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Immunogenicity of hydrolysate formulas in children (Part 2): 41 case reports
Insights
Hydrolyzed formulas (HF) may still trigger allergic reactions in infants with cow's milk allergy (CMA). Even partial HFs can be allergenic and immunogenic in predisposed babies, challenging their use in CMA management.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Infant Feeding
Background:
- Hydrolysate formulas (HF) are designed to reduce cow's milk protein (CMP) allergenicity for infants with cow's milk allergy (CMA).
- Despite their intended use, HFs have been associated with allergic reactions in infants, particularly those at high risk of atopy.
Observation:
- A study investigated reactions to a partial whey hydrolysate formula (Nidina HA) and whole cow's milk (CM) in 81 infants with suspected CMA.
- 41 infants were tested with Nidina HA, and 40 with CM. A control group of 97 healthy infants with no history of atopy was also included.
- All infants tested with Nidina HA and CM showed similar allergic symptoms, while the control group tested negative.
Findings:
- The study documented reactions in 41 infants to Nidina HA, adding to a total of 252 reported reactions to HFs.
- Partial HFs, like Nidina HA, demonstrated allergenicity in sensitized infants and immunogenicity in predisposed infants.
- Both partial HF and whole CM elicited comparable allergic responses in the study group.
Implications:
- These findings challenge the universal safety of partial hydrolysate formulas in managing CMA.
- Partial HFs may not be hypoallergenic and could potentially induce sensitization in at-risk infants.
- Further research is needed to evaluate the immunogenic potential and clinical efficacy of different types of hydrolysate formulas in infant nutrition.
Abstract:
Hydrolysate formulas (HF) have been developed with the purpose of reducing the allergenicity of cow's milk proteins, thus providing a suitable formula for feeding babies with cow's milk (CM) allergy (CMA). More recently, used for the treatment of CMA HFs have provoked 211 reactions in babies at high risk of atopy . In this paper we report 81 babies, who attended the Allergy and Clinical Immunology Division of the Pediatric Department of Rome University "La Sapienza" (study children) between June 1997 and October 1998, 41 of whom were tested with Nidina HA (a whey partial HF) and 40 with whole CM. Ninety-seven healthy children with no history of atopy of comparable age and sex formed the control group. All study children reacted to Nidina HA and to CM with similar symptoms. All the control babies tested negative. With these 41 case reports the number of reactions to HFs totals 252. These data strongly indicate that partial HFs may be allergenic not only in an already sensitized individual, but also immunogenic in a predisposed baby.