Dietary products used in infants for treatment and prevention of food allergy.: Joint statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition

A Høst; B Koletzko; S Dreborg; A Muraro; U Wahn; P Aggett; J-L Bresson; O Hernell; H Lafeber; K F Michaelsen; J-L Micheli; J Rigo; L Weaver; H Heymans; S Strobel; Y Vandenplas

doi:10.1136/adc.81.1.80

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Dietary products used in infants for treatment and prevention of food allergy.

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Re: Dietary products used in infants for treatment and prevention of food allergy
Arnaldo Cantani
Published on: 22 March 2016
Response to Prof. Analado Cantani
Berthold Koletzko
Published on: 22 March 2016
Dietary products used in infants for treatment and prevention of food allergy
Arnaldo Cantani
Published on: 22 March 2016

Published on: 22 March 2016
Re: Dietary products used in infants for treatment and prevention of food allergy
- Arnaldo Cantani, Professor of Pediatric Allergy and Immunology
Dear Editor
We agree with the letter from Professor Koletzko suggesting that more studies in this field are necessary (Arch Dis Child Rapid Response 6 June 2000). However, Table 4 of my study detailed all the data of the "other authors" and tried to make a mean among all such data. Since Sampson et al documented a 0% prevelence of sensitisation to soy, we concluded that about "80-100%" of children.
Professor...
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Dear Editor
We agree with the letter from Professor Koletzko suggesting that more studies in this field are necessary (Arch Dis Child Rapid Response 6 June 2000). However, Table 4 of my study detailed all the data of the "other authors" and tried to make a mean among all such data. Since Sampson et al documented a 0% prevelence of sensitisation to soy, we concluded that about "80-100%" of children.
Professor Koletzko fails to consider the 243 reactions to hydrolysate formulae documented by us. When both papers are published we shall gladly send him reprints.
The American Academy of Pediatrics distinguish between IgE and not IgE mediated reactions. However, we refer to the paper by Burks et al (J Pediatr Gastroenterol Nutr 1989;8:195-203) who demonstrated that most reactions to soy are not IgE mediated.
Returning to the data analysed in Table 4: we concluded that a proportion of children with colitis/enterocolitiis do not tolerate soy formulae and therefore are better fed the Rezza's diet, that is a home made, meat-based formula.
Arnaldo Cantani, MD, PhD
Monica Micera, MD
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Response to Prof. Analado Cantani
- Berthold Koletzko, Professor of Paediatrics
The comment of Dr. Cantani (Arch Dis Child rapid response, 2 June 2000) is interesting and reemphasizes our conclusion drawn in the joint statement of ESPGHAN and ESPACI (Arch Dis Child 1999;81:80-84) that in view of controversial judgements more studies are required to further elucidate the effects of soy protein based formulas in infants with food allergies. Although Cantani claims that 80-100% of infants with IgE media...
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The comment of Dr. Cantani (Arch Dis Child rapid response, 2 June 2000) is interesting and reemphasizes our conclusion drawn in the joint statement of ESPGHAN and ESPACI (Arch Dis Child 1999;81:80-84) that in view of controversial judgements more studies are required to further elucidate the effects of soy protein based formulas in infants with food allergies. Although Cantani claims that 80-100% of infants with IgE mediated food allergy would tolerate soy protein based formulas, other authors have reported less favourable results.
The ESPGHAN and ESPACI comment has acknowledged the fact that some infants with food allergy do not tolerate so called extensive protein hydrolysates but may require amino acid mixtures, which may be a proportion of about 10 % of infants allergic to cows' milk formula (de Boissieu et al, J Pediatr 1997;131:744-7). However, the relative rate of reactions observed against extensive protein hydrolysates versus soy protein has not been reported in direct comparative studies, hence, it is difficultto draw clear conclusions here.
In contrast to Dr. Cantani, we do not think that the classification "allergic reaction" should be solely reserved to IgE mediated reactions. A significant proportion of food allergies in infants, particularly in infants with gastrointestinal and cutaneous manifestations, are IgE negative and are missed by RAST or skin prick tests, but are immune mediated (e.g. cell mediated type 3 reactions). These are also allergic forms of food intolerance that are successfully treated by allergen elimination.
Berthold Koletzko
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Dietary products used in infants for treatment and prevention of food allergy
- Arnaldo Cantani, Professor of Pediatric Allergy and Immunology
Dear Editor
In a not cited paper published by Pediatric Allergy Immunology I have detailed everything about soy formulas (SFs). Children with atopic dermatitis fare well on SFs, those with colitis/enterocolitis have reactions to soy, but Burks demonstrated that these are not IgE-mediated, therefore it is improper to classify such reactions as allergenic.
In Table 4, 19.8% of children (mean) reacted to SFs, but...
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Dear Editor
In a not cited paper published by Pediatric Allergy Immunology I have detailed everything about soy formulas (SFs). Children with atopic dermatitis fare well on SFs, those with colitis/enterocolitis have reactions to soy, but Burks demonstrated that these are not IgE-mediated, therefore it is improper to classify such reactions as allergenic.
In Table 4, 19.8% of children (mean) reacted to SFs, but in the only DBPCFC study the prevalence was 0%, therefore 80-100% of such babies tolerate SFs. In all other seven studies no food challenge was attempted. Burks has also shown that children reacted to liquid SF, but not to powdered ones, thus indicating that epitopes could be present in one formula, but not in the other.
The American Academy of Pediatrics "recognized that soy protein is anti-genic does not mean that soy protein is highly allergenic" and that "most infants with documented IgE-mediated allergy to CM protein will do well on isolated SPFs". Høst et al also suggest to feed atopic infants with hydrolysate formulas (HFs). We have documented 202 reactions to HFs in a paper, and 41 case-reports in another. In total 17 cases of shock- anaphylaxis (one every 3.3 years) versus one case of anaphylaxis/22.3 years provoked by SPFs, with a difference of 676%.
Arnaldo Cantani, MD, PhD
Monica Micera, MD
Professor of Pediatric Allergy and Immunology
Rome University "La Sapienza"
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Conflict of Interest:
None declared.
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