Cow milk allergy in infancy and hypoallergenic formulas

doi:10.1016/S0022-3476(05)81419-2

The Journal of Pediatrics

Volume 121, Issue 5, Part 2, November 1992, Pages S116-S121

https://doi.org/10.1016/S0022-3476(05)81419-2 Get rights and content

Substitute feedings have been used to treat infants with cow milk protein allergy for most of this century. For the past 50 years, several infnat formulas based on animal proteins, both intact and chemically modified, or on vegetable protein have been labeled “hypoallergenic”. Because of the risk of anaphylaxis and other serious adverse reactions, formulas that are claimed to be hypoallergenic should be subjected to rigorous preclinical and clinical testing. At a minimum, such formulas should not provoke any allergic signs or symptoms in 90% of Infants with documented cow milk protein allergy when tested in double-blind, placebo-controlled trials. A standardized definition of “hypoallergenic” will allow clinicians and parents to understand the true risks to a cow milk-allergic infant fed such hypoallergenic formulas.

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Cited by (25)

Hypoallergenic hydrolysates for the prevention and treatment of cow's milk allergy
2007, Functional Dairy Products: Second Edition
This chapter discusses the methods for the characterization and safety evaluation of Hypoallergenic [“HA”] formulas, as well as the Potential of High Pressure [“HP”] and Microwave Irradiation [“MWI”] to produce protein hydrolysates with reduced antigenicity. It examines some general aspects of infant formulas. Hypoallergenic protein hydrolysates to be used as an ingredient in infant formulas of high nutritional and therapeutic value should be rich in low molecular weight peptides, especially di- and tripeptides, with the least quantity possible of free amino acids. Thorough research and innovation, new approaches for improving the composition of hypoallergenic dietary products for infant nutrition might be found, since it is desirable that the hydrolysates used as proteic ingredients present the minimum degree of hydrolysis compatible with absence of antigenicity. Extensive enzymatic digestion of proteins leads to a loss of nutritive value, low palatability, bitterness and off-flavors. Besides, high molecular weight peptides have an essential role in emulsion stabilization of infant formulas, improving other functional properties such as foam-forming ability. In this way, emerging technologies such as HP and MWI might be useful tools for obtaining protein hydrolysates with low antigenicity and acceptable sensorial/functional properties, although studies are needed to confirm their safety for allergic patients.
Physiologic and Inflammatory Abnormalities of the Gastrointestinal Tract
2005, Avery's Diseases of the Newborn
Use of infant formulas with reduced antigenic content
2000, Archives de Pediatrie
Three types of infant formulas with reduced antigenic content are presently available: formulas with partially hydrolyzed proteins (hypoallergenic formulas), formulas with extensively hydrolyzed proteins, and aminoacids mixtures. There respective indications for preventing, postponing or treating allergic manifestations are presented, recalling that breast milk remains the best recommendation. Patent cow milk allergy requires extensively hydrolyzed proteins formulas.
Protein hydrolysates as special nutritional ingredients
2000, Developments in Food Science
The use of hydrolyzed proteins as food ingredients dates back to the late 19th century, beginning in Europe and the Far East. These hydrolyzed proteins, which were produced by acid or enzymatic hydrolysis of vegetable and animal proteins, were used for flavoring purposes in bouillon, soups, and sauces, and they gained rapid consumer acceptance. It was only in the late 1930s and early 1940s that a parenteral grade of protein hydrolysate made by pancreatic enzyme digestion of casein was used for parenteral feeding. The discovery in the 1950s that careful charcoal treatment of casein hydrolysate could remove most of the aromatic amino acids (phenylalanine, tyrosine, and tryptophan) brought about the development of special formula for the dietary management of infants who suffer from phenylketonuria or tyrosinosis. Since then, protein hydrolysates have been widely used as the nitrogen source for the interal feeding of individuals who have specific nutritional and physiological needs. These include patients with impaired gastrointestinal function (e.g., Crohn's disease), short bowel syndrome, or specific organ disease (e.g., pancreatitis, renal and hepatic). Protein hydrolysates have also found application in sports nutrition, weight control diets, and nutritional supplements. More recently, protein hydrolysates have been used in dietetic products designed for the nutritional management of cancer patients and individuals with AIDS. However, the widest use of protein hydrolysates as nutritional ingredients has been for feeding infants with intact protein hypersensitivity. The use of protein hydrolysates in these products is based on the premise that predigested proteins, when fed as amino acids and peptides, provide essential nitrogen in a non-antigenic, easily absorbed form.
Use of infant formulas with reduced antigenic content
2000, Revue Francaise d'Allergologie et d'Immunologie Clinique
Trois sortes de formules à charge antigénique réduite, substituts du lait, sont actuellement disponibles : celles contenant des protéines partiellement hydrolysées, les hydrolysats de protéines et les mélanges d'acides aminés. Cette mise au point présente les indications de chacune des formules pour la prévention et la prise en charge de l'enfant allergique ou à risque d'allergie, tout en rappelant que le lait maternel reste la meilleure indication. En cas d'allergie avérée aux protéines du lait de vache, il est recommandé d'utiliser les hydrolysats de protéines.
Three types of infant formulas with reduced antigenic content are presently available : formulas with partially hydrolyzed proteins (hypoallergenic formulas), formulas with extensively hydrolyzed proteins, and aminoacids mixtures. Their respective indications for preventing, postponing or treating allergic manifestations are presented, recalling that breast milk remains the best recommendation. Patent cow milk allergy requires extensively hydrolyzed protein formulas.
Which milk for the atopic infant?
2000, Revue Francaise d'Allergologie et d'Immunologie Clinique
La prévention de l'allergie repose essentiellement sur l'allaitement maternel. Cependant, des nourrissons exclusivement allaités au sein peuvent présenter des manifestations allergiques envers certains aliments ingérés par leur mère. Il est essentiel de bien démontrer la culpabilité d'un aliment ; en effet, un régime d'éviction non fondé risque d'altérer les phénomènes de tolérance et fait également courir des risques nutritionnels à la mère et l'enfant. L'allergie au lait de vache ayant une place prédominante, on peut proposer que les nourrissons atopiques soient sevrés avec des laits d'allergénicité réduite. L'allergie au lait de vache confirmée nécessite l'éviction absolue des protéines de ce lait. Les laits ayant bénéficié d'une hydrolyse extensive sont en règle indiqués. Parfois on utilise les laits de soja. Si les hydrolysats de protéines sont mal tolérés, on a recours aux mélanges d'acides aminés. Des explorations sont actuellement menées sur les laits enrichis en probiotiques.
Over the last two decades the prevalence and severity of atopic diseases have increased in the industrialized countries. Food allergy frequently represents the first manifestation of these disorders. The current approach to food allergy is directed towards elimination diets. Applied in a clinically documented allergy to a specific food, therapeutic elimination diets have been shown to alleviate symptoms and reverse some disturbances of humoral and cell-mediated immune response. Consequently, the mainstay in the treatment of cow's milk allergy is complete avoidance of cow's milk proteins by using substitute formulas, the healthy breastfed infant representing the normative model for such substitute or supplementary formulas. As patients with cow's milk allergy do not represent a homogenous group, different formulas are used. Extensively hydrolyzed formulas are recommended as the treatment of choice. Soy formula may provide a safe alternative for older children with IgE-associated cow's milk allergy. The completeness of antigen elimination may be ensured by synthetic amino acid-derived formulas, which have been shown to be safe for children with multiple food allergies.

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Cow milk allergy in infancy and hypoallergenic formulas

J Pediatr

Reply J. Pediatr

Ann Allergy

J Pediatr

Pediatrics

J Allergy

Ann Allergy

Anal Biochem

Anaphylaxis to casein hydrolysate formula

J Pediatr

Prophylaxis of allergic disease in the newborn

JAMA

Development of childhood allergy in infants fed breast, soy or cow milk

J Allergy Clin Immunol

Colitis, persistent diarrhea and soy protein intolerance

J Pediatr

Prevalence of infant colic

Arch Dis Child

The passage of maternal dietary proteins into human breast milk

Int Arch Allergy Appl Immunol