema prevalence, between the groups at 12 months (29% in both) or at 18 months. IgE levels, both total and cow's milk specific, also did not differ. There were some differences in specific Ig1 and T-cell values which might suggest long-term protection.

On the basis of this evidence, therefore, we should …