Evaluation of an Amino Acid−Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula

Vanderhoof, Jon A.; Moore, Nancy; Boissieu, D. de

doi:10.1097/mpg.0000000000001374

Cited by 19 publications

(13 citation statements)

References 23 publications

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“…AAFs are used as an option for the dietary management of CMA. It is well‐known that AAFs effectively reduce allergic symptoms and improve growth in children with CMA 11,19–22,35 . However, whether AAFs also have the potential to prevent allergic sensitization and/or symptoms associated with CMA is not known.…”

Section: Discussionmentioning

confidence: 99%

“…Extensively hydrolyzed formulas (eHFs) are recommended for infants with mild CMA, whereas for infants with severe CMA and for infants who either do not tolerate eHFs or for whom eHFs fail to resolve CMA symptoms, amino acid‐based formulas (AAFs) are recommended 17 . Besides being nutritionally adequate, 18 AAFs are consistently demonstrated to provide relief and a faster recovery from symptoms of CMA, including gastrointestinal (eg, vomiting and diarrhea) and skin conditions (eg, atopic dermatitis) 11,19–21 . Moreover, nutritional intervention with an AAF has been shown to fully normalize the growth of patients with CMA 22,23 .…”

Section: Introductionmentioning

confidence: 99%

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A free amino acid‐based diet partially prevents symptoms of cow's milk allergy in mice after oral sensitization with whey

Sadelhoff

Hogenkamp

Wiertsema

et al. 2020

Immunity Inflam & Disease

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Background: Amino acid-based formulas (AAFs) are used for the dietary management of cowʼs milk allergy (CMA). Whether AAFs have the potential to prevent the development and/or symptoms of CMA is not known.Objective: The present study evaluated the preventive effects of an amino acid (AA)-based diet on allergic sensitization and symptoms of CMA in mice and aimed to provide insight into the underlying mechanism. Methods: C3H/HeOuJ mice were sensitized with whey protein or with phosphate-buffered saline as sham-sensitized control. Starting 2 weeks before sensitization, mice were fed with either a protein-based diet or an AA-based diet with an AA composition based on that of the AAF Neocate, a commercially available AAF prescribed for the dietary management of CMA. Upon challenge, allergic symptoms, mast cell degranulation, whey-specific immunoglobulin levels, and FoxP3 + cell counts in jejunum sections were assessed.Results: Compared to mice fed with the protein-based diet, AA-fed mice had significantly lower acute allergic skin responses. Moreover, the AA-based diet prevented the whey-induced symptoms of anaphylaxis and drop in body temperature. Whereas the AA-based diet had no effect on the levels of serum IgE and mucosal mast cell protease-1 (mMCP-1), AA-fed mice had significantly lower serum IgG2a levels and tended to have lower IgG1 levels (P = .076). In addition, the AA-based diet prevented the whey-induced decrease in FoxP3 + cells. In sham-sensitized mice, no differences between the two diets were observed in any of the tested parameters. Conclusion: This study demonstrates that an AA-based diet can at least partially prevent allergic symptoms of CMA in mice. Differences in FoxP3 + cell counts and serum levels of IgG2a and IgG1 may suggest enhanced antiinflammatory and tolerizing capacities in AA-fed mice. This, combined with ---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.How to cite this article: van Sadelhoff JHJ, Hogenkamp A, Wiertsema SP, et al. A free amino acid-based diet partially prevents symptoms of cowʼs milk allergy in mice after oral sensitization with whey. Immun Inflamm Dis. 2020;8:93-105.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A free amino acid‐based diet partially prevents symptoms of cow's milk allergy in mice after oral sensitization with whey

Sadelhoff

Hogenkamp

Wiertsema

et al. 2020

Immunity Inflam & Disease

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“…Compelling evidence has recently suggested that mitochondria in mammals, have multiple roles in immunity, and that in addition to being the powerhouse of the cell, they also represent the powerhouse of immunity [14]. In this light, increasing In our patient, the food allergy background led us to suspect this [17,18]. administered at an early stage of disease [19][20][21][22].…”

Section: Mitochondrial Diseases Have a Wide Spectrum Of Symptoms;mentioning

confidence: 90%

Mitochondrial disease, hypertrophic cardiomyopathy and cutaneous lupus in an infant with food hypersensitivity

Estrada-Reyes¹,

López-Gallegos²,

Faugier-Fuentes³

et al. 2020

Glob J Rare Dis

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This paper describes a 4 month-old-girl with food allergies, mitochondrial disease, cutaneous lupus, and hypertrophic cardiomyopathy. She suffered from infectious pericarditis due to Coxsakie virus as a complication. She additionally presented bicytopenia (hemoglobin levels 8.9 g/dL, platelets 127 x 10 3 / μL), high lactate levels (5mmol/L), seizures, hypertrophic cardiomyopathy. This was suggestive of mitochondrial disease. Specifi c IgE levels were positive for milk, patch tests were positive for milk and soy, with a persistency of symptoms with extensively hydrolyzed formula as well as an amino acid-based formula. A chicken-based formula was well tolerated. Coenzyme Q 10 levels were low (0.29L). Low Coenzyme Q 10 levels in mitochondrial patients have been found as well as in allergic diseases. We suggest that food hypersensitivity should be ruled out in mitochondrial patients with low Coenzyme Q 10 levels.

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“…Paediatrician recommendations stress careful nutritional guidance to manage CMA[3,6,28,29] , including the use of an adapted formula that meets the nutritional needs of non-breastfed infants and young children[30,31]. Therefore, evidence on the safety and suitability of these formulas should be obtained from children with CMA in particular, as recently reported for some eHFs[23,24] or AAFs[32,33]. Growth parameters of the children fed the TeHCF were within normal range throughout the 3-mo period, indicating that this hypoallergenic formula is safe.…”

Section: Discussionmentioning

confidence: 99%

Hypoallergenicity of a thickened hydrolyzed formula in children with cow’s milk allergy

Rossetti

Cucchiara

et al. 2019

WJCC

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BACKGROUND Allergy to cow’s milk is the most frequent allergy occurring in infants and young children. The dietary management of these patients consists of the elimination of any cow’s milk proteins from the diet, and for formula-fed infants, the substitution of the usual infant formula with an adapted formula that is generally based on extensively hydrolyzed cow’s milk proteins. The American Academy of Pediatrics has established specific criteria to confirm the hypoallergenicity of a formula intended for these children. AIM To assess the hypoallergenicity of a new thickened extensively hydrolyzed casein-based formula (TeHCF) in children with cow’s milk allergy (CMA). METHODS Children diagnosed with CMA through a double-blind placebo-controlled food challenge (DBPCFC) were randomly administered increased doses of a placebo formula or the TeHCF [Allernova, new thickener including fibres (Novalac)] under double-blind conditions and medical surveillance on two separate days. Otherwise, both of these formulas and a cow’s milk-based formula were randomly introduced to children who were highly suspected of having CMA on three separate days. Immediate and late reactions occurring after the introduction of any of these formulas were thoroughly recorded by the physician at the hospital and reported by parents to the physician after hospital discharge, respectively. If the children tolerated the TeHCF during the DBPCFC, they were exclusively fed this formula during a 3-mo period where potential allergic symptoms, anthropometric parameters, as secondary outcomes, and adverse events were registered. The Cow’s Milk-related Symptoms Score (CoMiSS TM ) was assessed and anthropometric parameters were compared to World Health Organization (WHO) reference data. RESULTS Of the 30 children included in the study, the CMA diagnosis of 29 (mean age: 8.03 ± 7.43 mo) patients was confirmed by a DBPCFC. The children all tolerated the TeHCF during both the challenge and the subsequent 3-mo feeding period, which they all completed. During the latter period, the CoMiSS TM remained at a very low level, never exceeding its baseline value (1.4 ± 2.0), growth parameters were within WHO reference standards and no adverse event related to the TeHCF was reported. Over the first week of this period, the proportion of patients with digestive discomfort significantly decreased from 20.7% (6/29) to 3.4% (1/29), P = 0.025. The proportion of satisfaction with the overall effect of the formula reported by the parents and investigator was high, as was the formula acceptability by the child. CONCLUSION The new TeHCF meets the hypoallergenicity criteria according to the American Academy of Pediatrics standards, confirming that the tested TeHCF is adapted to the dietary management of children with CMA. Moreover, growth was adequate in the included p...

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Evaluation of an Amino Acid−Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 23 publications

A free amino acid‐based diet partially prevents symptoms of cow's milk allergy in mice after oral sensitization with whey

A free amino acid‐based diet partially prevents symptoms of cow's milk allergy in mice after oral sensitization with whey

Mitochondrial disease, hypertrophic cardiomyopathy and cutaneous lupus in an infant with food hypersensitivity

Hypoallergenicity of a thickened hydrolyzed formula in children with cow’s milk allergy

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