PURPOSE OF THE STUDY.
The goal of this study was to evaluate the effect of dietary management strategies on the rate of acquiring tolerance in children with cow’s milk allergy.
This prospective multicenter study evaluated children with cow’s milk allergy who were otherwise healthy and aged between 1 and 12 months.
In an open, nonrandomized trial from July 1, 2010, to June 30, 2012, there were 260 children evaluated. They were divided into 5 groups based on a formula already selected by their physician for 15 to 30 days. The 5 groups were as follows: (1) extensively hydrolyzed casein formula (EHCF, n = 55); (2) EHCF + Lactobacillus rhamnosus GG (LGG, n = 71); (3) hydrolyzed rice formula (RHF, n = 46); (4) soy formula (n = 55); and (5) amino acid–based formula (AAF, n = 33). On initial visit, the children also underwent skin testing and oral challenge to confirm the diagnosis of cow’s milk allergy. A food challenge was performed after 12 months to assess acquisition of tolerance.
Of the 260 children, 64.2% were male, their average age was 5.92 months, and their average body weight was 6.66 kg. The rate of acquiring oral tolerance after 12 months was significantly higher in the groups receiving EHCF (43.6%) or EHCF + LGG (78.9%) compared with the RHF (32.6%), soy formula (23.6%), and AAF (18.2%) groups. Binary regression analysis coefficient showed that the rate of acquiring tolerance was influenced by IgE-mediated mechanism and formula choice.
Placing a child on EHCF accelerates tolerance acquisition in children with cow’s milk allergy compared with other formula choices and is further improved with the addition of LGG.
The results shown in this study with EHCF resulting in a greater rate of tolerance acquisition is likely due to the immunomodulatory effect induced by hydrolyzed casein peptides, as suggested from previous animal studies. This benefit will have to be factored in when specifically considering starting patients on EHCF versus AAF because some patients will react even to EHCF. The difference in the rate of tolerance acquisition between EHCF and AAF may be that those requiring AAF have a more severe form of milk sensitivity, thus requiring them to be on AAF initially.
- Copyright © 2014 by the American Academy of Pediatrics