Editor,—The joint statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN),1 deserves some comment.

Firstly, on the use of soy based formulas for the treatment, as well as for the prevention of food allergy: I was disappointed that no word about this subject appeared in the conclusions of the statement. Many have claimed that the use of soy bean formulas in infancy is an efficient way of treating or preventing food allergic disorders, but more recent prospective and randomised clinical studies have shown that soy protein is as allergenic as cow's milk protein.2 As the matter remains controversial,3 I believe that the conclusions should have been that soy based formulas are not recommended for the treatment or prevention of food allergy until more data are available.

The second issue concerns the use of partially hydrolysed formulas for preventing food allergy. A recent five year follow up prospective, randomised, and controlled study by Chandra,4 which showed a beneficial preventive effect of a partial whey hydrolysed formula in high risk infants, was ignored. The only study where the preventive effect of an extensively hydrolysed formula was compared with the effect of a partially hydrolysed one, showed that the former was superior to the second.5 This paper, however, has a possible methodological shortcoming: the manufacturer (Mead Johnson, Evansville, Indiana, USA) provided both a commercially available extensively hydrolysed formula (Nutramigen) and a non-commercially available (at least in Sweden where the study was undertaken) partially hydrolysed formula, prepared by mild (how mild?) enzymatic hydrolysis. In future, such studies should only use commercially available formulas of either the same or different brands. I consider that current data are insufficient to allow a firm view. Therefore, I believe the conclusions should have stated that no clear recommendation can be made for the use of a partially hydrolysed formula to prevent food allergy.

Conclusions of consensus statements are generally considered as guidelines for the practitioner. Omissions, as in the case of soy based formulas, or ambiguities, as in the case of partially hydrolysed formulas, do not clarify the issues so should be avoided. I believe that modified conclusions, as referred to above, would have been more in agreement with the literature and more helpful to the reader.