Abstract
Extensively hydrolyzed (EH) formula with Lactobacillus rhamnosus GG (LGG) was demonstrated to alleviate cow’s milk allergy (CMA) symptoms and promote faster acquisition of tolerance to cow’s milk protein. We previously demonstrated that partially hydrolyzed (PH) and EH formulas with LGG supported normal growth in healthy-term infants through 120 days of age. The objective of the current study was to evaluate growth, development, and specific adverse events through 5 years of age in participants from that cohort who continued receiving study formula. Infants who completed a double-blind, randomized growth and tolerance study were eligible to continue receiving the assigned study formula through 1 year of age (control: EH casein formula, EHF, or one of two investigational formulas: EH casein formula with LGG (EHF-LGG) or a PH formula with LGG (PHF-LGG)) and participate in follow-up through 5 years of age. Anthropometric measures, behavior development, and specific adverse events were recorded. No significant differences in achieved weight and height or behavioral development outcomes at 3 or 5 years of age were observed among study groups. Few statistically significant differences in the incidence of specific infection-related events through years 3 or 5 were observed among study groups, none of which were considered clinically relevant.Conclusion: Extensively and partially hydrolyzed formulas with LGG were associated with normal growth and development and long-term safety through 5 years of age.What is Known:• Infants with cow’s milk allergy often experience allergic manifestations that can lead to poor nutrition status and poor growth.• Providing partially hydrolyzed (PH) and EH formulas with or without LGG in infants can support normal growth in healthy-term infants.What is New:• This study provides long-term safety data for the first 5 years of life on the use of extensively and partially hydrolyzed formulas with LGG when fed through 1 year of age.• Extensively and partially hydrolyzed formulas with LGG are associated with normal growth, development, and long-term safety through 5 years of age.
Highlights
Cow’s milk allergy (CMA) affects ∼3% of infants [1, 2] who have immediate (IgE-mediated) or delayed onset reactions to cow’s milk protein (CMP), commonly manifested as atopic dermatitis (AD), urticaria, wheezing/ asthma, allergic rhinitis, or diarrhea [1, 3]
Extensively and partially hydrolyzed formulas with Lactobacillus rhamnosus GG (LGG) were associated with normal growth and development and long-term safety through 5 years of age
This study provides long-term safety data for the first 5 years of life on the use of extensively and partially hydrolyzed formulas with LGG when fed through 1 year of age
Summary
Cow’s milk allergy (CMA) affects ∼3% of infants [1, 2] who have immediate (IgE-mediated) or delayed onset (non-IgEmediated) reactions to cow’s milk protein (CMP), commonly manifested as atopic dermatitis (AD), urticaria, wheezing/ asthma, allergic rhinitis, or diarrhea [1, 3]. 80% of children affected can tolerate intact CMP by 3 years of age, it may take up to 5 years or longer for those with IgE-mediated reactions to achieve tolerance [3]. These children are at higher risk of subsequent development of allergy to other foods and/or inhalants [5,6,7]. Hydrolyzed (EH) cow’s milk-based formulas with demonstrated reduced allergenicity are recommended for infants with CMA [8,9,10]. Assessment of growth and development with EH formulas is a critical safety parameter, especially when a probiotic is added to the formula, since there is limited data on growth with probiotic-supplemented formulas [17]
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