Efficacy and safety of hydrolyzed cow milk and amino acid–derived formulas in infants with cow milk allergy☆,☆☆,★,★★
Section snippets
Patients and study design
Part 1 of the study was designed to assess the antigenicity of protein hydrolysates and amino acid–derived formulas used in the management of cow milk allergy, and part 2 to observe the clinical and nutritional outcome in infants fed with the chosen formulas.
In part 1 we first determined the β-lactoglobulin concentration in five hydrolysates and two amino acid formulas. Of these formulas, one was made with partially hydrolyzed whey protein, two with extensively hydrolyzed milk proteins (one
Bovine β-lactoglobulin content in protein hydrolysate and amino acid–derived formulas
Table II shows that the β-lactoglobulin content was highest in the partially hydrolyzed whey formula, followed by the amino acid–derived Nutri-Junior formula, the extensively hydrolyzed casein and whey formulas, and the amino acid–derived Neocate formula. In the partially hydrolyzed formula, the β-lactoglobulin content was 2400 to 52,000 times higher than in the others, and in the Nutri-Junior formula it was 20-fold that in the Neocate formula. The values, moreover, were equal in the
DISCUSSION
Management of cow milk allergy includes exclusion of cow milk antigens from the diet. Rigorous elimination preserves the intestinal integrity and prevents aberrant antigen absorption.15 Elimination diets in food-sensitive patients have been shown to reverse the disturbance of the humoral and cell-mediated immune responses, with decreases in the level of allergen-specific IgE and the proliferative response of peripheral blood mononuclear cells to food allergens,16 and improved capacity of
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2019, Immunology and Allergy Clinics of North AmericaCitation Excerpt :An early study of avoidance of milk and egg in children with AD showed some improvement in pruritus and sleeplessness,77 although a different study of milk- and egg-exclusion diets showed no significant benefit.78 Whereas 2 studies showed a significant clinical improvement in SCORAD index for eczema severity in patients with cow’s milk allergy/intolerance and AD after milk elimination,79,80 pooled data in a comprehensive review including these studies found no difference in AD severity at 2 to 3 months or 6 to 8 months.76 One study of children with egg sensitivity and AD did show some improvement in eczema severity score after egg elimination.81
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From the Departments of Pediatrics, Clinical Physiology, and Dermatology, University of Tampere Medical School and Tampere University Hospital, Tampere, Finland, and the Helsinki University Central Hospital, Hospital for Skin and Allergic Diseases, Helsinki, Finland
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Supported by the Academy of Finland.
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Reprint requests: Erika Isolauri, MD, Medical School, University of Tampere, P.O. Box 607, 33101 Tampere, Finland.
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