DESENSITIZATION TO EXTENSIVELY HYDROLYZED FORMULA IN INFANT WITH COW'S MILK PROTEIN ALLERGY

Abstract

<h3>Introduction</h3> Cow's Milk Protein Allergy (CMPA) is typically managed by avoidance. Limited evidence of oral desensitization for delayed-type hypersensitivity (DTH) reactions exist in the drug literature. We present a case of desensitization with hydrolyzed formula in an infant with CMPA. <h3>Case Description</h3> Allergy was consulted by NICU for a 5-month-old male infant with formula intolerance. Infant was born at term with gastroschisis and short bowel syndrome, with need for small bowel resection and gastrostomy tube placement. Maternal breast milk was insufficient to meet the infant's needs. Transition to formula was complicated by the development of bloody stools with cow's milk and hydrolyzed cow's milk formula consistent with CMPA. Introduction of elemental formulas was limited by the development of delayed onset vomiting and diarrhea felt to be consistent with Food Protein Induced Enterocolitis Syndrome (FPIES) to cornstarch. Donor breast milk was not available for outpatient use. Oral desensitization to Alimentum RTF, a cornstarch free hydrolyzed formula was successful, and the patient was discharged on this formula. <h3>Discussion</h3> Both FPIES and CMPA are predominantly delayed type hypersensitivity reactions. While desensitization approaches initially developed for management of IgE mediated drug allergy, similar approaches have been successful in management of both IgE mediated food allergy and delayed type hypersensitivity reactions to drugs. We report a potential option for oral desensitization in a patient with CMPA for whom typical therapy was contraindicated.