Growth of Infants With IgE-Mediated Cow's Milk Allergy Fed Different Formulas in the Complementary Feeding Period

Abstract

Agostoni C, Fiocchi A, Riva E, et al. Pediatr Allergy Immunol. 2007;18(7):599–606 PURPOSE OF THE STUDY. Observational studies have shown that allergic infants, irrespective of their type of diet, show various degrees of growth depression in the first year of life. The authors investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight-for-age [WA], length-for-age [LA], and weight-for-length [WL] z scores) in infants with cow's milk allergy (CMA). STUDY POPULATION. One hundred sixty infants with immunoglobulin E–mediated CMA entered the study in a 5-year period; 108 were formula fed and 52 were still breastfed at 6 months. METHODS. Infants were randomly assigned to 3 special formulas: a soy formula (n = 32); a casein hydrolysate (n = 31); or a rice hydrolysate (n = 30). A fourth, nonrandomized group was made up of allergic infants who were still breastfed at up to 12 months (n = 32). Groups were compared for WA, LA, and WL z scores at 6, 9, and 12 months of age. RESULTS. All groups showed low WA and LA z scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z-score increments in the 6- to 12-month period. The use of casein- and rice-based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. CONCLUSIONS. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA. REVIEWER COMMENTS. Use of infant formulas for children with CMA, if not exclusively breastfeeding, is necessary to provide adequate nutrition at a critical time for a child's growth. Few studies have compared growth parameters in children with CMA using different formulas. This study demonstrates that different formulas can contribute to different growth rates in allergic children. This area requires additional investigation to optimize nutrition for these infants.