Elsevier

The Journal of Pediatrics

Volume 131, Issue 5, November 1997, Pages 744-747
The Journal of Pediatrics

Allergy to extensively hydrolyzed cow milk proteins in infants: Identification and treatment with an amino acid–based formula,☆☆,

https://doi.org/10.1016/S0022-3476(97)70104-5Get rights and content

Abstract

We report on 13 infants allergic to extensively hydrolyzed protein formulas (EHFs) who were first seen with chronic digestive symptoms. Feeding with an amino acid–based formula decreased symptoms and improved weight gain. A challenge with EHF produced positive results in all these infants. Allergy to EHF must be considered in patients who are allergic to cow milk and have persisting symptoms on an EHF diet. (J Pediatr 1997;131:744-7)

Section snippets

Patients

Sixteen infants who had adverse reactions to CMP were referred to our unit because of persisting clinical symptoms in spite of CMP elimination with an EHF replacement diet (Table I) . All were treated for gastroesophageal reflux, and seven received H 2 -antagonists (15 mg/kg/day) for treatment of esophagitis. Apparent life-threatening events reported were episodes of pallor and hypotonia, which occurred after feeding. Atopic dermatitis lesions were assessed by the SCORAD index. 6 Growth failure

Results

In 13 infants, feeding with AABF induced the disappearance of noncutaneous symptoms within 3 days and improved eczema (SCORAD: 16 ± 12 vs 35 ± 13, p < 0.05). All these infants gained weight, and the increase in the body weight index after AABF feeding was statistically significant (97.9% ± 5.1% vs 90.2% ± 7.2%, p < 0.001). In those 13 infants the challenge with EHF produced positive results (Table II) . Adverse reactions, consisting of at least two symptoms, occurred during the double-blind,

Discussion

In our opinion, a diagnosis of allergy to EHF requires first the institution of an amino acid–based diet, which allows symptoms to disappear, and then a positive response to an oral challenge. All infants who exhibited a good response to the amino acid–based diet had a positive result when challenged with EHF. This study emphasizes the possible underrecognition of EHF allergy. Its frequency is unknown, especially because the issue of clinical unresponsiveness to EHF in infants with suspected

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    The systematic review by Hill et al22 supports this finding that an AAF and an EHF were equally effective in resolving skin symptoms in uncomplicated CMPA. However, according to the assessment in that systematic review, there is a subgroup of children in which an AAF is indicated, such as in those who present with severe early-onset AD when breast-feeding (see section “Symptoms while breast-feeding”), and/or with faltering growth (see section “Faltering growth in food allergy”) or when a trial of an EHF with optimal skin management is not sufficient for symptom resolution.7,21 The latter findings were based on 2 observational studies and 1 before and after clinical trial.

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The authors are not associated with the manufacturer. The manufacturer kindly supplied the authors with the amino acid formula.

☆☆

Reprint requests: D. de Boissieu, MD, Service du Pr Badoual, Hôpital Saint Vincent de Paul, 82 avenue Denfert-Rochereau, 75014 Paris, France.

0022-3476/97/$5.00 + 0 9/22/79825

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