Allergy to extensively hydrolyzed cow milk proteins in infants: Identification and treatment with an amino acid–based formula☆,☆☆,★
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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Cited by (161)
When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide
2018, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :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.
Multiple food protein intolerance of infancy or severe spectrum of non-IgE-mediated cow's milk allergy?-A case series
2016, Journal of Allergy and Clinical Immunology: In PracticeIn time: Misuse and overuse of amino acid formulas in cow milk allergy
2015, Revista Paulista de PediatriaPosition document: IgE-mediated cow's milk allergy
2015, Allergologia et Immunopathologia
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The authors are not associated with the manufacturer. The manufacturer kindly supplied the authors with the amino acid formula.
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Reprint requests: D. de Boissieu, MD, Service du Pr Badoual, Hôpital Saint Vincent de Paul, 82 avenue Denfert-Rochereau, 75014 Paris, France.
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0022-3476/97/$5.00 + 0 9/22/79825