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Highlights • β-caseins from human milk and from donkey, goat, and sheep milk have been purified. • Similar self-assembling behaviour between β-casein from different species was found. • Lower hypoallergenic potential of donkey and human β-caseins was determined. • Possible use of β-casein from other milk sources as nanocarriers has been suggested. Graphical abstract Abstract Caseins are a family of proteins constituted by α-caseins (αs-1 and αs-2 caseins), β-caseins and κ-caseins. β-caseins, in particular, show a temperature and concentration-dependent self-assembling behaviour. Recently, β-casein micelles have been proposed as natural nanocarriers for the delivery of hydrophobic compounds, promoting their bioavailability. Until now, all studies regarding both chemical-physical characterization and applications of β-caseins have employed the protein of bovine origin. However, it could be interesting to exploit the use of β-caseins from other milk sources for their potential encapsulation ability and immunogenicity but, at present, no information on the self-assembling behaviour is available for β-caseins from the milk of species different from bovine. In this work, for the first time, β-caseins from human milk and from donkey, goat, and sheep milk were purified and their self-assembling behaviour was compared to that of a commercial bovine β-casein, the only one for which the concentration and temperature aggregation behaviour is known. Furthermore, a preliminary evaluation of the immunogenicity potential of β-casein from other milk sources has been performed by cross-reaction experiments using anti-β-casein antibodies from bovine origin. The results indicated a similar self-assembling profile among all β-caseins examined compared to the bovine β-casein, suggesting the possible use of β-casein from other milk sources as nanocarriers. Since donkey and human β-casein do not cross-react with bovine anti-β-casein antibodies, they could be particularly interesting for the development of self-assembling systems with lower hypoallergenic potential. [ABSTRACT FROM AUTHOR]

The aim of this review paper is to assess the applicability of donkey's milk to infants suffering from Cow Milk Protein Allergy (CMPA) compared to human and other available milk types. The bioactive and immune-supportive character which could be beneficial as a fortifier to the formula-fed infants is described while limitations of this type of milk are also discussed. Studies showed that human and donkey's milk have similar, overall, chemical composition as well as protein homogeneity and antigenic similarities. Several in vitro and in vivo studies showed that donkey's milk has nutraceutical and functional properties that can support immunity, alter metabolism and beneficially modify gut microbiota. Clinical studies illustrated that donkeys' milk is well tolerated (82.6%–88%) by infants. Finally, the effect that processing (i.e. thermal, non-thermal treatments, drying methods) has on donkey milk components is also discussed pointing out the need for minimally processing this type of milk. [ABSTRACT FROM AUTHOR]

Background: In case of cow's milk allergy (CMA), pediatric guidelines recommend for children the use of extensively hydrolyzed formulas (eHFs) as elimination diet. According to the American Academy of Pediatrics, the hypoallergenicity of each specific eHF should be tested in subjects with CMA.Methods: A prospective, multicenter trial was performed to assess the tolerance/hypoallergenicity of a thickened casein-based eHF (eHCF, Allernova AR®, United Pharmaceuticals, France) in infants aged <12 months with CMA proven by a double-blind placebo-controlled food challenge. Its efficacy, measured through allergy symptoms monitoring and Cow's Milk-related Symptom Score (CoMiSS) calculation, and safety were evaluated during a 4-month feeding period. Growth z-scores were computed based on WHO anthropometric data.Results: Thirty infants (mean age: 4.8 ± 3.0 months) with CMA proven by a DBPCFC tolerated the eHCF during the 4-month study. The CoMiSS, crying and regurgitation scores significantly decreased by 4.2 ± 4.0, 0.9 ±1.2 and 0.7 ± 1.1 respectively, after 14 days of feeding (p < 0.001). The Scoring Atopic Dermatitis index, of 33.2 ± 14.8 at inclusion in 9 patients, significantly decreased by 15.5 ± 6.7 and 21.1 ± 11.2, after 14 and 45 days of feeding, respectively (p < 0.001). The percentage of infants having normal stool consistency (soft or formed stools) significantly improved from 66.7 % (20/30) at inclusion to 90.0 % (27/30) after 14 days of feeding (p = 0.020). The growth z-scores, negative at study inclusion, significantly improved over the 4-month study. No adverse event was related to the eHCF.Conclusion: The thickened eHCF was tolerated by more than 90 % of included allergic infants with 95 % confidence interval and can therefore be considered as hypoallergenic in accordance with current guidelines. The improvement of growth indices and absence of related adverse events confirmed its safety. Results of this trial back the use of the tested thickened eHCF as an efficient and safe alternative in children with CMA.Trial Registration: ClinicalTrials.gov, number NCT02351531 , registered on 27 January 2015. [ABSTRACT FROM AUTHOR]

Background: The management of cow's milk allergy (CMA) includes initial dairy exclusion with suitable dietary substitution, diagnostic challenges where indicated, and supervised re-introduction as the condition resolves. Information on clinician practice is limited. We audited the current practice of clinicians in the UK to evaluate adherence to international guidelines. Methods: An online questionnaire was sent to all clinicians whose practice included children identified on the national allergy society website. One hundred and sixty questionnaires were sent and 116 (73%) responded. Results: Skin prick tests were more commonly used than serum-specific IgE as diagnostic tests. Respective proportions selecting amino acid formulas (AAF) or extensively hydrolysed formulas (EHF) in severe versus mild/moderate presentations were 78 and 40% versus 20 and 88%; soya formula was the first choice in 8.6 and 24%. The criteria for selection of AAF as the first choice were predominantly severe IgE-mediated and non-IgE-mediated reactions, failure to thrive and if infants refused EHF. Oral challenges might be used to diagnose CMA in 69%, whereas nearly 90% performed challenges to assess tolerance. Most of these were open challenges, more commonly with fresh milk (90%) than baked milk (60%). Home baked milk challenges were frequently considered (70%), although only after consideration of the clinical scenario. Practice did not vary with experience. Conclusions: Current practice amongst UK clinicians of the management of CMA is broadly in line with current guidance, particularly the positioning of hypoallergenic milks as substitute milk choices. A notable deviation was the use of home baked milk challenges or re-introduction. [ABSTRACT FROM AUTHOR]

Hypoallergenic infant formulas based on hydrolysed milk proteins are used in the diet for cow's milk allergic infants. For a preclinical evaluation of the immunogenicity and allergenicity of new protein ingredients for such hypoallergenic infant formulas as well as for the investigation of which characteristics of hydrolysates that contribute to allergenicity, in vivo models are valuable tools. In this study, we examine the immunogenicity and allergenicity of two hydrolysates in a Brown Norway (BN) rat model, using i.p. dosing, which allows for the use of small quantities. Intact BLG, hydrolysed BLG and a hydrolysed whey product suitable for use in extensively hydrolysed formulas were thoroughly characterized for protein chemical features and administered to BN rats by i.p. immunization with or without adjuvant. Sera were analysed for specific IgG and IgE for evaluation of sensitizing capacity, immunogenicity and antibody-binding capacity. For evaluation of eliciting capacity a skin test was performed. The study showed that the hydrolysates had no residual allergenicity, lacking the capacity to sensitize and elicit reactions in the BN rats. Dosing with or without adjuvant induced a large difference in immunogenicity. Only antibodies from rats sensitized to intact BLG with adjuvant were able to bind the hydrolysates, and the whey-based hydrolysate only showed immunogenicity when dosed with adjuvant. This study showed that hydrolysates can be evaluated by an i.p. animal model, but that the choice of in vitro tests used for evaluation of antibody responses may greatly influence the result as well as may the use of adjuvant. [ABSTRACT FROM AUTHOR]

Milk (M), soya (S) and hypoallergenic ( HA) infant formulas were evaluated for an effect-directed assessment of whole food on human liver (HuH6) and colon ( DLD-1) cell lines. Treatment concentrations were derived from an estimated meal for a 4-month infant. The expression of a panel of genes ( ERα, ERβ, AR, PPARγ, AhR) and functional markers ( TNFα, IL-8 in DLD1; γ- GT in HuH6) were evaluated comparing results with bisphenol A, vinclozolin, genistein, TCDD and mixture effects at concentrations reflecting dietary exposures. M increased only ERα in DLD-1; HA affected only DLD-1 ( ERα and ERβ upregulation; AhR and TNFα downregulation); S upregulated ERβ both cell lines), ERα ( DLD-1) and AR (HuH6). Bisphenol A showed similar effects as HA and S in DLD-1; the mixture upregulated AR and ERβ in HuH6 as S. Although DLD-1 was more responsive than HuH6, the use of both cell lines and all selected endpoints allow to characterise each tested formula or substance. [ABSTRACT FROM AUTHOR]

Background Infants and children with chronic diarrhea (CD) often require specialized foods or parenteral nutrition (PN) to achieve adequate nutrient intakes to support growth and development. We assessed the efficacy of an amino acid-based formula (AAF) in supporting growth and improving symptoms in infants and children with CD from multiple etiologies. Methods Two studies were conducted: CD study in children (CD-C) and CD study in infants (CD-I). Each was a single group, baseline-controlled study in which each subject served as his/her own control. At enrollment, all subjects had CD lasting > 2 weeks and had = 4 stools/day. Subjects were fed an AAF for 80 days starting at SD5, and were assessed at SD 28 and 84. Results CD-C: 18 of 19 subjects completed the study. At enrollment, the mean age was 5.6 ± 0.7 years, the most common diagnosis was short bowel syndrome (SBS) (n = 13), and 5 subjects with SBS were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.026). Over 50% of subjects achieved improvements in clinical outcomes targeted most frequently by their physicians. Of the five subjects on PN at enrollment, four had substantial weight gain and four had their PN requirements decreased. CD-I: 22 of 27 subjects completed the study. At enrollment, the mean age was 3.3 ± 0.3 months, the most common diagnosis was food allergy (n = 20), and no subjects were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.0023), significant decreases in the number of stools/day (p = 0.0012), and improvements in stool consistency (p = 0.0024). Over 80% of subjects achieved improvements in the clinical outcomes targeted most frequently by their physicians. Conclusions Infants and children with CD fed an AAF for three months displayed significant improvements in weight-for-age z-scores and clinical symptoms. Children dependent on PN also grew well and four of five decreased their dependence on PN. Trial registration Both trials were registered on ClinTrials.gov (CD-C, NCT01812629; CD-I, NCT01820494). [ABSTRACT FROM AUTHOR]

Background: Amino acid-based formulas (Aaf) are increasingly used in children with cow's milk allergy (CMA). To be labeled hypoallergenic these formulas must demonstrate in clinical studies that they don't provoke reactions in 90% of subjects with confirmed CMA with 95% confidence when given in prospective randomized, double-blind, placebo-controlled challenge (DBPCFC) trials. The majority of available safety data on Aaf derived from patients with IgE-mediated CMA. Considering substantial differences in the immunologic mechanism and clinical presentation of non-IgE-mediated CMA it's important to investigate the hypoallergenicity of these formulas also in these patients. We prospectively assessed the tolerance to a new commercially available Aaf in children affected by IgE- or non-IgE-mediated CMA. Methods: Consecutive patients affected by IgE- or non-IgE-mediated CMA, aged ⩽ 4 years, were enrolled. DBPCFC was carried out with increasing doses of the new Aaf (Sineall, Humana, Milan, Italy), using validated Aaf as placebo. Faecal concentrations of calprotectin (FC) and eosinophilic cationic protein (ECP) were monitored. Results: Sixty patients (44 male, 73.3%, median age 37, 95%CI 34.5-39.6 months, IgE-mediated CMA 29, 48.3%) were enrolled. At the diagnosis clinical symptoms were gastrointestinal (46.6%), cutaneous (36.6%), respiratory (23.3%), and systemic (10.0%). After DBPCFC with the new Aaf, no patient presented early or delayed clinical reactions. Faecal concentration of calprotectin and of ECP remained stable after the exposure to the new Aaf. Conclusions: The new Aaf is well tolerated in children with IgE- or non-IgE-mediated CMA, and it could be used as a safe dietotherapy regimen for children with this condition. [ABSTRACT FROM AUTHOR]

The prevalence of food allergy is increased during the last decades (25-30%); it is involved in skin and respiratory allergic diseases. Elimination diet of the food identified through history and specific tests represents the only benefic therapeutic measure. The quality of life's impact of food allergy is influenced by the necessity of a continuous vigilance for careful reading of the labels of the commercial foods, recognition of the less known terms, correction of the nutritional deficiencies due to the absence of an essential food, increased price of the hypoallergenic formula, other allergic comorbidities and parents' concerns of fatal allergic reaction. [ABSTRACT FROM AUTHOR]

Allergy prevention remains a vexing problem. Food sensitization frequently occurs early in life and is often the first sign of future atopic disease. Therefore, interventions to prevent food allergies and the development of the atopic phenotype are best made early in life. The results of studies regarding the effects of breast-feeding and the prevention of allergy remain inconclusive. Several factors in breast milk either induce or protect against food allergies. Probiotic and prebiotic supplemented whey hydrolysate formulas need further research in order to determine the future of this intervention in the prevention of food allergies. Several dietary manipulations in infancy, such as prolonged breast feeding, maternal avoidance diets during pregnancy and lactation, the use of hypoallergenic formulas, have been proposed as ways of altering the Th1/Th2 balance in infants, with varying degrees of success. Studies have examined whether food atopy can be prevented by controlling the intake of highly allergenic foods by a high-risk infant from a variety of sources, that is, both direct ingestion and indirect ingestion through the breast milk. The previous studies showed that in high risk infants who are unable to be completely breast fed, there is evidence that prolonged feeding with a hydrolysed formula compared to a cow's milk formula reduces infant and childhood allergy and infant cow's milk allergy ,while other studies reported that an antigen avoidance diet for high risk mothers is unlikely to reduce the atopic diseases in their children substantially, and that such a diet may adversely affect maternal and/or fetal nutrition. [ABSTRACT FROM AUTHOR]

Abstract: Hypoallergenic infant formulas are commonly used for genetically predisposed children and infants diagnosed with cow''s milk allergy. This study describes both in vitro and in vivo approaches to assess residual allergenicity of partially hydrolysed infant formulas. Electrophoretic patterns indicated that β-lactoglobulin and other whey proteins were largely degraded. For safety reasons, according to the European commission-guidelines, it is required that the sensitizing capacity of hypoallergenic formulas is tested in an animal model. In contrast to whey sensitization, no elevated levels of whey-specific IgE, anaphylactic reactions or drop in body temperature were observed in sensitized mice exposed to whey hydrolysates. This indicates that the whey hydrolysates lost their putative sensitizing capacity in a mouse model using oral sensitization, which is highly relevant in relation to the human situation. In combination with the lost capacity of hydrolysed infant formulas to cross-link human IgE antibodies on RBL-huFcɛRI in vitro, both the sensitization and the challenge phase of the allergic response were studied. This combination of assays is proposed as a strategy for the screening of new hypoallergenic formulas aimed at preventing sensitization in atopic children and avoiding clinical symptoms in infants suffering from cow''s milk allergy. [Copyright &y& Elsevier]

Background: Allergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formula Methods: We have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy. Results: Prick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants. Conclusions: These data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding. [ABSTRACT FROM AUTHOR]

Abstract: In this study, we use capillary electrophoresis–mass spectrometry (CE–MS) for the identification of bioactive peptides in hypoallergenic infant milk formulas (IF), which are complex bovine milk protein hydrolysates. A sample clean-up pretreatment with a citrate buffer containing dithiothreitol and urea followed by solid-phase extraction (SPE) with different reversed-phase commercial cartridges was investigated to achieve optimum detection sensitivity in CE–MS. SPE with C18, StrataX and Oasis HLB cartridges allowed detection of the largest number of low molecular mass components, but combination of C18 and StrataX results was enough to achieve an excellent coverage of the studied IF. The monoisotopic molecular mass values of the low molecular mass components obtained by capillary electrophoresis ion-trap mass spectrometry (CE–IT–MS) allowed the tentative identification of nine bioactive sequences. Only the identification of five of them could be confirmed when accurate mass measurements were performed by capillary electrophoresis time-of-flight mass spectrometry (CE–TOF–MS), namely LKP, IPY, ALPM, PGPIHN and VAGTWY, which were reported to present angiotensin-converting enzyme (ACE) inhibitory and antimicrobial activity (only VAGTWY). [ABSTRACT FROM AUTHOR]

Abstract: In infant period, human milk and infant formulae are the major sources of exposure to dioxins (polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (PCB). Since in many parts of Europe the mothers are increasingly reluctant to breastfeed their babies, the main objective of the present study is to assess the level of exposure of non-breast-fed infants during their early development. Consequently, the concentration levels of PCDD/F and dioxin-like PCB were determined in industrial infant formulae including “starting” (aged 0–4months) and “follow-on” (after 4months) products of milk formula, soy formula and hypoallergenic infant formula, available on the EU market. Furthermore, dietary exposure to dioxin of exclusively formula-fed infants was assessed at each month from 0 to 9months. The results suggest that dietary exposure to dioxins via formulae is higher when consuming “starting” than “follow-on” infant formulae on a body-weight basis. Estimated dietary exposure after 4months of age was always below the lowest range of the Tolerable Daily Intake (TDI) of 1pg WHO-TEQkg−1 bwd−1 and Provisional Tolerable Monthly Intake (PTMI) of 70pg WHO-TEQkg−1 bwmonth−1. The highest estimated cumulative dietary exposure to PCDD/F and dioxin-like PCB was obtained considering infants of 0–1months fed with the “starting” hypoallergenic infant formula (2.8pg WHO-TEQkg−1 bwd−1 and 84pg WHO-TQkg−1 bwmonth−1). However, these elevated levels are much lower than those observed in some studies in breast-fed infants. The study can be used for further risk assessments in regard to infant exposure. [ABSTRACT FROM AUTHOR]

AbstractObjective:Infants with a documented hereditary risk of atopy (i.e., an affected parent and/or sibling) who cannot be breastfed exclusively are recommended to receive a formula with confirmed reduced allergenicity, i.e., a partially or extensively hydrolyzed formula (pHF and eHF, respectively), as a means of preventing allergic reactions. The efficacy of each hydrolyzed formula for the prevention of allergic diseases should be established separately, as factors such as the protein source, hydrolysis method and degree of hydrolysis that often depend on the manufacturer contribute to differences among hydrolysates. The aim was to systematically review data on the efficacy of a partially hydrolyzed 100 whey formula (pHF) in reducing the risk of allergy in healthy infants at high risk for allergy.Methods:The Cochrane Library, MEDLINE, EMBASE, and CINAHL databases were searched in September 2009 (from inception to September 2009) for randomized and quasi-randomized controlled trials (RCTs); additional references were obtained from reviewed articles. The company that manufactures the pHF used was contacted for unpublished data.Results:The search yielded 84 citations. Fifteen RCTs were included, some of which had potential methodological limitations such as unclear or inadequate allocation concealment, no intention-to-treat analysis, and no true blinding. For primary outcomes, i.e., all allergic diseases and atopic eczema/atopic dermatitis, use of the pHF compared with standard formula (SF) was associated with reduced risks (incidence, cumulative incidence, period prevalence) that were statistically significant for most, albeit not all, time points. Comparison of groups who received the pHF versus extensively hydrolyzed (eH) whey formula revealed no significant differences in outcomes except for reductions in the cumulative incidences of all allergic diseases at 0 to 36 months of age. Comparison of groups who received the pHF versus eH casein formula revealed no significant difference in outcomes between groups.Conclusions:The use of the pHF compared to SF is effective in allergy prevention in children at high risk for allergy at most time points. These results should be interpreted with caution due to a lack of methodological rigor in many trials. Reassuringly, the strongest evidence comes from a well-designed and conducted, independently funded RCT. [ABSTRACT FROM AUTHOR]

Hypernatremic dehydration is a rare but serious clinical condition in newborns and small infants. It is usually caused by diarrhea, improperly prepared infant formula, decreased fluid intake, or exclusive breastfeeding. Symptoms are usually masked until neurological symptoms occur. We report two infants who presented with fever and hypernatremic dehydration caused by concentrating infant formula to alleviate symptoms of constipation, and careless formula preparation due to confusion over spoon sizes, respectively. In the first case, status epilepticus occurred during early treatment, despite close serum sodium monitoring, though the infant was asymptomatic and thriving 4 years after discharge, with no identified neurodevelopmental deficits. The course of treatment was smooth in the second case, and no neurological complications developed. The practice of concentrating infant formula to relieve symptoms of constipation, although temporarily effective, is hazardous to newborns or young infants and can cause hypernatremic dehydration. Spoon sizes supplied with commercial infant formulas (30 mL/spoonful or 60 mL/spoonful) should be unified to avoid mistakes during preparation, especially by inexperienced and teenage mothers. [Copyright &y& Elsevier]

Although the American Academy of Pediatrics and the American Academy of Family Physicians recommend breast milk for optimal infant nutrition, many parents still choose formula as an acceptable alternative. The wide variety of available formulas is confusing to parents and physicians, but formulas can be classified according to three basic criteria: caloric density, carbohydrate source, and protein composition. Most infants require a term formula with iron. There is insufficient evidence to recommend supplementation with docosahexaenoic acid or arachidonic acid. Soy formulas are indicated for congenital lactase deficiency and galactosemia, but are not recommended for colic because of insufficient evidence of benefit. Hypoallergenic formulas with extensively hydrolyzed protein are effective for the treatment of milk protein allergy and the prevention of atopic disease in high-risk infants. Antireflux formulas decrease emesis and regurgitation, but have not been shown to affect growth or development. Most infants with reflux require no treatment. Family physicians can use these guidelines to counsel parents about infant formula, countering consumer advertising that is not evidence-based. [ABSTRACT FROM AUTHOR]

Very fussy or extremely fussy infants were randomized to receive: soy-based formula (Soy: n = 82) or a partially hydrolyzed cow's milk protein (CMP), low-lactose formula (PHF: n = 77) in a multicenter, double-blind, randomized, parallel, prospective 28-day feeding trial. Body weight and infant formula tolerance were reported. Adverse events were recorded throughout the study. A significant reduction in mean scores of fussiness, gas, spit-up, and crying compared with baseline measures was observed in infants who received either Soy or PHF within 1 day of formula intake; improvement in symptoms was sustained by study end. Stool consistency remained constant through day 28 in the PHF group, whereas stools in the Soy group became more firm by day 2 and did not return to prestudy consistency. PHF, with a protein profile patterned more closely on human breast milk, improved symptoms of formula intolerance as well as soy-based formula. [ABSTRACT FROM AUTHOR]

Background Cows' milk allergy (CMA) is the most common cause of food allergy in infancy. The only proven treatment is the complete elimination of cows' milk proteins (CMPs) from the diet by means of hypoallergenic formulas. Soybean-based formulae are widely used although intolerance to soy has been reported to occur in 15–40% of infants with CMA. Objective The aim of this work was to analyse the in vitro reactivity of the soybean cultivar Raiden, which naturally lacks glycinin A4A5B3, to evaluate whether this genotype could be a safe CMP substitute for CMA patients. Methods The reactivity of conventional soybean (CS) and Raiden soybean (RS) genotypes and also recombinant glycinin A4A5B3 and αβ-conglycinin with casein-specific monoclonal antibodies and CMP-specific polyclonal serum was evaluated by immunoblotting and ELISA. A sequential competitive ELISA with the polyclonal antiserum and different soluble inhibitors was performed. In addition, an indirect ELISA with sera of atopic children with CMA was carried out to analyse the IgE-binding capacity of the different soybean components. Results We have shown that CS contains four components that cross-react with CMP, while RS has only one. The remaining cross-reactive component in RS was identified as α-subunit β-conglycinin. By means of inhibitory ELISA, we demonstrated that CS, RS and the α-subunit β-conglycinin extracts inhibited the binding of CMP-specific antibodies to the CMP-coated solid phase. Finally, we showed that CS, RS and the recombinant proteins were recognized by human CMP-specific IgE antibodies. Conclusion This work shows that although Raiden has fewer cross-reactive components than conventional soybean, it still has a residual cross-reactive component: the α-subunit β-conglycinin. This reactivity might make this genotype unsuitable to treat CMA and also explains adverse reactions to soybean in CMA infants. [ABSTRACT FROM AUTHOR]

A mixture of neutral short-chain galactooligosaccharides lscGOS) and long-chain fructooligosaccharides (lcFOS) has been shown to reduce the incidence of atopic dermatitis (AD) and infectious episodes during the first 6 mo of life. This dual protection occurred through the intervention period. The present study evaluated if these protective effects were lasting beyond the intervention period. In a prospective, randomized, double-blind, placebo-controlled design, healthy term infants with a parental history of atopy were fed either a prebiotic-supplemented (8 g/L scGOS/IcFOS) or placebo-supplemented (8 g/L maltodextrin) hypoallergenic formula during the first 6 mo of life. Following this intervention period, blind follow-up continued until 2 y of life. Primary endpoints were cumulative incidence of allergic manifestations. Secondary endpoints were number of infectious episodes and growth. Of 152 participants, 134 infants 168 in placebo, 66 in intervention group) completed the follow-up. During this period, infants in the scGOS/IcFOS group had significantly lower incidence of allergic manifestations. Cumulative incidences for AD, recurrent wheezing, and allergic urticaria were higher in the placebo group, 127.9, 20.6, and 10.3%, respectively) than in the intervention group (13.6, 7.6, and 1.5%) (P< 0.05). Infants in the scGOS/IcFOS group had fewer episodes of physician-diagnosed overall and upper respiratory tract infections (P < 0.01), fever episodes (P < 0.000011, and fewer antibiotic prescriptions (P < 0.051. Growth was normal and similar in both groups. Early dietary intervention with oligosaccharide prebiotics has a protective effect against Both allergic manifestations and infections. The observed dual protection lasting beyond the intervention period suggests that an immune modulating effect through the intestinal flora modification may be the principal mechanism of action. [ABSTRACT FROM AUTHOR]

This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use of hypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease. The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis. Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit. There is also little evidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease. [ABSTRACT FROM AUTHOR]

We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to ‘high risk’ families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted. [ABSTRACT FROM AUTHOR]

To assess the familiarity of pediatricians with commercially available formulas and their use for cow's milk protein allergy and colic, a list of formulas was generated by visiting several grocery stores. Pediatricians were ask to indicate their familiarity with these and other ‘specialized’ formulas with regard to protein and carbohydrate sources, energy content, hypoallergenicity, and indication for infant colic. The participants answered an average of 46% of the questions correctly. Respondents were very familiar with 27% of the formulas, and unfamiliar with 35%. The highest score was 70%, and 10% of the responders correctly answered 65% or more of the questions. Fifty-one percent correctly identified the protein source of the formulas; 32% correctly identified the carbohydrate source. The energy content of the formulas was correctly identified by 54%. These data suggest that pediatricians have a poor understanding of the content and appropriate use of neonatal and infant formulas. [ABSTRACT FROM AUTHOR]

Abstract: All infant and follow-on formulae available on the market are of high quality. Nevertheless, they are not identical. Several formulae recently launched are characterized by innovations that may have interesting functional effects in some infants. The rising number of formulae and the uncertainty on the validity of the claims presented to justify these innovations make more and more difficult the prescription of a formula that has to be individually tailored for each child. A rational prescription should only be approached on the principle of evidence-based dietetics. Infant formulae satisfy by themselves the nutritional needs of infants up to 6 months of age whereas follow-on formulae should only be used after 6 months when complementary feeding has been introduced into the diet. None of these formulae can claim any nutritional superiority, in particular over breast feeding, which is the reference mode of feeding during the first 6 months of life. The nature of the protein source is the main criteria for choosing an infant formula. In the absence of breast feeding, cow''s milk protein infant and follow-on formulae represent the first choice, with the exception of infants at risk for allergy, who should be exclusively fed a hypoallergenic formula during the first 6 months of life. The main interest of soy protein infant and follow-on formulae is feeding infants in vegan families. A functional benefit has only been shown for anti regurgitation formulae as well as for formulae that have the potential to soften stools. Except for the prevention of allergic disease in at-risk families with the use of hypoallergenic infant (and not follow-on) formulae, there is no convincing evidence supporting the prescription of specific formulae in a preventive approach. [Copyright &y& Elsevier]

Abstract: Whey proteins, α-lactalbumin (α-La) and β-lactoglobulin (β-Lg), are powerful inducers of allergy in infancy. Since in early infancy milk is the fundamental nutritional source, if breast feeding is not possible or sufficient, an hypoallergenic formula is required. Allergenicity control of hypoallergenic formulas is fundamental to ensure a safety product. The objective of this work is to develop an immunological method to test residual immunoreactivity of whey hydrolysates during industrial process. Latex agglutination test is rapid, simple and economical, so it is ideal to routine control of whey hydrolysates production. Two latex agglutination test reagents capable of controlling α-La or β-Lg residual immunoreactivity were developed and used. Detection limit of latex reagents was 12ng/mL for α-La and 24ng/mL for β-Lg. No cross-reaction between α-La and anti-β-Lg latex was observed. Anti-α-La latex reagent cross-reaction with β-Lg was detected. [Copyright &y& Elsevier]

Background: Parietaria judaica (Par j) is one of the main causes of allergy in the Mediterranean countries. The activation of Toll-like receptor 4 (TLR4) by lipopolysaccharide (LPS) inhibits nasal inflammation of atopic children. Objective: To examine, in vivo and in vitro, the effect of recombinant Par j 2 (rPar j 2) and of its fragments (1–55 and 52–102) on atopic children. Methods: We used skin prick test for in vivo evaluations. We assessed, in vitro, in peripheral blood mononuclear cells (PBMC), the effect of rPar j 2 and of the two fragments on neutrophil chemotaxis, on CD45RO, on TLR2 and TLR4 expression, on LPS binding and on interferon (IFN)- γ release, by a microchemotaxis chamber, by flow cytometry and by enzyme-linked immunosorbent assay, respectively. Results: In vivo while rPar j 2 induced a positive skin reaction, 1–55 and 52–102 fragments did not. In vitro, while rPar j 2 increased both CD45RO expression and neutrophils chemotaxis in PBMC, both Par j 2 fragments did not. 1–55 fragment of Par j 2 upregulated both TLR2 and TLR4 expression and LPS binding, while the rPar j 2 and 52–102 fragment did not. Finally, 1–55 fragment of Par j 2 induced IFN γ release, while the rPar j 2 and 52–102 fragment did not. Conclusions: Hypoallergenic 1–55 fragment, upregulating innate immunity receptors and increasing IFN γ, might re-orientate, in atopics, the immune system toward a physiologic balance between Th1 and Th2 responses. [ABSTRACT FROM AUTHOR]

To assess the effect of docosahexaenoic acid and arachidonic acid supplementation in infant formula on the incidence of respiratory illnesses, pediatricians assigned infants to receive docosahexaenoic acid/arachinonic acid—supplemented formula or control formula. Anthropometrics, medical history, and illnesses were reported. Among 1342 infants, there was a higher incidence of bronchiolitis in control versus docosahexaenoic acid/arachinonic acid— supplemented groups at 5, 7, and 9 months (P < .01). Weight, length, and head circumference were similar for both groups. Infants fed formula supplemented with 0.32% docosahexaenoic acid and 0.64% arachidonic acid experienced a lower incidence of bronchiolitis compared with infants fed formula supplemented with no docosahexaenoic acid/arachidonic acid or lower levels of docosahexaenoic acid/arachidonic acid in the first year of life. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this study was to evaluate the efficacy on crying episodes owing to infantile colic of a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high β-palmitic acid content.Design:Prospective randomized controlled study.Setting:Italy.Subjects:Two hundred and sixty-seven formula-fed infants, aged less than 4 months, with infantile colic, were randomized to receive either the new infant formula (study treatment (ST)) or a standard formula and simethicone (6 mg/kg twice a day) (control treatment (CT)). A questionnaire was given to parents to evaluate for 14 days the daily number of colic episodes and crying time.Results:Out of the 199 infants who completed the study, 96 were treated with the new formula and 103 were not treated. Infants receiving the new formula had a significant decrease in colic episodes after 1 week (2.47±1.94 at day 7 vs 5.99±1.84 at the study entry) compared to infants receiving the CT (3.72±1.98 at day 7 vs 5.41±1.88 at the study entry) (P<0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76±1.60 in ST vs 3.32±2.06 in CT) (P<0.0001).Conclusions:The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes in infants with colic after 7 and 14 days when compared with a standard formula and simethicone.Sponsorship:The study was supported by funds from Numico, Italy.European Journal of Clinical Nutrition (2006) 60, 1304–1310. doi:10.1038/sj.ejcn.1602457; published online 31 May 2006 [ABSTRACT FROM AUTHOR]

Abstract: The use of hydrolysed formulas for feeding babies is efficient for preventing allergic diseases. Several hypoallergenic formulas (HF) based on hydrolysed cows’ milk proteins have been commercialised. However, some children fed such formulas suffer allergic reactions. β-lactoglobulin (βLG) is the main allergen present in cows’ milk. In addition to the whole protein, βLG fragments have also shown allergenic character. Detection of βLG and its peptides can be a useful marker of the presence of milk in food. Enzyme linked immunoassays (ELISAs) are general methods used to analyse allergens in foods. These techniques are sensitive and selective but they have several drawbacks. Immunoassay methods performed in chromatographic systems keep the advantages of classic ELISA while avoiding the disadvantages. A sandwich enzyme linked immunoaffinity chromatography (ELIAC) method was applied to determine βLG and its peptides in several commercial HF based on different milk proteins. Samples were also fractionated by employing membranes with different molecular weight cut-offs, and the antigenicity of the peptide fractions was determined. Applying the ELIAC method, for which one analysis takes 30min, βLG was determined at the pm level in formulas based only on caseins, and at the nm to μm level in formulas based on hydrolysed whey proteins. Peptides of molecular weight less than 3000 derived from βLG showed positive results in ELIAC assays, indicating antigenic character. [Copyright &y& Elsevier]

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Aim: To gain insight into the use of hypoallergenic formula in Australia by analysis of prescribing statistics. Methods: Statistics on supply of amino acid and extensively hydrolyzed formula were obtained from the Health Insurance Commission web site. The number of prescriptions supplied in 2003 and 2004 per 1000 children aged 4 years and younger were calculated for each State and Territory. This was related to the numbers of paediatric physicians and paediatric allergists in each State. Results: There was a marked rise in the use of amino acid formula (AAF) commencing in 2001. The Australian Capital Territory, New South Wales and Victoria had 6–7 times more AAF items per 1000 children prescribed than Western Australia. This did not appear to relate to the numbers of paediatricians or paediatric allergists in each State. In all States and Territories the prescribing of extensively hydrolyzed formula was less than that of AAF. Conclusions: There are significant regional differences which do not appear to be related to the prevalence of allergic disease. In some States and Territories AAF may be frequently prescribed as a first line treatment for cows milk allergy and for prevention of allergic disease in contradistinction to current recommendations of the Pharmaceutical Benefits Scheme and authoritative statements and position papers. Re-examination of both the Pharmaceutical Benefit Scheme guidelines and the knowledge and perceptions of the prescribing community is indicated. [ABSTRACT FROM AUTHOR]

The etiology of allergy is multifactorial, with many variables contributing to the final expression of atopic disease. Three breeding grounds are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s) and environmental factors. Timing and dosing of allergen(s) are of major importance. Contact with (dietary) allergens and various agents such as tobacco smoke and infections occur not only during post-natal life, but also perinatally and even pre-natally. A critical review of published evidence regarding the impact of maternal exposure to antigens during pregnancy on later development of allergy in the offspring can only conclude that more research is urgently needed. Contact with multiple dietary allergens should be in general of benefit to the fetus to develop tolerance. Current knowledge suggests that pregnant women should have a normal diversified diet, avoiding toxic agents such as tobacco and alcohol. The role of maternal intake of poly-unsaturated fatty acids on the development of atopy in the infants needs to be further evaluated. If parental history would be insufficient to determine the fetal risk, preventive measurements would be advisable for all fetuses. [ABSTRACT FROM AUTHOR]

Background: Recently, rice-based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. Aim: To evaluate the growth of infants fed with a rice-based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. Methods: A total of 88 infants were enrolled between March 2002 and March 2004. Fifty-eight infants with atopic dermatitis (AD) and cow's milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice-based hydrolysate formula (RHF), 17 with a soy-based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cow's milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3-monthly intervals in the first year of life, and at 6-monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z-scores of weight for age were calculated. Statistics: One-way analysis of variance and Student's t -test were used for statistical comparison. Significance was set at p Conclusion: Even if our findings show no significant difference between RHF and control, low weight observed in infants fed with RHF raises doubts about the nutritional adequacy of rice-hydrolysate formulas. [ABSTRACT FROM AUTHOR]

Discusses the etiology, diagnosis and management of excessive crying or colic in an infant. Occurrence of infantile colic in community-based samples; Organic causes of excessive crying; Role of hypoallergenic formulas in children with a family history of atopy; Effect of Simethicone, a counter drug, on colicky episodes.

Hypoallergenic formulas are processed by enzymatic hydrolysis of different protein sources such as bovine casein/whey and soy followed by further processing such as heat treatment and/or ultrafiltration, or they are based on amino acid mixtures. The products have been classified according to the degree of protein hydrolysis as ‘extensively’ or ‘partially’ hydrolysed protein products. Product properties may be characterized by biochemical techniques, and reduction of allergenicity may be assessed in vitro with various immunological methods, and in vivo with skin prick tests, patch tests and challenge tests. In vitro tests do not predict the allergenic effects in humans, and at present there is no evidence of a specific threshold of immunogenic protein. Only pure amino acid mixtures are considered to be nonallergenic. Other ‘hypoallergenic’ products contain residual allergenicity. At present, the potential of a product for treatment and prevention of food allergy can only be determined by clinical trials using scientifically appropriate standards. It has been recommended that dietary products for treatment of cow's milk protein allergy in infants should be tolerated by at least 90% (with 95% confidence) of infants with documented cow's milk protein allergy. Some extensively hydrolysed products and amino-acid-based products have met these criteria. Formulas intended for prevention should have a very low, if any, allergenic activity until otherwise proven. So far there are no firm criteria available for the design of hypoallergenic foods for prevention. Newborns included in prevention studies should be from high-risk families; they should be randomized at birth and fed the formula when supplements are needed for at least the first 4–6 months of life. Follow-up should be at least 18 months, and children should be investigated when symptoms appear. Validated clinical criteria, including controlled food challenges, should be used for diagnosis. Infants fed formulas that claim to prevent or delay allergy should have a statistically significant lower prevalence of allergy when compared with infants fed a standard cow's milk formula. Feeding high-risk infants a documented hypoallergenic formula combined with avoidance of solid foods during the first 4–6 months reduces the cumulative incidence of cow's milk protein allergy and atopic dermatitis as compared with a standard cow's-milk-based formula. Partially hydrolysed formulas may have an effect, though it seems to be less than that of extensively hydrolysed formulas at present. Thus, if exclusive breast-feeding for 4–6 months is not possible in high-risk infants, a documented hypoallergenic formula and avoidance of solid foods are recommended for the first 4 months of life. [ABSTRACT FROM AUTHOR]

Poi is a pasty starch made from the cooked, moshed corm of the taro plant (Colocasia esculenta L). Originating in Asia, this root crop is now found primarily in tropical and subtropical regions and was a major dietary staple in the Pacific islands. We hypothesize that poi has potential use as o probiotic—defined by FAO/WHO as, ‘live microorganisms which when administered in adequate amounts confer a health benefit to the host.’ No scientific studies have explored the possibility of poi being used as a probiotic in medical nutrition therapy, however, an investigator determined that the predominant bacteria in poi are Lactococcus lactis (95%) and Lactobacilli (5%), both of which are lactic acid-producing bacteria. This investigator also reported that poi contains significantly more of these bacteria per gram than yogurt. To determine if poi is beneficial for certain health conditions, a literature search was conducted to find all available research studies in which poi was used as a complementary treatment. Documented evidence suggests that poi shows promise for use in infants with allergies or failure-to-thrive. However, to support previous findings, more research needs to be conducted with poi and its potential use as a probiotic. [ABSTRACT FROM AUTHOR]

Background: The major birch pollen allergen Bet v 1 represents one of the most prevalent environmental allergens responsible for allergic airway inflammation. Objective: In the present study we sought to compare the complete recombinant Bet v 1 allergen molecule with genetically produced hypoallergenic fragments of Bet v 1 regarding mucosal tolerance induction in a mouse model of allergic asthma. Methods: BALB/c mice were intranasally treated with recombinant Bet v 1 or with two recombinant Bet v 1 fragments (F I: aa 1–74; F II: aa 75–160) prior to aerosol sensitization with birch pollen and Bet v 1. Results: Intranasal application of F II, containing the major T cell epitope, led to significant reduction of IgE/IgG1 antibody responses, in vitro cytokine production (IL-5, IFN-γ, IL-10) and negative immediate cutaneous hypersensitivity reactions comparable to the pretreatment with the complete rBet v 1 allergen. Moreover, airway inflammation (eosinophilia, IL-5) was inhibited by the pretreatment with either the complete Bet v 1 or F II. However, for prevention of airway hyperresponsiveness the complete molecule was required. The mechanisms leading to immunosuppression seemed to differ in their dependence on the conformation of the molecules, since tolerance induced with the complete Bet v 1, but not with F II, was transferable with spleen cells and associated with increased TGF-β mRNA levels. Conclusion: We conclude that mucosal tolerance induction with recombinant allergens and genetically engineered hypoallergenic derivatives thereof could provide a convenient and safe intervention strategy against type I allergy.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

ABSTRACT. The American Academy of Pediatrics is committed to breastfeeding as the ideal source of nutrition for infants. For those infants who are formula-fed, either as a supplement to breastfeeding or exclusively during their infancy, it is common practice for pediatricians to change the formula when symptoms of intolerance occur. Decisions about when the formula should be changed and which formula should be used vary significantly, however, among pediatric practitioners. This statement clarifies some of these issues as they relate to protein hypersensitivity (protein allergy), one of the causes of adverse reactions to feeding during infancy. [ABSTRACT FROM AUTHOR]

Cow’s milk‐based formulas used for infants with cow’s milk allergy are based on hydrolyzed proteins. The formulas that are successful in preventing allergic responses are extensively hydrolyzed. Nevertheless, reactions to such formulas are occasionally reported, and protein material of higher molecular weight than expected has been detected by binding immunoglobulin E (IgE) from patients’ sera. This paper presents the identification of high‐molecular‐weight material in the extensively hydrolyzed casein formula, Nutramigen. The material was concentrated by simple centrifugation. The proteins in the pellet were separated by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis (SDS‐PAGE), and protein‐containing bands were analyzed by protein sequencing after electroblotting. The proteins were identified as maize zeins, which are water‐insoluble proteins of apparent Mr 20 000 and 23 000, presumably originating from the maize starch in Nutramigen. Rabbits immunized with this formula developed antibodies against zeins but not against milk proteins. The maize zeins are probably identical to the recently reported components in Nutramigen (), detected by binding of IgE from milk allergic patients, but not correlated to clinical allergic reactivity. The clinical relevance of maize proteins in Nutramigen remains to be established. [ABSTRACT FROM AUTHOR]

In a comparative study six different protein hydrolysates, marketed as 'hypoallergenic' infant formulae were investigated by skin prick tests, RAST, RAST inhibition and titrated provocation tests. Whey hydrolysates containing a high percentage of larger peptides were found to. have the highest capacity to induce positive skin tests, provocation tests and. to: bind to human serum IgE antibodies of cow's milk allergic children. Casein hydrolysates appeared to have the least residual allergenic activity. We recommend that 'hypoallergenic' formulae should be tested in each case, before being prescribed to cow's milk sensitive children. [ABSTRACT FROM AUTHOR]

The article discusses hypoallergenicity of hypoallergenic cow's milk-based formulas. The author states that cow's milk allergy/intolerance (CMA/CMI) is mainly a problem of infancy and early childhood. It has its onset mostly during infancy. In prospective studies, the incidence of CMA/CMI in infancy has been estimated to be about 2-3 percent with strict diagnostic criteria. Most children with CMA/CMI are tolerant of milk before the age of 3 years. At present, several hypoallergenic infant formulas with reduced allergenicity in varying degree are available. Most of these products arc produced by enzymatic hydrolysis of cow's milk protein.

Up to 2.5% of infants are affected by cow milk hypersensitivity in the first two years of life, although most of these children will "outgrow" their reactivity within 2-3 years. Extensively hydrolyzed ("hypoallergenic") cow milk-based formulae are often recommended as a substitute formula and are generally well tolerated. However, a small minority of cow milk-allergic children experience allergic reactions to the hypoallergenic formulae as well. Utilizing inhibition-ELISAs and sera from patients with IgE-mediated cow milk allergy, we have identified residual protein fractions less than 20 kD in several of the extensively hydrolyzed cow milk-based formulae. Although many of the cow milk allergic children had positive skin prick tests [SPT] to one of the hydrolysate formulae (Nutramigen™). the positive skin test result generally did not correlate with clinical reactivity, although the negative predictive value of the negative SPT was excellent. Children with IgE-mediated cow milk allergy and a positive skin prick test to the hypoallergenic formula should probably receive their first dose of the formula in a medical setting so that appropriate therapy can be administered in the unlikely event of an allergic reaction. [ABSTRACT FROM AUTHOR]

Since food allergy may contribute to the development of atopic disease, eczema, asthma, and others, attempts at prevention have employed exclusive breast feeding, hypoallergenic formula, and maternal dietary restrictions during pregnancy and lactation. Many studies have found a reduction, but not elimination, of atopic eczema among high-risk infants fed exclusively on the breast. The apparent "failure" of even exclusive breast feeding to entirely prevent atopic symptoms may be attributed to several factors. One, sensitization may have occurred in vitro so that it is already too late at birth to entirely, prevent atopic disease. Two, food antigens may be passed into human milk and cause allergic symptoms among the breast-fed group.

Allergic (immune-mediated) reactions to cow milk and other dietary proteins encountered during infancy are responsible for some of the adverse symptoms and syndromes observed in infants intolerant to cow milk, infant formulas and occasionally human milk. Iron deficiency anemia associated with gastrointestinal blood loss, protein losing enteropathy, enterocolitis, colitis, and malabsorption syndrome are examples of putative allergic reactions to dietary antigens which occur in infancy. A number of symptoms referable to the gastrointestinal tract such as, vomiting, colic and chronic non-specific diarrhea occur in infants both with and without immune-mediated reactions to dietary antigens. Verification of adverse reactions to dietary antigens, including allergic reactions, should be accomplished through the use of double-blind, placebo-controlled food challenge, with the dietary antigen to be tested presented in a liquid vehicle or, in older children, in capsule form. Approximately 8%-25% of children with immediate hypersensitivity to cow milk have been found to be allergic to soy products. Soy and other intact protein substitutes for cow milk, such as beef and lamb based formulas, have produced anaphylactic reactions both in human infants and in animal models. Hypoallergenic formulas should have a chemically modified protein base which demonstrates significant reduction in antigenicity when tested in the laboratory both in vitro and in vivo. Such formulas should meet rigorous standards for hypoallergenicity in clinical testing in human allergic infants or infants at high risk for developing allergy before being labelled hypoallergenic. [ABSTRACT FROM AUTHOR]

The article provides information regarding the best treatment for infants with colic. Infantile colic, defined as excessive crying of a healthy baby, is a distressful phenomenon, but there is small evidence to support the various treatments offered. Several studies report benefit from use of a hypoallergenic formula, reduced stimulation of the baby, and maternal diet adjustment. Meanwhile dicyclomine has been indicated to be effective for colic, there are important concerns about its safety, and the manufacturer has opposed its use in the society. A herbal tea that contains chamomile, vervain, licorice, fennel, and balm-mint was also considered effective in treating babies with colic.