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[Allergy to protein hydrolysates. Report of 30 cases]
F Ammar1, D de Boissieu, C Dupont
1Service de néonatologie, hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Cow's milk protein hydrolysate allergy is a concern in infants with persistent digestive issues. An amino acid-based formula, Neocate, effectively managed symptoms and improved growth in these allergic children.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Clinical Nutrition
Context:
- Cow's milk protein allergy (CMPA) is common in infants.
- Protein hydrolysate formulas are often used as substitutes for CMPA.
- Some infants remain symptomatic despite using hydrolysate formulas, suggesting potential allergy to the hydrolysates themselves.
Purpose:
- To describe the population of infants allergic to cow's milk protein hydrolysates.
- To evaluate the efficacy of an amino acid-based formula (Neocate) in managing these allergies.
- To characterize the clinical presentation and diagnostic findings in this patient group.
Summary:
- Thirty infants with confirmed allergy to protein hydrolysates were studied.
- Common symptoms included digestive issues like regurgitation, diarrhea, and colic, as well as failure to thrive.
- Neocate rapidly improved clinical condition and promoted weight gain, with significant reduction in intestinal permeability.
Impact:
- Highlights the occurrence of allergy to protein hydrolysates, necessitating consideration in persistent infant symptoms.
- Demonstrates the effectiveness of amino acid-based formulas in managing complex cow's milk protein allergies.
- Provides evidence for Neocate as a safe and effective alternative for infants with hydrolysate intolerance.
Aim Of The Study:
To describe the population of children allergic to cow's milk protein and their usual substitutes made of protein hydrolysates, and who are efficiently taken care of by using Neocate, an amino acid based formula.
Patients And Methods:
Allergy to protein hydrolysates was diagnosed in 30 infants, aged from 15 d to 13 months (median = 3 months), who remained symptomatic while receiving a protein hydrolysate for 15 d to 12 months (median = 1.8 months). After a complete clinical and biological evaluation, an amino acid based diet using Neocate was attempted, followed after one month by an oral challenge test with the protein hydrolysate.
Results:
Symptoms occurred mainly in the digestive tract (25 cases) in the form of regurgitations (18 cases), diarrhea (17 cases) and colicky pain (10 cases); failure to thrive was seen in ten cases. Neocate improved the clinical condition rapidly (within 3-10 d), and allowed the children to gain weight (27.5 +/- 10.8 g/d). Skin prick tests with cow's milk hydrolysates were positive in 13 out of 26 children; total IgE was raised in cases of cutaneous symptoms (six cases), and associated with increased specific IgE for cow's milk. During the intestinal permeability test, the lactitol/mannitol ratio which initially increased, decreased following Neocate (6.58 +/- 2.92% vs. 3.47 +/- 1.58%, P = 0.0004). Multiple food allergies were present in 22 cases. During challenge with a hydrolysate, the clinical reaction was immediate in 13 cases, partially delayed in 13 cases and delayed in four cases.
Conclusion:
Allergy to cow's milk hydrolysates may occur and has to be considered in the presence of anaphylaxis and also chronic digestive symptoms such as regurgitations, diarrhea and colicky pain, when these symptoms persist during cow's milk free diet.