Hypoallergenic and nonallergenic infant formulas

Case in point, continued: Ryan’s pediatrician prescribed an extensively hydrolyzed commercial formula, along with slow initiation of solid foods to his diet.

CMPA accounts for up to 20% of all food allergies in children, yet only 2% to 3% of infants have true IgE-mediated CMPA and develop antibodies to the large protein molecules in cow’s milk.10,13For these infants, as well as for those with confirmed non-IgE-mediated milk intolerance, feeding with a hypoallergenic formula is first-line treatment.6,7 

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These formulas are derived from cow’s milk but contain proteins that have been extensively hydrolyzed into smaller peptides that are less likely to stimulate the production of antibodies.6,7,14 

Many infants who are fed extensively hydrolyzed protein formulas show improvement in their atopic symptoms; even partially hydrolyzed cow’s milk formula has been found to be beneficial in reducing flares of allergic dermatitis in atopic infants and in providing an allergy-preventive effect in atopic preschool-aged children.7,15

In the rare cases in which infants with CMPA also react to extensively hydrolyzed formula, an amino-acid formula that contains no peptides that can be bound by IgE is recommended.7,8,16 

An amino-acid formula is also recommended for infants who have severe reactions to cow’s milk protein or who develop CMPA symptoms while being exclusively breastfed.6However, use of these formulas is limited by their high cost and reported “bad” taste.17

Delaying the introduction of solid food until the child is aged 4 to 6 months has been shown to inhibit the development of food allergies. In one study, infants who received a diagnosis of food allergy (primarily to eggs or to cow’s milk protein) before age 2 years had been introduced to solid foods earlier (between ages 12 and 16 weeks) than were nonallergic infants. 

The foods most commonly introduced before age 17 weeks were rice and fruits, and the first cow’s milk protein introduced was from yogurt. In addition, infants with a diagnosis of food allergy were less likely to be receiving breast milk when cow’s milk protein was introduced into the diet.18

CMPA in the toddler years

Case in point, continued: Since birth, Ryan has fallen low on growth charts in both height and weight. However, he is otherwise healthy and has not demonstrated signs of other types of allergy. The patient’s mother would like to switch him to cow’s milk, as it is cheaper and easier to obtain. She read online that most babies outgrow CMPA after age 1 year, and she would like more information on the safety of making the change. 

Only 50% of children with CMPA outgrow the condition by their first birthday; by age 5 years, up to 20% may still be intolerant of cow’s milk. Children who continue to demonstrate CMPA symptoms beyond infancy are at increased risk for nutritional deficiencies, particularly in dietary calcium, protein, and vitamin D.19

Available for older infants and toddlers (aged 9 to 24 months) are special milk-based formulas that are fortified with iron, vitamins C and E, and zinc and contain more calcium, docosahexaenoic acid (DHA), and arachidonic acid (AA) than do standard infant formulas to support rapidly growing bones, teeth, and nervous system.7Many of these formulations also contain probiotics to support the strength of the intestinal barrier and promote digestive health. Soy-based toddler formulas are also available. However, up to 50% of all children with CMPA are also sensitive to soy protein.4