Five-year follow up of high-risk infants with family history of allergy exclusively breast-fed or fed partial whey hydrolysate, soy and conventional cow's milk formulas

Abstract

The effect of feeding different infant formulas on the incidence of atopic disease and food allergy was assessed in a prospective randomized double-blind study of high-risk infants with a family history of atopy. Two hundred and sixteen high-risk infants whose mothers had elected not to breast-feed were randomized to receive a partial whey hydrolysate formula (Good Start) or a conventional cow's milk formula (Similac) or a soy formula (Isomil). Each formula was used exclusively for 6 months. In addition, a group of 72 consecutively born infants with family history of atopy whose mothers elected to breast-feed and were able to do so for at least the first 4 months were studied. Follow-up until 5 years of age showed a significant lowering in the cumulative incidence of atopic disease in the breast-fed (odds ratio 0.422 [95% confidence intervals 0.200 – 0.891]) and the whey hydrolysate (odds ratio 0.322 [95% confidence intervals 0.159 – 0.653]) groups, compared with the conventional cow's milk group. Feeding with soy formula was not associated with a lower incidence of atopy (odds ratio 0.759 [95% confidence intervals 0.384 – 1.501]). The occurrence of both eczema and asthma was lowest in the breast-fed and whey hydrolysate groups and was comparable in the cow's milk and soy groups. Similar significant differences were noted in the period prevalence of eczema and asthma during 18 – 60 months of age. Eczema severity was less in the whey hydrolysate group compared with the other groups. Double-blind placebo-controlled food challenges showed a lower prevalence of food allergy in the whey hydrolysate group compared with the other formula groups. It is concluded that exclusive breast-feeding or feeding with a partial whey hydrolysate formula is associated with lower incidence of atopic disease and food allergy. This is a useful, cost-effective approach to the prevention of allergic disease in infants and children.