Growth of Infants with IgE-Mediated Cow’s Milk Allergy

Abstract

The infant’s growth pattern in the first few months of life may be particularly relevant, because it may be associated with later health outcome. Different studies have shown a reduced growth in atopic dermatitis (AD) infants with allergy to cow’s milk (CMA) during the first year of life. Differences between AD infants and healthy children are significant from the second month of age onward, more markedly in the second 6 months of life. The effects of the early type of feeding on the growth pattern of AD infants during the first 12 months of life have been investigated. An impairment of growth occurred in both breastfed and formula-fed AD children. Recently, clinical trials have investigated whether the type of formula in the complementary feeding period (6–12 months of age) might differently affect growth in infants with CMA. In the complementary feeding period hydrolyzed formulas may provide better short-term weight gain compared with soy formula. However, few randomized controlled trials have investigated the long-term effects of infant feeding with hydrolyzed formulas on the development of growth in infancy and childhood. No adverse long-term effect on BMI up to age 6 years was found for partially hydrolyzed whey (pHF-W), extensively hydrolyzed whey (eHF-W), extensively hydrolyzed casein (eHF-C), or cow-milk formula (CMF), whether comparisons were made between formula groups or with respect to breastfed children. Because growth in length was not impaired in any studied formula group, all four formulas may be considered safe from a developmental point of view. Causes of impaired growth in infants affected by CMA are still unclear. An impaired ability to utilize nutrients, possibly caused by an allergy-induced inflammation of the gut mucosa, together with increased nutritional demands, particularly in cases of AD, considering the high metabolic requirements of the skin turnover and the high energy expenditure due to agitation, represents plausible explanations. “Individually tailored elimination diets” may be required to reduce the negative effect of AD on growth and, therefore, sustain an adequate growth in this population.