Milk Allergy Research Articles

A Comparative Study of Consumption of Animal Milk and Plant Based Milk among Young Adults

Milk is a nutrient dense food that is recognized as nature's most complete meal which continues to play a significant role in people's diets all across the world. The most commonly consumed animal milks are cow's milk, goat's milk, and buffalo's milk however, people are becoming more aware of the darker aspects of dairy, such as the cruelty it inflicts on animals, the environmental damage, and the health risks. As a result of these factors, plant milk consumption has increased in recent years. These beverages are preferred by those who have a cow's milk allergy, lactose intolerance, environmental concerns, hypercholesterolemia, calorie concerns, or are adopting new lifestyles such as veganism. Even with the growing economic success of plant milk beverages, no research has been done to compare the consumer’s perception, awareness, and health issues of animal milk to those of plant milk among young adults in India, and therefore, further investigation is needed. Because young adults are still growing, providing accurate milk information will encourage them to increase their milk consumption. As a result, the focus of this study will be on Indian young adults’ opinions, awareness, and health concerns surrounding animal and plant milk.

The Efficacy and Safety of Epicutaneous Immunotherapy for Milk Allergy: A Systematic Review

Introduction: Cow’s milk allergy (CMA) is rising among children and adults, affecting 2-3% of children in affluent countries. Currently, the only standard of care is dairy restriction. However, epicutaneous immunotherapy (EPIT) is being studied as a potential treatment involving transdermal administration of an allergen to induce tolerance. EPIT has been proven safe for managing other food allergies in children and adolescents, but its efficacy for CMA is yet to be determined. Methods: A systematic search of four databases (PubMed, ScienceDirect, SCOPUS, and clinicaltrials.gov) was conducted in September 2022 by three independent reviewers. Additional studies were found by manual reference browsing. All published articles and randomized controlled trials (RCTs) that assessed the effect of EPIT on CMA in children and adolescents aged ≤18 years were included. The search terms used were “epicutaneous immunotherapy” or “immunotherapy” or “EPIT”; “milk allergy” or “cow’s milk allergy” or “CMA” or “CMPA”; “children” or “young” or “kids.” Results: Six studies were included after a systematic search of 123 studies, with three RCTs evaluating the safety and efficacy of EPIT in children with CMA and three meta-analyses and reviews on EPIT for CMA. The findings were inconclusive but suggested the possibility of treating cow’s milk allergy. Discussion: EPIT shows promise in treating food allergies, including CMA. Evidence is lacking to determine its efficacy for CMA. More clinical trials with different dosages and longer follow-ups are needed. Results should be interpreted with caution due to limited studies.

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update – VII – Milk elimination and reintroduction in the diagnostic process of cow's milk allergy

The diagnosis of cow's milk allergy (CMA) in infants and young children remains a challenge because many of the presenting symptoms are similar to those experienced in other diagnoses. Both over- and under-diagnosis occur frequently. Misdiagnosis carries allergic and nutritional risks, including acute reactions, growth faltering, micronutrient deficiencies and a diminished quality of life for infants and caregivers. An inappropriate diagnosis may also add a financial burden on families and on the healthcare system.Elimination and reintroduction of cow's milk (CM) and its derivatives is essential for diagnosing CMA as well as inducing tolerance to CM. In non-IgE mediated CMA, the diagnostic elimination diet typically requires 2–4 weeks before reintroduction, while for IgE mediated allergy the time window may be shorter (1–2 weeks). An oral food challenge (OFC) under medical supervision remains the most reliable diagnostic method for IgE mediated and more severe types of non-IgE mediated CMA such as food protein induced enterocolitis syndrome (FPIES). Conversely, for other forms of non-IgE mediated CMA, reintroduction can be performed at home. The OFC cannot be replaced by the milk ladder after a diagnostic elimination diet. The duration of the therapeutic elimination diet, once a diagnosis was confirmed, can only be established through testing changes in sensitization status, OFCs or home reintroduction, which are directed by local protocols and services' availability. Prior non-evidence-based recommendations suggest that the first therapeutic elimination diet should last for at least 6 months or up to the age of 9–12 months, whichever is reached first. After a therapeutic elimination diet, a milk-ladder approach can be used for non-IgE mediated allergies to determine tolerance. Whilst some centers use the milk ladder also for IgE mediated allergies, there are concerns about the risk of having immediate-type reactions at home. Milk ladders have been adapted to local dietary habits, and typically start with small amounts of baked milk which then step up in the ladder to less heated and fermented foods, increasing the allergenicity.This publication aims to narratively review the risks associated with under- and over-diagnosis of CMA, therefore stressing the necessity of an appropriate diagnosis and management.

"Frequency of fatal and recurrent anaphylaxis due to COW'S milk: A systematic review and meta-analysis of observational studies".

Cow's milk allergy can result in anaphylactic reactions. The estimated prevalence of cow's milk allergy in developed countries ranges from 0.5% to 3% at age 1 year. Our objective was to perform a systematic review and, if possible, a meta-analysis to assess the frequency of fatal and recurrent anaphylaxis induced by cow's milk. We searched PubMed/MEDLINE, EMBASE, and the Web of Science for studies that had assessed fatal and recurrent anaphylaxis induced by cow's milk for the population of a country or at least an administrative region. Our review included cohort, cross-sectional, and registry studies that had assessed the incidence or prevalence of recurrent anaphylaxis or the incidence of fatal anaphylaxis due to cow's milk. The pooled prevalence of recurrence (PR) for at least an episode of anaphylaxis was 26.98% (3.85-189.1). Teymourpour et al (Iran) reported the highest PR (53.10%); the two studies with the lowest PR were from France (5.2 and 0.42, respectively) (p < .01). Nine studies on fatal anaphylaxis were selected (41 deaths) and found to be highly heterogeneous (I2 = 75.9%). Levy et al and Bassagio et al reported the highest incidence rate (IR 0.15 and 0.6 deaths per million persons-year). The PR of anaphylaxis was approximately one quarter of patients with anaphylaxis due to cow's milk, while deaths from anaphylaxis caused by cow's milk were very rare, although some studies report rates as high as 15 times the lowest IR.

Oral food challenge to milk is still necessary to diagnose cow's milk allergy and should be conducted in adequate facilities.

Oral food challenge to milk is still necessary to diagnose cow's milk allergy and should be conducted in adequate facilities.

June 2023-Printed Issue

The summer 2023 issue of Patient Safety is available to read online and download at no charge. This issue features two in-depth data analyses from the largest event reporting database of its kind in the United States, which reveal patient safety trends in serious events and incidents (https://patientsafetyj.com/article/74752-patient-safety-trends-in-2022-an-analysis-of-256-679-serious-events-and-incidents-from-the-nation-s-largest-event-reporting-database) and offer insights on healthcare-associated infections (https://patientsafetyj.com/article/74494-long-term-care-healthcare-associated-infections-in-2022-an-analysis-of-20-216-reports) in Pennsylvania last year. We also share some recent healthcare success stories in recognition of the winners of the 2023 I AM Patient Safety awards. Additional highlights include • A safety alert about methylprednisolone (https://patientsafetyj.com/article/77633-patient-safety-alert-methylprednisolone-and-patients-with-hypersensitivity-to-cow-s-milk-components), a medication that sometimes contains lactose monohydrate, and its risk of anaphylaxis, a life-threating allergic reaction, to patients with a cow’s milk allergy. • An expert on artificial intelligence discusses what AI can and can’t do in healthcare (https://patientsafetyj.com/article/77632-artificially-intelligent-machine-learning-in-healthcare-and-why-it-may-not-be-as-advanced-as-you-think), now and in the future. • Human factors researchers review best practices from high-risk industries (https://patientsafetyj.com/article/77769-informing-visual-display-design-of-electronic-health-records-a-human-factors-cross-industry-perspective) that may inform visual display design of electronic health records. • How an evidence-based teaching plan (https://patientsafetyj.com/article/77630-evidence-based-teaching-plan-test-and-evaluation-on-caring-for-healthcare-provider-second-victims) might raise awareness of the effect that significant patient and employee crises have on the staff who witness such events. • A study explores the feasibility of monitoring patients’ vital signs (https://patientsafetyj.com/article/77776-continuous-monitoring-of-vital-signs-after-hospital-discharge-a-feasibility-study) at home. Patient Safety is fully open access (no fees for authors or readers). We welcome manuscripts from all over the world. If your work can help advance patient safety, please submit it to us for consideration (https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers.

Some properties of semi-hard cheese made from cow’s and goat’s milk

Goat's milk has been among the priority milk in consumer preferences, in recent years. It is an excellent food for children and adults due to its chemical composition and functional properties, and it can be easily consumed by individuals with cow's milk allergy. In the study, semi-hard type cheese was produced from cow’s and goat’s milk. Acidity, pH, fat, dry matter, ash, water activity, salt, color, protein, yield, organic acid and textural properties of cheeses were investigated. As a result of the analysis, it was determined that the titration acidity (% lactic acid), ash, total protein and value of cheese produced from goat's milk were higher. In terms of color, goat's cheese has a more matte appearance than cow's cheese, a* values are higher in semi-hard type cheese produced from goat's milk, and b* value is lower. The study determined that the firmness value of cheese produced from cow's milk was higher than that of goat cheese. In the study, 6 organic acids (oxalic acid, tartaric acid, formic acid, lactic acid, acetic acid and succinic acid) were determined. Formic, succinic and tartaric acid amounts were found higher in cheeses produced from goat milk. It was determined that the lactic acid level was designated the highest organic acid in cheese produced from both milk types. Cheeses produced from goat milk are more appreciated in terms of cross-sectional appearance and taste in sensory analysis. It is thought that semi-hard type cheeses can be produced from goat's milk can be an alternative to cheeses produced from cow's milk.

Cost-effectiveness of therapeutic infant formulas for cow's milk protein allergy management.

Cow's milk protein allergy (CMPA) is children's most common food allergy. Therapeutic infant formulas for CMPA lead to symptom-free and potentially benefit early tolerance induction and reducing the allergic march in non-breastfed babies. This study assessed the cost-effectiveness of CMPA management with different therapeutic infant formulas in Thailand, which may reflect situations in developing countries throughout Asia. An analytic decision model was developed to simulate the occurrence of eczema, urticaria, asthma, rhinoconjunctivitis, or being symptom-free in infants with CMPA over 36 months. Extensively hydrolyzed casein formula with added probiotic Lacticaseibacillus rhamnosus (previously Lactobacillus rhamnosus) strain GG (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), soy protein-based formula (SPF), and amino acid formula (AAF) were compared from the healthcare payer perspective. The results from a prospective cohort study were used for comparative effectiveness measures, while local experts were interviewed to estimate the healthcare resource used in the management of CMPA. The costs of healthcare resources were obtained from standard, publicly available sources. The direct medical cost of CMPA management was lowest for EHCF+LGG (USD 1,720), followed by SPF (USD 2,090), EHWF (USD 2,791), and AAF (USD 7,881). Compared with other formulas, EHCF+LGG was expected to save USD 370 (SPF), USD 1,071 (EHWF), and USD 6,161 (AAF) in the total cost of CMPA management over 36 months. In conclusion, EHCF+LGG was the most cost-effective strategy for managing non-breastfed infants with CMPA. This strategy was associated with more children developing immune tolerance to cow's milk and being symptom-free, contributing to overall cost-saving potential.

Formula milk companies and allergy healthcare professionals in India.

India is a low-middle income country with a population of 1.4 billion and home to one quarter of the world's children. Exclusive breastfeeding until 6 months and continued breastfeeding until at least 2 years as per global recommendations are common practice. The Indian government and associated organisations have strived to protect breastfeeding, which is important in a country with high under-5 mortality, malnutrition and stunting. Allergic disease is under-recognised in India, but despite the absence of a dedicated allergy medical specialty, awareness of allergy is increasing among healthcare practitioners and in the general population. In high-income countries, overdiagnosis of allergy has become recognised as an issue in recent years. Allergy healthcare professionals have also attracted criticism for close relationships with the formula industry, which appear to have contributed to excessive use of specialised formula products and undermining of breastfeeding. Specialised formula has been used unnecessarily for preventing allergy, based on fraudulent and selectively reported science; and for managing normal infant symptoms which are mislabelled as milk allergy. This forms part of a broader formula industry corporate strategy to widen the boundaries of illness in order to expand sales and markets. In India, allergic disease management is hindered by limited understanding of the disease entity among practitioners, low access to diagnostics, limited healthcare resources, high exposure to air pollution and a large, diverse population. Data specific to India on allergic disease prevalence and interpreting allergy diagnostics are incomplete. The knowledge gaps mean allergy management in India is often extrapolated from guidance developed in high-income countries with low breastfeeding rates. As the allergy specialty develops in India, local guidance and practice will need to recognise the threat that current allergy practice poses to India's normative infant feeding culture, and ensure that breastfeeding continues to be supported at all levels.

Short-term symptom improvement in infants with suspected cow's milk protein allergy using amino acid formula: a prospective cohort analysis.

Cow's milk protein allergy (CMPA) occurs commonly in infants. While the long-term efficacy of amino acid formulas for managing CMPA is well-established, there is limited data on the short-term symptom improvement of using amino acid formula (AAF). This study aimed to determine the short-term effects of managing suspected CMPA in infants aged 6 months and under using a commercial AAF. Healthcare providers who treated infants with suspected CMPA aged 6 months or younger (n = 104) provided de-identified survey data in this prospective study. Healthcare providers scored symptoms for severity from 0 to 3 (none, low, moderate, severe) before using a commercial AAF at Visit 1 and at Visit 2 (3-6 weeks later). Gastrointestinal (94%), skin (87%), respiratory (86%), and uncategorized symptoms (89%) improved from AAF initiation, and these findings were consistent across different follow-up visit durations. This study is the most extensive prospective analysis conducted in the United States examining the short-term change in suspected CMPA symptoms using an AAF. These findings suggest that AAF may decrease the severity of suspected CMPA symptoms in infants 6 months or younger, often by the next follow-up visit. Further randomized controlled trials are required to confirm these initial findings.

Practical issues of oral immunotherapy for egg or milk allergy.

Oral immunotherapy (OIT) has been recommended to reduce parental burden related to strict allergen avoidance and induce desensitization and immune tolerance for patients with long-lasting allergies to hen's eggs (HE) or cow's milk (CM). OIT should be monitored by pediatric allergists specializing in OIT and oral food challenge tests to manage allergic reactions. Although a previous history of anaphylaxis or multiple food allergies is not a contraindication to OIT, it is contraindicated if the patient has uncontrolled asthma, a malignancy, active systemic autoimmune disorders, or diseases requiring treatment with beta-blockers. A variety of OIT protocols have been de veloped to ensure better outcomes and safe up-dosing, including adjunctive therapies with biologics. This review provides insight into the practical issues of various immunotherapy options for children with HE or CM allergies.

Development of a novel polyclonal antibody against bovine αS1-casein IgE epitopes for prediction of potential allergenicity of milk in foods

ABSTRACT Bovine αS1-casein (αS1-CN) is the main allergen in cow's milk, and immunoglobulin E (IgE) epitopes are the material basis to trigger allergic reactions. Thus, IgE epitopes could be as key targets for precise αS1-CN detection and allergenicity assessment. Here, we designed a tandem containing nine IgE linear epitopes of αS1-CN (tαS1-CN), expressed the recombinant tαS1-CN in Escherichia coli, and prepared the rabbit polyclonal antibody against recombinant tαS1-CN (pAb-tαS1-CN). The obtained recombinant tαS1-CN had a purity of 94.43% and retained the antigenicity and potential allergenicity of IgE epitopes. The pAb-tαS1-CN could recognize the nine IgE epitopes of αS1-CN, and also showed high specificity. The ability of pAb-tαS1-CN to evaluate the potential allergenicity of milk in foods was validated by sera from cow's milk allergy patients. These findings indicate that our prepared pAb-tαS1-CN may represents a valuable tool for the evaluation of milk allergenicity in processed foods.

Full Breastfeeding and Allergic Diseases-Long-Term Protection or Rebound Effects?

A previous follow-up of the GINIplus study showed that breastfeeding could protect against early eczema. However, effects diminished in adolescence, possibly indicating a "rebound effect" in breastfed children after initial protection. We evaluated the role of early eczema until three years of age on allergies until young adulthood and assessed whether early eczema modifies the association between breastfeeding and allergies. Data from GINIplus until 20-years of age (N = 4058) were considered. Information on atopic eczema, asthma, and rhinitis was based on reported physician's diagnoses. Adjusted Odds Ratios (aOR) were modelled by using generalized estimating equations. Early eczema was associated with eczema (aORs = 3.2-14.4), asthma (aORs = 2.2-2.7), and rhinitis (aORs = 1.2-2.7) until young adulthood. For eczema, this association decreased with age (p-for-interaction = 0.002-0.006). Longitudinal models did not show associations between breastfeeding and the respective allergies from 5 to 20 years of age. Moreover, early eczema generally did not modify the association between milk feeding and allergies except for rhinitis in participants without family history of atopy. Early eczema strongly predicts allergies until young adulthood. While preventive effects of full breastfeeding on eczema in infants with family history of atopy does not persist until young adulthood, the hypothesis of a rebound effect after initial protection cannot be confirmed.

Integrating widely targeted lipidomics and transcriptomics unravels aberrant lipid metabolism and identifies potential biomarkers of food allergies in rats.

Oral food challenges (OFCs) are currently the gold standard for determining the clinical reactivity of food allergy (FA) but are time-consuming, expensive, and risky. To screen novel peripheral biomarkers of FA and characterize the aberrant lipid metabolism in serum, 24 rats were divided into four groups: peanut, milk, and shrimp allergy (PA, MA, and SA, respectively) and control groups, with six rats in each group, and used for widely targeted lipidomics and transcriptomics analysis. Widely targeted lipidomics revealed 144, 162, and 206 differentially accumulated lipids in PA, MA, and SA groups, respectively. We integrated widely targeted lipidomics and transcriptomics and identified abnormal lipid metabolism correlated with widespread differential accumulation of diverse lipids (including triacylglycerol, diacylglycerol, sphingolipid, and glycerophospholipid) in PA, MA, and SA. Simplified random forest classifier was constructed through five repetitions of 10-fold cross-validation to distinguish allergy from control. A subset of 15 lipids as potential biomarkers allowed for more reliable and more accurate prediction of FA. Independent replication validated the reproducibility of potential biomarkers. Our results revealed the major abnormalities in lipid metabolism and suggested the potential role of lipids as novel molecular signatures for FA. This article is protected by copyright. All rights reserved.

Children with cow’s milk allergy: prediction of oral immunotherapy response in clinical practice

Children with cow’s milk allergy: prediction of oral immunotherapy response in clinical practice

Evaluation of IgG/IgE-binding capacity and functional properties of enzymatic hydrolysis in skimmed cow milk system.

Cow's milk (CM) allergy is a common food allergy that seriously impacts the growth and development of infants and children. However, CM is an important source of nutrients, and few studies focus on the effects of enzymatic hydrolysis treatment on the whole skimmed CM system. In this study, the IgG/IgE-binding and functional properties of Alcalase-, Protamex-, and Flavourzyme-treated skimmed CM (AT, PT, and FT, respectively) were systematically evaluated. The results showed that the treatment groups were mainly composed of low molecular weight (MW) peptides (<3kDa), accounting for 94.85%-97.90%. Additionally, the IgG reactivity of these peptides was significantly lower (p<0.05) than those of higher MW peptides (10-30kDa and >30kDa). The IgE reactivity of FT with higher MW peptides was the lowest among these groups, with the OD value reaching 0.089. Moreover, the total amino acid content of hydrolysates of skimmed CM (HM) increased significantly (skimmed CM, 5.94µg/mL; AT, 123.70 µg/mL; PT: 136.20µg/mL; FT, 988.72µg/mL) compared to that in skimmed CM. A total of 10, 10, and 7 flavor compounds were increased in AT, PT, and FT, respectively. Furthermore, the solubility, foamability, and emulsifying ability of HM were significantly improved, being 2.17-fold, 1.52-fold, and 1.96-fold higher in PT than in skimmed CM. These results lay a theoretical foundation for the development of hypoallergenic dairy products.

Factors influencing accidental food allergic reactions in schools and preschools

BackgroundChildren spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings.AimThe aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS.MethodsA prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here.ResultsA total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6–7.0) and in preschool CCS 5% (95% CI 1.8–11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow’s milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff.ConclusionThe incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of “nut bans” remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.

Molecular Mechanism and Clinical Effects of Probiotics in the Management of Cow's Milk Protein Allergy.

Cow's milk protein allergy (CMPA) is the most common food allergy (FA) in infancy, affecting approximately 2% of children under 4 years of age. According to recent studies, the increasing prevalence of FAs can be associated with changes in composition and function of gut microbiota or "dysbiosis". Gut microbiota regulation, mediated by probiotics, may modulate the systemic inflammatory and immune responses, influencing the development of allergies, with possible clinical benefits. This narrative review collects the actual evidence of probiotics' efficacy in the management of pediatric CMPA, with a specific focus on the molecular mechanisms of action. Most studies included in this review have shown a beneficial effect of probiotics in CMPA patients, especially in terms of achieving tolerance and improving symptoms.

Growth retardation in children with allergies: A review

The increase in the prevalence of food allergies among children in recent years is evident with onset in infancy and childhood in most cases. The full value of the elimination diet, the time before diagnosis, and the severity of allergic inflammation can affect the nutritional status of the children and, ultimately, their linear growth. Age-correspondent height is one of the most important indicators of a child's health and well-being, especially in the first few years of life when energy and nutrient requirements per body weight are highest. Insufficient nutrient intake in children with food allergies can impair growth, and developmental delay in infancy and early childhood can have long-term sequelae. It is essential to understand the frequency of developmental retardation in kids with food allergies, the most prevalent allergen that causes it, and whether or not growth retardation may be reversed with effective diet therapy. Based on the studies presented in the article, the following key provisions were identified: of the entire spectrum of food allergens, cow milk protein allergy (CMPA) has the most significant effect on growth; the impact of CMPA on the formation of improper eating habits is also high; careful management of a child with CMPA with adequate diet therapy and timely re-introduced dairy products to induce tolerance can reduce the adverse effect of CMPA on growth and nutrition; apparently, multiple food allergies also harm growth; a nutritionist should more often observe children with multiple food allergies; regular assessment of growth and diet with individual nutrition recommendations to date has shown the best results in achieving the growth target of children with food allergies.

The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial.

The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow's milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.