Partially Hydrolyzed Whey Infant Formula: Literature Review on Effects on Growth and the Risk of Developing Atopic Dermatitis in Infants from the General Population

Sauser, Julien; Nutten, Sophie; Groot, Nanda de; Pecquet, Sophie; Simon, Dagmar; Simon, Hans‐Uwe; Spergel, Jonathan M.; Koletzko, Sibylle; Blanchard, Carine

doi:10.1159/000489861

Cited by 26 publications

(23 citation statements)

References 18 publications

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“…Other data from the GINI study showed that there was no significant difference in BMI ( z score) of infants fed with 100% pHF-W in the first 4 months of life compared with those fed with standard CMF for up to 10 years [25]. Eight clinical trials were included in a recent review, seven of which used the same pHF-W [26]. Six out of 8 studies indicated a reduction in atopic manifestations using a specific pHF-W versus CMF in the first years of life [26].…”

Section: Phf For All Nonbreastfed Babiesmentioning

confidence: 99%

“…Eight clinical trials were included in a recent review, seven of which used the same pHF-W [26]. Six out of 8 studies indicated a reduction in atopic manifestations using a specific pHF-W versus CMF in the first years of life [26]. The literature review confirmed that pHF-W supports normal growth in infants and suggests that the risk of AD may be reduced in not-fully breastfed infants when supplemented with a specific pHF-W during the first 4–6 months of life [26].…”

Section: Phf For All Nonbreastfed Babiesmentioning

confidence: 99%

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A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

et al. 2019

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The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

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Section: Phf For All Nonbreastfed Babiesmentioning

confidence: 99%

Section: Phf For All Nonbreastfed Babiesmentioning

confidence: 99%

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

et al. 2019

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“…A recent study using a freshly prepared puree of cow’s milk, egg yolk, egg white, and soy, provided high sensitivity and specificity as well as positive and negative predictive values, illustrating that the atopy patch test is a valuable diagnostic test for food allergy in patients without specific IgE [33]. A recent literature review investigating the efficacy and safety of a partially hydrolyzed whey-based formula in the general population concluded that it supports normal growth in infants, and may reduce the risk of AD in infants who are not fully breastfed as compared to infants receiving a cow’s milk formula during the first 4–6 months of life [34]. Another study correlated 25-hydroxyvitamin D levels in umbilical cord blood and serum of infants with the development of allergic sensitization and diseases in early childhood.…”

Section: Understanding the Pathogenesis Of Atopic Dermatitismentioning

confidence: 99%

Recent Advances in Clinical Allergy and Immunology

Simon

2018

Int Arch Allergy Immunol

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Allergic diseases are of great concern because of their high prevalence, which is still rising in several regions, their impact on patients’ physical and psychological health, the huge burden they place on patients’ quality of life, as well as the socioeconomic consequences that they cause. Recent research has provided new data on both genetic and environmental risk factors of atopic/allergic diseases. The application of new technologies such as “omics” has allowed a better understanding of the pathogenesis and has helped with the identification of therapeutic targets. Immense progress has been made in developing and applying novel, targeted therapies, for example for asthma and urticaria. Intensive efforts are being made to find biomarkers that help to classify patients, to identify their potential responsiveness to specific therapies, and to monitor the disease severity. Based on recent insights in the pathogenesis of food allergy and drug hypersensitivity, novel strategies for diagnostics, allergen avoidance, and induction of tolerance have been developed. Here, we summarize important findings in the field of clinical allergy and immunology with a special focus on asthma, allergic rhinitis, atopic dermatitis, food allergy, urticaria, angioedema, and drug hypersensitivity.

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“…However, this seemed doubtful for prevention under recent negative outcomes of PHF, even in high-risk infants. Second, they showed a literature review of studies using PHF in the general population (for which a family history of allergy was neither an inclusion nor an exclusion criterion), which indicated a reduction in atopic manifestations on using a specific PHF compared with standard formula in the first years of life [10]. However, numerous limitations to these studies were identified, and this study was also industry-supported.…”

mentioning

confidence: 99%

“…However, numerous limitations to these studies were identified, and this study was also industry-supported. Third, they mentioned that PHF meets all nutritional requirements and supports normal growth [10]. However, the long-term data of PHF in healthy infants on growth, body composition, hormonal responses, and serum metabolites are limited, although no data suggest that PHF is potentially harmful for healthy term infants.…”

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confidence: 99%

Should partially hydrolyzed infant formula be given to the general infant population for the primary prevention of allergic disease?

Song

2019

Korean J Pediatr

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Peptides must be in the range of 10-70 kD to act as an allergen. Whole cow milk-based formulas contain proteins in the range of 14-67 kD. Partially hydrolyzed infant formula (PHF) was developed to reduce protein allergenicity through heat treatment and chemical and enzymatic hydrolysis, resulting in a reduced molecular weight and peptide size. PHF contains shortened oligopeptides that have a molecular weight <5 kD (range, 3-10 kD), and extensively hydrolyzed infant formula contains peptides with a molecular weight <3 kD. 1) Primary prevention involves blocking immunologic sensitization to an allergen. For the primary prevention of allergic disease, studies have focused on high-risk infants with a family history of allergic disease. For all infants, exclusive breastfeeding is recommended for at least the first 4-6 months of life. A Cochrane review published in 2018 presented no evidence that the use of hydrolyzed formula over breastfeeding prevents allergic disease. 2) According to current infant feeding guidelines, if breastfeeding is impossible, the use of extensively hydrolyzed infant formula (EHF) is recommended for patients of cow milk allergy, and the use of EHF or PHF can be considered in cases of high-risk infants as a strategy for preventing allergic disease. 3,4) However, questionable and negative outcomes with the use of PHF for the prevention of allergic disease have been reported very recently. According to the results of a 15-year followup of the German Infant Nutritional Intervention (GINI) study, a prospective randomized double-blind trial of full-term neonates with atopic heredity in a German birth cohort, PHF failed to show a significant influence on immunoglobulin E sensitization but showed a preventative effect on eczema until adolescence without a rebound phenomenon. 5) A systematic review and meta-analysis of studies published between 1946 and 2015 found no consistent evidence to support the current recommendations; rather, it reported evidence of publication bias, methodological bias, and conflicts of interest in those studies reporting allergic outcomes, including the GINI study. 6) The authors suggested that the current recommendation of using hydrolyzed formula in place of standard cows' milk formula to prevent allergies in high-risk infants be revised. 6) A Cochrane review published in 2018 also found no evidence to support prolonged feeding of a hydrolyzed compared with standard formula for preventing allergic disease in infants who cannot be exclusively breastfed. 2) Another recent meta-analysis showed positive prevention outcomes with PHF from one company, but the majority of included studies were industry-supported. 7) A pharmacoeconomic analysis demonstrated that PHF compared with standard formula was cost-effective for high-risk infants for preventing atopic dermatitis and cost-saving compared with extensively hydrolyzed infant formula when used in prevention, but this study was also industry-supported. 8) In the current issue of Korean Journal of Pediatrics, Vandenplas et al. 1) r...

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Partially Hydrolyzed Whey Infant Formula: Literature Review on Effects on Growth and the Risk of Developing Atopic Dermatitis in Infants from the General Population

Cited by 26 publications

References 18 publications

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

Recent Advances in Clinical Allergy and Immunology

Should partially hydrolyzed infant formula be given to the general infant population for the primary prevention of allergic disease?

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