Milk Allergy Research Articles

Continuous cow’s milk protein ingestion during infancy may promote casein-specific IgG4 production

BackgroundEarly supplementation and subsequent discontinuation of cow’s milk formula (CMF) may increase the risk of cow’s milk allergy in breastfed infants, but little is known about the relationship between continuous CMF ingestion and cow’s milk protein-specific immunoglobulin production. ObjectiveThis study aimed to clarify this relationship in cow’s milk-sensitized infants. MethodsUsing data from a randomized controlled trial of a Japanese birth cohort, we performed a subgroup analysis of participants who had ingested CMF in the first 3 days of life and exhibited a positive skin prick test response to cow’s milk at 6 months of age. We compared the differences in median titers of cow’s milk-specific IgE, casein-specific IgE, and casein-specific IgG4 between participants who continued daily or intermittent CMF ingestion up to 6 months of age (“continuous group”) and participants who discontinued CMF ingestion before 6 months of age (“discontinued group”). ResultsFrom 462 trial participants, 49 (10.6%) were included in this study (continuous group: 21, discontinued group: 28). The median titer of cow’s milk-specific IgE was 0.17 kUA/L (interquartile range: <0.10-0.57) in the continuous group and 0.66 kUA/L (0.49-1.18) in the discontinued group (P=.0008). The median titer of casein-specific IgE was <0.10 kUA/L (<0.10-0.15) in the continuous group and <0.10 kUA/L (<0.10-0.37) in the discontinued group (P=.51). The median titer of casein-specific IgG4 was 2.58 mgA/L (0.77-6.73) in the continuous group and 0.09 mgA/L (0.07-0.13) in the discontinued group (P<.0001). ConclusionContinuous CMF ingestion may promote casein-specific IgG4 production in cow’s milk-sensitized infants.

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children.

Over the past two decades, food allergy prevention strategies have shifted from 'delayed introduction' to 'no delayed introduction' to 'early introduction' of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention. Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing. Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.

Out-of-pocket expenses and parent reported quality of life in children with cow's milk protein allergyin Bogotá, Colombia.

To identify the out-of-pocket expenses and parent-reported quality of life (QoL) of children with a diagnosis of cow's milk protein allergy (CMPA)between the ages of 0 and 5 using the Food Allergy Quality of Life Questionnaire - Parent Form. A cross-sectional study was conducted in two tertiary care centers in Bogotá. Demographic, medical information, and QoL scores were collected by parental interview. We carried out a cost-of-illness analysis based on self-reported out-of-pocket expenses attributed to the treatment as a whole and the family's monthly income. Exploratory analyses used the QoL scores and the percentage of out-of-pocket expenses attributable to treatment as outcomes. 122 families were analyzed. Median subject age was 17 months (Q1-Q3: 11-26.75 months) and female subjects made up 71% of the sample. The median QoL score was 3.21 points (Q1-Q3: 2.43-4.34) and only differed by age groups and personal history of other food allergies. The median out-of-pocket treatment related costs was 300,000 Colombian pesos (COP) (Q1-Q3: 280,000-340,000 COP). About 17% of the families had to pay over 15% of their monthly income to purchase food and dietary products. Out-of-pocket treatment related costs differed depending on whether the treatment included formulas (Mann-Whitney test p < 0.001). Out-of-pocket treatment expenses were uncorrelated with the QoL scores. Food allergy related QoL scores were not associated with out-of-pocket expenses as a whole or as a fraction of monthly income but were higher in children with additional food allergies and in older age groups, suggesting a lower QoL.

Goat milk exerts anxiolytic and anti-depressive effects through modulating JAK/STAT3 and p-Akt/CREB signaling pathways in chronic unpredictable mild stress mice

Anxiety and depression are the second major diseases in the world. Current antidepressants are not universally effective and always cause numerous side effects and strong dependence. Cow milk, as a daily nutritional supplement, can assist in the treatment to improve anxiety and depression symptoms. Whereas, cow milk allergy and lactose intolerance are present in a sizable portion of the population. Compared with cow milk, goat milk has higher nutritional value, easier digestion, lower allergy and better tolerance. However, the anxiolytic and anti-depressive effects of goat milk are still pending, and the related mechanisms are not confirmed. Therefore, in the present study, cow milk as a control, the anxiolytic and anti-depressive effects of goat milk were investigated in chronic unpredictable mild stress mice, and the corresponding mechanism was explored. Our data suggested that goat milk elevated monoamine neurotransmitters, reduced pro-inflammatory cytokines release, increased anti-inflammatory cytokine concentration, inhibited the expression of NSE, STAT3, and NF-κB, and increased the expression of p/Akt and CREB. We concluded that goat milk exerted anxiolytic and anti-depressive effects by increasing neurotransmitters and reducing inflammatory mediators via modulating hippocampal JAK/STAT3 and p-Akt/CREB signaling pathways. No significant difference in the anti-depressive effect between cow and goat milk was observed. This study firstly demonstrates that goat milk has a similar effect as cow milk in improving anxiety and depression symptoms and goat milk might be expected as an ideal nutritional supplement for people suffering from anxiety and depression who are allergic or lactose intolerant to cow milk.

Clinical guideline highlights for the hospitalist: Evaluation, management, and prevention of cow's milk allergy.

An ESPGHAN position paper on the diagnosis, management and prevention of cow's milk allergy RELEASE DATE: Journal of Pediatric Gastroenterology and Nutrition, July 26, 2023 PRIOR VERSION: 2012 DEVELOPER: ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition), NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition) FUNDING SOURCE: ESPGHAN TARGET POPULATION: Infants and young children with suspected cow's milk allergy.

Selenium in plant-based beverages: How can in vitro bioaccessibility contribute to an accurate daily intake?

BackgroundLactose intolerance, cow milk protein allergy, and environmental and ethical concerns drive the global market for plant-based beverages (PPBs). Despite this, data on the occurrence of selenium (Se) in these beverages are scarce. ObjectiveThe objectives of this study were to assess total selenium and determine the bioaccessible fractions in plant-based beverages (PBBs) from cereals, oilseeds, and pumpkin seeds, using an in vitro static method to simulate human digestion; and estimate the contribution these beverages have to the reference daily intake (RDI) for children and adults. MethodologyThe study involved beverages made under laboratory conditions. Samples and extracts were submitted to acid digestion (ultrasonic and block digester); total and bioaccessible Se levels were determined by ICP-MS. In vitro bioaccessibility was assessed using the INFOGEST protocol. ResultsThe results revealed a wide variation in Se content in the studied plant-based beverages from 10.3 µg kg−1 (sunflower seeds) to 3509 µg kg−1 (Brazil nuts). The bioaccessibility of Se was found only in PBBs made from oilseeds with macadamia, cashew and Brazil nut, with a variation in values from 86 to 96 %. The Se content and its bioaccessible fraction of Brazil nut PBB may contribute to 1276 % and 1218 % of the RDI for children and adults, respectively. ConclusionsThe Se content varied among samples of cereals, oilseeds and pumpkin seeds, reflecting the diversity in the studied PBBs. Only PBBs containing oilseeds (macadamia, cashews, and Brazil nuts) exhibited measurable amounts of bioaccessible Se, indicating an association with the raw material. However, the consumption of the PBB containing Brazil nuts may pose a risk of adverse effects, due to its high contribution to the RDI in both children and adults.

Clinical characteristics, laboratory findings, and tolerance acquisition in infants with cow's milk protein allergy in a private center in Lima, Peru for the period 2021-2022.

Cow's milk protein allergy (CMPA) remains relatively understudied in Latin America. In this observational study, we enrolled 64 patients with a median age of 3 months, of whom 60% were male. Patients included had a history of IgE-mediated reactions with IgE sensitization or non-IgE-mediated reactions or symptoms following exposure to cow's milk. They underwent skin prick test, ImmunoCAP, fecal calprotectin (FC), and fecal eosinophil-derived neurotoxin (EDN), in addition to double-blinded placebo-controlled oral food challenges (DBPCFC), with clinical evolution and tolerance acquisition observed over 1 year. Malnutrition was present in 78.1% of patients, and 87.5% had a family history of atopy, with 51.6% receiving exclusive breastfeeding. Gastrointestinal manifestations were prevalent in 90.6% of patients, followed by dermatological manifestations (10.9%), with only 2 experiencing anaphylaxis. IgE-mediated CMPA was observed in only six patients. In those with non-IgE-mediated CMPA, FC had a median of 284 mg/dL (IQR: 138.5-415.5), while EDN had a median of 508.5 mg/dL (IQR: 160.25-868). One year after diagnosis, median FC significantly decreased (p < 0.0001), and malnutrition prevalence reduced to 17.1%. Moreover, 81% of patients acquired tolerance following DBPCFC, with 52% utilizing nutritional replacement formulas at diagnosis. Notably, 94% of those extensively hydrolyzed casein-based formulas achieved tolerance (p = 0.08). Our findings provide a foundational framework for future investigations into CMPA diagnosis, tolerance acquisition, and the utilization of hypoallergenic formulas tailored to the unique characteristics of our region.

Assessing and Comparing Potential Allergenicity of Two Partially Hydrolyzed Whey-Based Formulas for Infants: A Population-Based Study in China.

In cases where breast milk is unavailable or inadequate, hydrolyzed infant formula is recommended as the primary alternative. The aim of this study is to assess and compare the allergenicity of two partially hydrolyzed whey-based formulas (PHF-Ws) using serum samples from patients with cow's milk allergy (CMA). LC-MS/MS technology is used to investigate the peptide distribution in both samples. The immunoreactivity of two PHF-Ws in 27 serum samples from 50 Chinese infants (02 years) with CMA is analyzed. The results demonstrate that even with a similar a degree of hydrolysis (DH), primary protein sources, peptides with molecular weights <5 kDa, and differences in the number of residual allergenic epitopes in the hydrolyzed peptide segments can lead to varying immune responses. The two PHF-Ws have notably high intolerance rates, exceeding 10% among infants with CMA. Therefore, suggesting that PHF-Ws may not be suitable for infants and children with CMA in China.

Consumption of cow's milk formula in the nursery and the development of milk allergy.

The effect of the amount of transient cow's milk formula (CMF) consumed during the first days of life on IgE-cow's milk allergy (IgE-CMA) is unknown. A cohort of 58 patients with IgE-CMA was identified from a large scale population-based study of 13,019 infants followed from birth. A group of 116 infants matched for sex and breastfeeding only duration (beyond the nursery period), and another random group of 259 healthy infants were used as controls. Parents were interviewed and the infants' medical records were searched to assess CMF consumption in the nursery. While 96% of the mothers of the 174 infants (58 with Cow's milk allergy and 116 controls) reported on exclusive breastfeeding during the stay in the nursery, CMF consumption was documented in 96 (55%) of the infants. Of those, most (57; 59%) received one to three feedings, 20 (21%) received four to nine feedings, and 19 (20%) received ≥10 feedings. Fewer formula feeds (1-3) were significantly more common in the allergic group than ≥4 feeds (p=0.0003) and no feeds at all (p=0.02) compared to controls (n=116). Of those exclusively breastfed in the nursery, 13/23 allergic infants (57%) introduced CMF at age 105-194days (the period with highest-risk for IgE-CMA) compared to 33/98 (34%) from the random control group (n=259) (p=0.04). Most infants end up receiving few CMF feeds in the nursery. Transient CMF in the nursery is associated with increased risk of IgE-CMA.

Development of IgE-mediated food allergies in children with history of food protein-induced allergic proctocolitis: a series of five cases.

Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated allergic condition that presents with hematochezia in otherwise healthy infants. It is most commonly induced by cow's milk protein via breast milk or formula. The prognosis for FPIAP is generally considered favorable with most infants achieving symptomatic resolution after diet modification. Most infants go on to tolerate the offending foods by 1-3 years of age. Over 8 years at our institution, five patients were identified and noted to have FPIAP to cow's milk during infancy with subsequent development of IgE-mediated allergic reaction to cow's milk and other foods. All five cases developed other atopic disorders (atopic dermatitis in four cases). IgE-mediated cow's milk allergy has persisted beyond the preschool years in at least two patients (currently 8 and 16 years old). For three of the patients, the IgE-mediated reaction to cow's milk was severe with development of anaphylaxis or angioedema. In addition, three patients experienced anaphylaxis or angioedema to allergens other than milk. While FPIAP is a non-IgE-mediated process traditionally thought not to progress past the first year of life, some infants with FPIAP develop severe, persistent IgE-mediated cow's milk allergy. To our knowledge, this is the first detailed clinical description of such patients.

Rational Design of a Multi-epitope Vaccine for Yak Milk Allergy by Immuno-informatics Approach

Milk is a wholesome nutrient source, but one of the problems associated with milk consumption is the allergy observed in humans due to major milk proteins. Yak is one of the milch animal which is well adapted to high altitude and serve as source of nutritious milk for inhabiting human population. However, yak and cow milk are similar in composition, and are known to elicit hyperimmune reaction especially in infants and children. The several therapeutic attempts have already been made to counter cow’s milk allergic response but their response is temporary in nature. So, the following study is an attempt to overcome Yak’s milk allergic response by in-silico multi-epitope vaccine construction. For this, the suitable epitopes and adjuvants were coupled for increased vaccine efficacy and immune stimulation. The vaccine construct was found to be antigenic and free from allergens and toxins. As per computational modelling, the proposed multiepitope vaccine is physically stable and may induce immune responses in allergic conditions.

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XII – Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA

BackgroundCow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit. ObjectiveThese evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA. MethodsWAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders. ResultsAfter reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as “conditional” following the GRADE approach due to the very low certainty about the health effects based on the available evidence. ConclusionsIf breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers’ values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.

Effects of Lacticaseibacillus paracasei XJ-003 on the allergenicity and antigenicity of milk proteins during fermentation

Fermentation with lactic acid bacteria (LAB) provides an effective method to alleviative cow milk allergy. In this research, we identified a specific strain of Lacticaseibacillus paracasei, named as XJ-003, that exhibited stable proteolytic activity and had the capability to reduce milk protein allergenicity. After various safety evaluation tests and genetic-level analysis, it was confirmed that XJ-003 is a safe LAB to use. SDS-PAGE analysis revealed that the hydrolysis efficiency of XJ-003 fermentation on casein was better than that of whey protein. During fermentation, the antigenicity of all milk proteins significantly reduced (p < 0.05), and α-casein exhibited a 67.74% reduction in antigenicity at the end of fermentation. Additionally, after 8 h of fermentation, the allergenicity of all proteins significantly reduced by 33.25%–56.94% (p < 0.05). The fluctuations in antigenicity and allergenicity throughout the fermentation process were attributed to continuous hydrolysis and the release of new epitopes. However, we did not find a direct relationship among the degree of hydrolysis, antigenicity, and allergenicity. It is concluded that the reduction of protein allergenicity is not only attributable to the proteolytic of LAB but is also influenced by the specificity of protein hydrolysis. Therefore. It is not appropriate to screen LAB that can alleviate CMA only according to degree of hydrolysis and antigenicity of the proteins.

Metabolomics identifies phenotypic biomarkers of amino acid metabolism in milk allergy and sensitized tolerance

BackgroundA substantial proportion of sensitized individuals tolerate suspected foods without developing allergic symptoms; this phenomenon is known as sensitized tolerance. The immunogenic and metabolic features underlying the sensitized-tolerant phenotype remain largely unknown. ObjectiveIn this study, we aimed to uncover the metabolic signatures associated with clinical milk allergy and sensitized tolerance using metabolomics. MethodsWe characterized the serum metabolic and immunological profiles of children with clinical IgE-mediated milk allergy (MA; n = 30) or milk-sensitized tolerance (MST; n = 20) and healthy controls (n = 21). A comparative analysis was performed to identify dysregulated pathways associated with the clinical manifestations of food allergy. We also analyzed specific biomarkers indicative of different sensitization phenotypes in children with MA. The candidate metabolites were validated in an independent quantification cohort (n = 41). ResultsMetabolomic profiling confirmed the presence of a distinct metabolic signature that discriminated children with MA from those with MST. Amino acid metabolites generated via arginine, proline, and glutathione metabolism were uniquely altered in children with sensitized tolerance. Arginine depletion and metabolism through the polyamine pathway to fuel glutamate synthesis were closely associated with the suppression of clinical symptoms in the presence of allergen-specific IgE. In children with MA, the polysensitized state was characterized by disturbances in tryptophan metabolism. ConclusionsBy combining untargeted metabolomics with targeted validation in an independent quantification cohort, we identified candidate metabolites as phenotypic and diagnostic biomarkers of food allergy. Our results provide insights into the pathological mechanisms underlying childhood allergy and suggest potential therapeutic targets.

The Effect of Extensive Hydrolyzate Formula on the Growth and Development of Infants With Cow's Milk Allergy

Cow's milk allergy is a common condition in babies and children. Allergic reactions can occur when the body reacts to the proteins in cow's milk, causing various symptoms such as skin rashes, vomiting, diarrhea, or even more serious reactions. Babies who suffer from cow's milk allergy need appropriate treatment so that their growth and development is not disrupted. One approach used in managing cow's milk allergy is to provide an extensive hydrolyzate formula. The aim of this study was to evaluate the effect of providing extensive hydrolyzed formula on the growth and development of babies suffering from cow's milk allergy. This study used qualitative research methods. The data collection technique in this research is literature study. The data that has been collected is then analyzed in three stages, namely data reduction, data presentation and drawing conclusions. The results of the study concluded that the use of extensive hydrolyzed formula is an effective choice for babies who are allergic to cow's milk. This research shows that this formula has a positive impact on the baby's weight growth according to his age. However, in terms of infant development, there is no significant difference in the effect between the use of extensive hydrolyzed formula and soy protein isolate on various aspects, including global development, gross motor skills, fine motor skills, language and social personality in children who are allergic to cow's milk

Simple closed-system combining direct PCR and fluorescence for all types of milk and dairy product authentication

Cow's milk is a popular food choice due to its nutritional value. However, some people have cow milk protein allergy. Alternative milk and dairy products are available, but they may be adulterated or fraudulently substituted with cow's milk to lower the production cost. Current conventional methods for cow DNA detection suffer from laboratory-based instruments and settings, which can be expensive, limit on-site usage, lack sensitivity, or cannot be used with highly degraded samples. Here, a simple closed-system based on direct PCR, which eliminates the need to extract DNA from samples, and SYBR Green I detection of PCR amplicons using the naked eye was developed and validated. Fluorescence detection was enhanced with the use of a self-designed portable LED lightbox, which mitigated color interference, enabling detection in products with diverse colorations without any sample preparation. Validation studies revealed 100% specificity when tested with 13 other species, over 99% accuracy with 208 cow’s milk and dairy products in both liquid and solid forms, 1×10−5 ng limit of detection, and 100% accuracy with blind testing. Market testing of 156 samples showed a fraud ratio of 0.0% in cow’s milk and dairy products, while non-cow’s milk and dairy products showed a fraud ratio of 10.7%, emphasizing the assay's capacity to identify fraudulent substitutions. Overall, this is the first time a cow-specific simple closed-system direct PCR with fluorescence has been used to authenticate fresh milk and dairy products, with one of the quickest turn-around time from sampling to detection of 50 min. It could be useful in a semi-laboratory setting or in the field with a portable PCR machine.

Probiotics supplementation during pregnancy or infancy on multiple food allergies and gut microbiota: a systematic review and meta-analysis.

Probiotics show promise in preventing and managing food allergies, but the impact of supplementation during pregnancy or infancy on children's allergies and gut microbiota remains unclear. This study aimed to assess the effects of maternal or infant probiotic supplementation on food allergy risk and explore the role of gut microbiota. A systematic search of databases (PubMed, Cochrane Library, Embase, and Medline) identified 37 relevant studies until May 20, 2023. Two independent reviewers extracted data, including probiotics intervention details, gut microbiota analysis, and food allergy information. Probiotics supplementation during pregnancy and infancy reduced the risk of total food allergy (relative risk [RR], 0.79; 95% CI, 0.63-0.99), cow-milk allergy (RR, 0.51; 95% CI, 0.29-0.88), and egg allergy (RR, 0.57; 95% CI, 0.39-0.84). Infancy-only supplementation lowered cow-milk allergy risk (RR, 0.69; 95% CI, 0.49-0.96), while pregnancy-only had no discernible effect. Benefits were observed with over 2 probiotic species, and a daily increase of 1.8 × 109 colony-forming units during pregnancy and infancy correlated with a 4% reduction in food allergy risk. Children with food allergies had distinct gut microbiota profiles, evolving with age. Probiotics supplementation during pregnancy and infancy reduces food allergy risk and correlates with age-related changes in gut microbial composition in children. PROSPERO registration no. CRD42023425988.

Specific changes in gut microbiota and short-chain fatty acid levels in infants with cow's milk protein allergy

To explore the changes in gut microbiota and levels of short-chain fatty acids (SCFA) in infants with cow's milk protein allergy (CMPA), and to clarify their role in CMPA. A total of 25 infants diagnosed with CMPA at Children's Hospital Affiliated to Zhengzhou University from August 2019 to August 2020 were enrolled as the CMPA group, and 25 healthy infants were selected as the control group. Fecal samples (200 mg) were collected from both groups and subjected to 16S rDNA high-throughput sequencing technology and liquid chromatography-mass spectrometry to analyze the changes in gut microbial composition and metabolites. Microbial diversity was analyzed in conjunction with metabolites. Compared to the control group, the CMPA group showed altered gut microbial structure and significantly increased α-diversity (P<0.001). The abundance of Firmicutes, Clostridiales and Bacteroidetes was significantly decreased, while the abundance of Sphingomonadaceae, Clostridiaceae_1 and Mycoplasmataceae was significantly increased in the CMPA group compared to the control group (P<0.001). Metabolomic analysis revealed reduced levels of acetic acid, butyric acid, and isovaleric acid in the CMPA group compared to the control group, and the levels of the metabolites were positively correlated with the abundance of SCFA-producing bacteria such as Faecalibacterium and Roseburia (P<0.05). CMPA infants have alterations in gut microbial structure, increased microbial diversity, and decreased levels of SCFA, which may contribute to increased intestinal inflammation.

Impact of the 2022 national formula shortage on clinical decision-making of healthcare providers in switching amino acid formulas for infants with cow's milk protein allergy: a survey-based study.

In 2022, the United States experienced a national shortage of infant formula due to a global supply chain crisis and a large-scale domestic formula recall. The existing literature on healthcare providers' (HCPs) clinical decision-making during formula shortages is limited. This study aims to analyze the factors influencing pediatric HCP clinical decision-making when switching between amino acid formulas (AAF) for managing cow's milk protein allergy (CMPA) in infants under 24 months of age during an unprecedented national formula shortage. The study included pediatric HCPs with experience managing CMPA in infants and toddlers under 24 months during the formula shortage from January 2022 to November 2022. A de-identified survey comprising 26 questions examining driving factors used in clinical decision-making was administered to pediatric HCPs using a real-time mobile data collection tool. Among the surveyed pediatric HCPs (n = 75), the factors most frequently considered as "extremely important" when switching to another AAF included safety (85%), tolerability (73%), and efficacy (83%). No statistically significant differences were found in HCP ratings among the listed examined factors of the four AAFs. The availability of specific formulas was the only factor that exhibited a statistically significant difference in perceived performance among pediatric HCPs when comparing the four AAFs (p < 0.05). This study elucidates the crucial aspects that influenced pediatric HCPs' selection of AAFs for CMPA management during the 2022 formula shortage. The findings highlight the significance of safety, tolerability, efficacy, and availability in the pediatric HCP decision-making processes.

Extensively Hydrolyzed Formula and Infant Colic Symptoms: Secondary Analysis of a Prospective Cohort Study.

Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care.