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Improved Tolerance to a New Amino Acid-Based Formula by Infants With Cow's Milk Protein Allergy
Pipop Jirapinyo1, Narumon Densupsoontorn1, Channagan Kangwanpornsiri1
11 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
A new amino acid-based formula (NAAF) using rice starch shows improved tolerance in infants with cow's milk protein allergy (CMA). This formula is better tolerated than standard amino acid-based formulas (AAFs) for managing CMA symptoms.
Area of Science:
- Pediatric Allergy and Immunology
- Nutritional Science
- Gastroenterology
Background:
- Cow's milk protein allergy (CMA) prevalence is rising in infants.
- Some infants with CMA react to commercial amino acid-based formulas (AAFs).
- Residual protein in glucose polymers (GPs) from corn starch in AAFs may cause intolerance.
Purpose of the Study:
- To evaluate a novel amino acid-based formula (NAAF) with protein-free rice starch-derived GPs.
- To compare the tolerance of NAAF versus a standard AAF in infants with CMA.
- To determine if NAAF reduces symptoms in infants with diagnosed CMA.
Main Methods:
- A double-blind, placebo-controlled food challenge (DBPCFC) was used.
- Infants (<4 months) with CMA were given NAAF and AAF sequentially for 14 days each.
- Tolerance was assessed by the absence of respiratory, dermatologic, and gastrointestinal symptoms.
Main Results:
- Out of 46 infants, 23 were intolerant to the standard AAF.
- Sixteen of these 23 infants (69.6%) tolerated the NAAF (P < .05).
- NAAF demonstrated a 34.8% greater reduction in intolerance compared to the standard AAF.
Conclusions:
- The novel amino acid-based formula (NAAF) is better tolerated than a standard AAF.
- NAAF offers a promising alternative for managing infants with cow's milk protein allergy.
- Eliminating protein from carbohydrate sources in formulas may improve tolerance in sensitive infants.
Background:
Prevalence and severity of cow's milk protein allergy (CMA) in infants are increasing. A proportion of infants with CMA still elicit signs and symptoms of CMA while ingesting commercial amino acid-based formulas (AAFs). We propose that protein in glucose polymers (GPs) derived from corn starch in the AAFs might be the cause of intolerance to AAF in some infants. We thus have produced small molecules of GPs from rice starch, eliminating the protein fraction from them, and subsequently used them as the sole source of carbohydrate in a new amino acid-based formula (NAAF).
Methods:
The efficacy of the NAAF was compared with that of an AAF in a double-blind, placebo-controlled food challenge (DBPCFC) in young infants with CMA aged <4 months. Infants consumed each formula for 14 days before switching to the other one. If no respiratory, dermatologic, and gastrointestinal symptom occurred, it was considered tolerance. After the challenge, infants consumed the tolerated formula for 4 weeks to prove real tolerance to that formula.
Results:
Of 46 infants, 23 were intolerant to the AAF, of whom 7 (30.4%) were also intolerant to the NAAF. Sixteen of the 23 infants who were intolerant to the AAF could tolerate the NAAF ( P < .05). The minimal important difference of decreasing percentage of intolerance to the NAAF was 34.8% compared with the infants who were intolerant to the AAF.
Conclusion:
The NAAF is better tolerated than a commercially available AAF for the management of infants with CMA.
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