Pediatr. praxi. 2020;21(4):238-242 | DOI: 10.36290/ped.2020.049
Extensive hydrolysates and their role in clinical practice
- Centrum dětské gastroenterologie, hepatologie a výživy, Klinika pediatrie a dědičných poruch metabolismu (KPDPM) VFN a 1. LF UK, Praha
Cow's milk protein allergy (CMPA) is a common health problem encountered by paediatric general practitioners. After establishment of the diagnosis, an elimination diet is indicated. Mothers of fully breast-fed infants should be recommended a strict dairy-free diet. Extensively hydrolysed formulas (eHF) are usually sufficient in the treatment of 90% of formula fed infants. Amino acid formulas (AAF) are indicated less frequently. Results of clinical studies regarding eHF have various and often conflicting results. This seems to be due to different degrees of hydrolysis and residual allergenicity between various eHF. It seems that long-term use of eHF does not affect the thriving of children negatively. However, it would seem that children fed with whey-based eHF have better weight gains than their casein-based eHF fed counterparts. Usage of eHF with the highest level of hydrolysis and contents of peptides with a molecular weight <1000 Da should be used in clinical practice.
Keywords: cow's milk protein allergy, extensively hydrolysed formula, amino acid formula, molecular weight, whey, casein.
Published: September 3, 2020 Show citation
References
- Koletzko S, Niggemann B, Arato A et al. Diagnostic approach and management of cow's‑milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012; 55(2): 221-229.
Go to original source... 
Go to PubMed... - Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127: 594-602. Go to original source...
- Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta‑analysis. J Allergy Clin Immunol 2007; 120: 638-646. Go to original source...
- Vandenplas Y, Brueton M, Dupont C et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 2007; 92(10): 902-908. Go to original source...
- Lifschitz C, Szajewska H. Cow's milk allergy: evidence‑based diagnosis and management for the practitioner. Eur J Pediatr 2015; 174: 141-150. Go to original source...
- Høst A. Frequency of Cow's Milk Allergy in Childhood. Ann Allergy Asthma Immunol 2002; 89(6 Suppl 1): 33-37. Go to original source...
- Høst A, Halken S, Jacobsen HP et al. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 2002; 13 (suppl 15): 23-28. Go to original source...
- Spergel JM. Natural history of cow's milk allergy. J Allergy Clin Immunol 2013; 131(3): 813-814. Go to original source...
- Greer FR, Sicherer SH, Burks AW et al. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods and hydrolyzed formulas. Pediatrics 2008; 121(1): 183-191. Go to original source... Go to PubMed...
- Luyt D, Ball H, Makwana N et al. BSACI guideline for the diagnosis and management of cow's milk allergy. Clin Exp Allergy 2014: 44(5): 642-672. Go to original source...
- Petrus NC, Schoemaker AF, von Hoek MW et al. Remaining symptoms in half the children treated for milk allergy. Eur J Pediatr 2015; 174(6): 759-765. Go to original source...
- Chauveau A, Nguyen‑Grosjean VM, Jacquenet S et al. Immediate hypersensitivity to extensively hydrolyzed formulas: An important reminder. Pediatr Allergy Immunol 2016; 27(5): 541-543. Go to original source...
- Rapp M, Martin‑Paschoud C, Nutten S et al. Characterization of an extensively hydrolyzed whey infant formula with low bitterness. Clin Transl Allergy 3, P132.
- Hochwallner H, Schulmeister U, Swoboda I et al. Infant milk formulas differ regarding their allergenic aktivity and induction of T‑cell and cytokine response. Allergy 2017; 72(3): 416-424. Go to original source...
- Nutten S, Maynard F, Järvi A et al. Peptide size profile and residual immunogenic milk protein or peptide content in extensively hydrolyzed infant formulas. Allergy 2020; 7(6): 1446-1449. Go to original source...
- Estrada‑Reyes E, García‑Hernández G, Martínez‑Gimeno A et al. Effect of extensively hydrolyzed milk formule on growth and resistence to bronchitis and atopic dermatitis in infants and toddlers. J Investig Allergol Clin Immunol 2016; 16(3): 183-187.
- Rzehak P, Sausenthaler S, Koletzko S et al. Short- and long‑term effects of feeding hydrolyzed protein infant formulas on growth at < or = 6 y of age: results from the German Infant Nutritional Intervention Study. Am J Clin Nutr 2009; 89(6): 1846-1856. Go to original source...
- Vandenplas Y, Steenhout P, Planoudis Y et al. Treating cow's milk protein allergy: a double‑blind randomized trial comparing two extensively hydrolysed formulas with probiotics. Acta Paediatr 2013; 102(10): 990-998. Go to original source... Go to PubMed...