Abstract

An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.

Highlights

  • Cow’s milk (CM) protein is one of the most common food allergies (FAs) in infancy, with a region-dependent prevalence of 2–3% [1,2,3,4].The immune reaction to CM proteins can be IgE-mediated, non-IgE-mediated, or mixed

  • N = 45 infants with atopic dermatitis and Severity of eczema (SCORAD) and growth measured as median at 3 and 6 months in each group and extensively hydrolysed formula (eHF) resulted in a significant clinical improvement; amino acid formulas (AAF) resulted in improved growth compared with eHF

  • Commercial hydrolysed formulas (HF) vary in terms of source of protein, degree of hydrolysis, the content of lactose and additional components

Read more

Summary

Introduction

The immune reaction to CM proteins can be IgE-mediated, non-IgE-mediated, or mixed. It can differ in its timing of symptom onset and organ involvement. Immediate reactions occur from within a few minutes to no more than two hours after exposure to the offending food, while delayed reactions can occur up to 48 h or even a week later. The former are classified as IgE-mediated, while the latter are generally non-IgE-mediated [1]. Clinical manifestations of cow’s milk allergy (CMA) vary greatly in type and severity, making it one of the most difficult food allergies to diagnose [4,5]

Objectives
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call