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Outgrowth of cow’s milk-allergy in children fed specific hypoallergenic formula

Published: July 2, 2021

Cow’s milk allergy (CMA) is one of the most common food allergies in infancy. Most children outgrow their allergy naturally, before the age of 3, but more persistent cases also exist. The speed of outgrowth is influenced by the type of CMA and is notably slower for children with immuno-globulins E (IgE)-mediated CMA than those with non-IgE-mediated CMA. The microbes in the gut (gut microbiota) have been shown to be associated with the development of the immune system in early life and, subsequently, the development of tolerance to foods. Clinical evidence has shown that infants with CMA have an aberrant gut microbiota and their microbiota is therefore a new target in the dietary support of infants with CMA. Recently an amino acid formula (AAF), designed for dietary management of severe CMA, containing specific combination of prebiotics and probiotics (called synbiotics) was developed. The outgrowth of IgE-mediated CMA while infants receive a specific AAF with or without additional synbiotics has not been investigated previously.

A recent study, reported in The Journal of Allergy and Clinical Immunology (JACI), by P. Chatchatee, K. Beyer et al. examined the outgrowth of CMA in infants, enrolled in the UK, Germany, Italy, Singapore, Thailand, and the USA, with confirmed CMA fed a specific AAF with and without synbiotics. 196 infants with IgE-mediated CMA, including infants with a history of anaphylaxis, at median age of 9 months were randomized to receive either study formula for a period of 12 months. After 12 months, infants followed a diet as advised by the clinician. At 12 and 24 months after study entry, CMA outgrowth was evaluated by a double-blind placebo-controlled food challenge to cow’s milk. During the 12 months of the dietary intervention all adverse events needing medical intervention were collected to assess the safety and overall well-being of the infants, with a predetermined focus on infections.

After 12 months, almost half of the study population was able to tolerate cow’s milk, and this increased to 62% at 24 months. There were no statistically significant differences between the groups and the outgrowth was in line with clinical expectations for the outgrowth trajectory of CMA. During the 12-month dietary intervention, the percentage of infants reporting at least one adverse event did not significantly differ between groups; however, fewer infants were hospitalized due to infections in the group receiving AAF with synbiotics compared to the group fed AAF without these ingredients (9% vs 20%; p=0.036).  

Infants with IgE-mediated CMA receiving hypoallergenic AAF including synbiotics outgrow their allergy in line with what has been reported previously in literature and may be at lower risk for infections requiring hospitalization.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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