Double-Blind, Placebo-Controlled Food Challenges (DBPCFC) Demonstrating Acute IgE-Mediated Allergic Reactions to Good Start, Ultrafiltered Good Start, Alfaré, Nutramigen, and Alimentum in a Seven-Year-Old

Abstract

A 7-year-old girl with IgE-mediated cows' milk allergy (immediate reactor) underwent double-blind, placebo-controlled food challenge (DBPCFC) with three whey hydrolysate formulas (Good Start, Ultrafiltered Good Start, Alfaré) and two casein hydrolysates (Nutramigen, Alimentum), using a soy protein formula (Isomil) as a control. She developed acute reactions to Good Start (3 ml; gastrointestinal, respiratory), Ultra Good Start (8 ml; respiratory, cutaneous), Alfaré (158 ml; respiratory), Nutramigen (3 ml; respiratory, cutaneous), and Alimentum (4 ml; respiratory, cutaneous, gastrointestinal) and tolerated the Isomil control (318 ml) on three separate challenges under similar conditions. The generalized urticarial reactions to Nutramigen and Alimentum began 90 minutes after receiving less than 1 teaspoonful (3 ml and 4 ml, respectively) of formula. These observations indicate that all current commercially available cows' milk protein hydrolysate formulas can cause serious allergic reactions in the highly sensitized cows' milk-allergic child. To our knowledge, this is the first report of an acute allergic reaction to Alimentum, which is currently marketed as hypoallergenic. Although many less sensitive cows' milk-allergic children can tolerate these formulas, the authors believe that the term "hypoallergenic" can create a false sense of security.