Allergy to extensively hydrolyzed cow milk proteins in infants: Identification and treatment with an amino acid–based formula

Do infants with gastroschisis may have a high incidence of non-IgE-mediated cow’s milk protein allergy?

“…In our series nearly half the infants exhibiting features of CMPA were receiving BM at the time. It has been suggested that infants who develop CMPA when on BM are reacting to the very small quantities of allergen (particularly bovine beta-lactoglobulin) that exist in BM of mothers who are drinking milk and that the levels of this protein in BM are similar to that found in EHF [7,21,22]. The options for avoiding CMP include BM-CMPF, EHF or AAF.…”

Hypoallergenicity of a New Extensively Hydrolyzed 100% Whey-based Formula Containing Probiotics

“…For the purpose of this study, all sites adhered to the clinical practice criteria established at Icahn School of Medicine at Mount Sinai, Division of Pediatric Allergy and Immunology (New York, New York). CMPA had to be documented within 6 months prior to enrollment by either: 1) reported convincing allergic symptoms following an exposure to milk or a milk-containing food product and detectable serum milk-specific IgE (>0.7 kIU/L) or positive skin prick test (wheal greater than or equal to 5 mm); or 2) physician-supervised oral food challenge that elicited immediate allergic symptoms; or 3) serum milk IgE ≥ 15 [kIU/L]or ≥ 5 [kIU/L if younger than 1 year; or 4) skin prick tests mean wheal >10 mm [11][12][13]. All subjects were following a strict milk elimination diet at the time of enrollment and during the study.…”

Allergenicity of Milk Proteins

“…The European Union regulates that infant formulas contain immunoreactive proteins in quantities lower than 1% of nitrogen compounds [177] to reduce allergenicity knowing that only pure amino acids are strictly non-allergenic. This criterion could be encountered by milk proteins that have undergone extensive hydrolysis partially to cleave amino acids [178][179][180]. In contrast, formulas with moderately reduced allergenicity (partially hydrolyzed) are not recommended for the treatment of allergies because of the high amounts of residual allergens [181].…”

“…The low quantity of native proteins or residual high molecular mass peptides may produce adverse effects in highly sensitive patients. Therefore, a milk hydrolysate can be considered safe and non-allergenic if the nitrogen fraction does not contain unmodified milk proteins or high molecular mass peptides [178][179][180]. In the latter case, the product could be classified in the "low degree" protein hydrolysate category.…”