PURPOSE OF THE STUDY.
To examine whether formula selection in children with cow’s milk allergy (CMA) will affect development of tolerance to cow’s milk protein.
A total of 260 CMA infants, ages 1 to 12 months. CMA was confirmed at the initial visit through clinical evaluation, skin prick testing (SPT) (immunoglobulin E [IgE]-mediated CMA), atopy patch testing (APT) (non–IgE-mediated CMA), and double-blind, placebo-controlled oral food challenges (DBPCFC).
This open-label, nonrandomized study evaluated the acquisition of tolerance in infants with CMA fed 5 different formulas: extensively hydrolyzed casein formula (EHCF) (group 1), extensively hydrolyzed casein formula plus the probiotic Lactobacillus rhamnosus GG (EHCF + LGG) (group 2), hydrolyzed rice formula (group 3), soy formula (group 4), and amino acid–based formula (group 5). Development of tolerance was assessed after a 12-month period with repeat SPT, APT, and DBPCFC.
At the 12-month follow up, a significant difference in SPT wheal diameter was seen in only group 2 (EHCF + LGG) infants with IgE-mediated CMA. Of the non–IgE-mediated CMA infants, only group 1 (EHCF) and group 2 (EHCF + LGG) exhibited a significant decline in positive APT results. Based on DBPCFC, group 1 (EHCF) and group 2 (EHCF + LGG) also demonstrated higher rates of cow’s milk tolerance at 12 months compared with the other groups; group 2 (EHCF + LGG) had the greatest influence. Binary logistic regression analysis revealed that the rate of attaining tolerance was influenced by an IgE-mediated mechanism and the choice of formula.
Compared with other commonly used formulas, EHCF + LGG is effective in promoting cow’s milk protein tolerance in IgE-mediated and non–IgE-mediated CMA infants. Of note, EHCF alone also led to significantly higher rates of cow’s milk tolerance only when compared with soy and amino acid–based formula but not with EHCF + LGG or hydrolyzed rice formulas.
Extensively hydrolyzed formulas are recommended for CMA infants due to their safety profile and clinical efficacy. Muraro et al (BMJ Open. 2012;2:e000637) demonstrated the additional benefits of EHCF + LGG, including decreased atopic dermatitis, diminished intestinal inflammation, and improved recovery of allergic colitis. This study reinforces these findings by demonstrating EHCF’s ability, predominantly with LGG, in promoting tolerance to cow’s milk protein in infants with CMA. Future studies are required to address long-term outcomes of these formulas, with respect to both safety and tolerance, in IgE-mediated and non–IgE-mediated CMA.
- Copyright © 2013 by the American Academy of Pediatrics