BACKGROUND: Products based on hydrolysed cow milk proteins or amino acid mixtures are recommended in children with cow's milk hypersensitivity. However, some children who are allergic to cow's milk and who clinically react to substitute milk formulas have been observed. OBJECTIVE: To determine the tolerance and allergenicity of protein hydrolysate or amino acid-derived formulas in children with IgE-mediated cow's milk allergy. METHODS: Twenty children with positive cow's milk challenges, positive skin prick tests and/or serum-specific IgE antibodies to cow's milk were selected. Oral challenges, skin prick tests and serum-specific IgE antibodies to extensively hydrolysed whey formula, partially hydrolysed whey formula, extensively hydrolysed casein formula and amino acid-derived formula were performed. RESULTS: Five out of 17 (5/17) children reacted to partially hydrolysed whey formula, (3/16) to extensively hydrolysed whey formula, (2/10) to amino acid-derived formula, (1/16) to extensively hydrolysed casein formula. Only extensively hydrolysed casein formula was tolerated by at least 90% (with 95% confidence intervals) of children. Hydrolysates provoked early and delayed clinical reactions, amino acid mixtures only delayed reactions. Partially hydrolysed whey formula elicited a significantly higher number of positive skin prick test reactions than other formulas. Two children had specific IgE antibodies to extensively hydrolysed whey formula, one to partially hydrolysed whey formula, one to extensively hydrolysed casein formula and none to amino acid-derived formula. CONCLUSION: In this study, none of the cow's milk substitutes has been found to be non-allergenic. Our results suggest that in children with IgE-mediated cow's milk allergy, the first ingestions of extensively hydrolysed cow's milk protein formulas require strict medical supervision because of immediate reactions. This is not the case for amino acid-derived formula. Moreover, our data suggest that treatment of children allergic to cow's milk with cow's milk substitutes should be monitored for several days to document tolerance.
BACKGROUND: Products based on hydrolysed cow milk proteins or amino acid mixtures are recommended in children with cow's milk hypersensitivity. However, some children who are allergic to cow's milk and who clinically react to substitute milk formulas have been observed. OBJECTIVE: To determine the tolerance and allergenicity of protein hydrolysate or amino acid-derived formulas in children with IgE-mediated cow's milk allergy. METHODS: Twenty children with positive cow's milk challenges, positive skin prick tests and/or serum-specific IgE antibodies to cow's milk were selected. Oral challenges, skin prick tests and serum-specific IgE antibodies to extensively hydrolysed whey formula, partially hydrolysed whey formula, extensively hydrolysed casein formula and amino acid-derived formula were performed. RESULTS: Five out of 17 (5/17) children reacted to partially hydrolysed whey formula, (3/16) to extensively hydrolysed whey formula, (2/10) to amino acid-derived formula, (1/16) to extensively hydrolysed casein formula. Only extensively hydrolysed casein formula was tolerated by at least 90% (with 95% confidence intervals) of children. Hydrolysates provoked early and delayed clinical reactions, amino acid mixtures only delayed reactions. Partially hydrolysed whey formula elicited a significantly higher number of positive skin prick test reactions than other formulas. Two children had specific IgE antibodies to extensively hydrolysed whey formula, one to partially hydrolysed whey formula, one to extensively hydrolysed casein formula and none to amino acid-derived formula. CONCLUSION: In this study, none of the cow's milk substitutes has been found to be non-allergenic. Our results suggest that in children with IgE-mediated cow's milk allergy, the first ingestions of extensively hydrolysed cow's milk protein formulas require strict medical supervision because of immediate reactions. This is not the case for amino acid-derived formula. Moreover, our data suggest that treatment of childrenallergic to cow's milk with cow's milk substitutes should be monitored for several days to document tolerance.
Authors: Nicole C M Petrus; Anne-Fleur A Schoemaker; Meike W van Hoek; Laura Jansen; Marijke C Jansen-van der Weide; Wim M C van Aalderen; Aline B Sprikkelman Journal: Eur J Pediatr Date: 2014-11-22 Impact factor: 3.183
Authors: Alessandro Fiocchi; Jan Brozek; Holger Schünemann; Sami L Bahna; Andrea von Berg; Kirsten Beyer; Martin Bozzola; Julia Bradsher; Enrico Compalati; Motohiro Ebisawa; Maria Antonieta Guzman; Haiqi Li; Ralf G Heine; Paul Keith; Gideon Lack; Massimo Landi; Alberto Martelli; Fabienne Rancé; Hugh Sampson; Airton Stein; Luigi Terracciano; Stefan Vieths Journal: World Allergy Organ J Date: 2010-04-23 Impact factor: 4.084
Authors: Vincenzo Fierro; Rocco L Valluzzi; Claudia Banzato; Ma A Plaza; Montserrat Bosque; Marcel Íbero; Luis A Z Echeverría; Maurizio Mennini; Lamia Dahdah; Roser de Castellar; Gloria Tort; Jesus Jiménez Journal: Immun Inflamm Dis Date: 2020-02-28
Authors: Antonella Muraro; Debra de Silva; Susanne Halken; Margitta Worm; Ekaterina Khaleva; Stefania Arasi; Audrey Dunn-Galvin; Bright I Nwaru; Nicolette W De Jong; Pablo Rodríguez Del Río; Paul J Turner; Pete Smith; Philippe Begin; Elizabeth Angier; Hasan Arshad; Barbara Ballmer-Weber; Kirsten Beyer; Carsten Bindslev-Jensen; Antonella Cianferoni; Céline Demoulin; Antoine Deschildre; Motohiro Ebisawa; Maria Montserrat Fernandez-Rivas; Alessandro Fiocchi; Bertine Flokstra-de Blok; Jennifer Gerdts; Josefine Gradman; Kate Grimshaw; Carla Jones; Susanne Lau; Richard Loh; Montserrat Alvaro Lozano; Mika Makela; Mary Jane Marchisotto; Rosan Meyer; Clare Mills; Caroline Nilsson; Anna Nowak-Wegrzyn; Ulugbek Nurmatov; Giovanni Pajno; Marcia Podestà; Lars K Poulsen; Hugh A Sampson; Angel Sanchez; Sabine Schnadt; Hania Szajewska; Ronald Van Ree; Carina Venter; Berber Vlieg-Boerstra; Amena Warner; Gary Wong; Robert Wood; Torsten Zuberbier; Graham Roberts Journal: World Allergy Organ J Date: 2022-09-07 Impact factor: 5.516