Usefulness of a Cow's Milk Whey Infant Formula (Good Start) in the Management of Children with Group 1A (Topical Reactors) IgE-Mediated Cow's Milk Allergy

Abstract

Despite the fact that cow's milk protein hydrolysate infant formulas have reduced allergenicity (i.e., are hypoallergenic), all of those that are currently commercially available in the United States have caused anaphylactic reactions in highly sensitized children with IgEmediated cow's milk allergy (CMA). Skin prick testing (SPT) with CM, a whey hydrolysate (Good Start), and a casein hydrolysate (Nutramigen) can identify those children with mild topical IgE-mediated CMA (group 1A) and separate them from those children with more severe systemic IgE-mediated CMA (groups IB and 1C). Thirteen children in group 1A tolerated a whey hydrolysate formula (Good Start) when challenged with it and when fed the formula daily for at least 2 weeks. All (13/13) were challenge-positive to CM before the Good Start challenge and trial. Eleven (11/13) remained challenge-positive after being fed Good Start. There was no change in their level of sensitivity during the interval. Two children outgrew their clinical sensitivity to CM. Good Start is recommended for children with mild IgE-mediated CMA (Group 1A). In contrast, in a double-blind, placebo-controlled study, we have shown that 62% (8/13) of children with group IB or 1C IgE-mediated CMA had systemic urticarial and respiratory reactions when fed Good Start. Good Start should not be fed to these children who are more highly sensitized.