Introducing formula to infants at risk for allergic disease
- David M Fleischer, MD
David M Fleischer, MD
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- University of Colorado Denver School of Medicine
The term "allergy" refers to a hypersensitivity reaction initiated by immunologic mechanisms. Three factors are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s), and environmental factors, such as timing, amount, and frequency of exposure.
The most prevalent allergic or atopic disorders include atopic dermatitis (AD), asthma, allergic rhinitis (AR), and food allergies. These conditions afflict 20 percent of the population of the United States, and their prevalence is rising in developed nations. The increase in atopic diseases has been recognized as a pandemic, thus emphasizing the need for effective allergy prevention .
Convincing studies support the existence of a critical time early in infancy during which the genetically predisposed atopic infant is at higher risk for becoming sensitized . Thus, dietary interventions in the first year of life have been analyzed for their effects on the prevalence of allergic disease .
Studies examining the associations between the use of various infant formulas and the development of allergic diseases in infants at high risk for atopic conditions are discussed in this topic review. Associations between early or delayed introduction of complementary foods and the development of atopy are reviewed separately, as are other aspects of the primary prevention of allergic disease. (See "Primary prevention of allergic disease: Maternal diet in pregnancy and lactation" and "The impact of breastfeeding on the development of allergic disease" and "Introducing highly allergenic foods to infants and children".)
The definition of an infant at high risk for developing allergic disease is reviewed here, as are the different formulas available for infants.
- Eichenfield LF, Hanifin JM, Beck LA, et al. Atopic dermatitis and asthma: parallels in the evolution of treatment. Pediatrics 2003; 111:608.
- Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003; 111:1662.
- Pali-Schöll I, Renz H, Jensen-Jarolim E. Update on allergies in pregnancy, lactation, and early childhood. J Allergy Clin Immunol 2009; 123:1012.
- Sicherer SH, Burks AW. Maternal and infant diets for prevention of allergic diseases: understanding menu changes in 2008. J Allergy Clin Immunol 2008; 122:29.
- Greer FR, Sicherer SH, Burks AW, et al. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121:183.
- Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46:99.
- Dharmage SC, Lowe AJ, Matheson MC, et al. Atopic dermatitis and the atopic march revisited. Allergy 2014; 69:17.
- American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346.
- Friedman NJ, Zeiger RS. The role of breast-feeding in the development of allergies and asthma. J Allergy Clin Immunol 2005; 115:1238.
- Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract 2013; 1:29.
- Saarinen KM, Savilahti E. Infant feeding patterns affect the subsequent immunological features in cow's milk allergy. Clin Exp Allergy 2000; 30:400.
- Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. J Allergy Clin Immunol 2010; 126:77.
- Onizawa Y, Noguchi E, Okada M, et al. The Association of the Delayed Introduction of Cow's Milk with IgE-Mediated Cow's Milk Allergies. J Allergy Clin Immunol Pract 2016; 4:481.
- Boyle RJ, Ierodiakonou D, Khan T, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ 2016; 352:i974.
- ASCIA Guidelines for allergy prevention in infants http://www.allergy.org.au/images/pcc/ASCIA_PCC_Guidelines_Allergy_Prevention_Infants_2016.pdf.
- Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
- Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; :CD003664.
- Juvonen P, Månsson M, Andersson C, Jakobsson I. Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life. A three-year prospective follow-up. Acta Paediatr 1996; 85:1047.
- Saarinen KM, Juntunen-Backman K, Järvenpää AL, et al. Supplementary feeding in maternity hospitals and the risk of cow's milk allergy: A prospective study of 6209 infants. J Allergy Clin Immunol 1999; 104:457.
- Muraro A, Dreborg S, Halken S, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol 2004; 15:291.
- Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr 2010; 50:422.
- Vandenplas Y, Hauser B, Van den Borre C, et al. Effect of a whey hydrolysate prophylaxis of atopic disease. Ann Allergy 1992; 68:419.
- Vandenplas Y, Hauser B, Van den Borre C, et al. The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease. Eur J Pediatr 1995; 154:488.
- Berg Av, Krämer U, Link E, et al. Impact of early feeding on childhood eczema: development after nutritional intervention compared with the natural course - the GINIplus study up to the age of 6 years. Clin Exp Allergy 2010; 40:627.
- von Berg A, Filipiak-Pittroff B, Schulz H, et al. Allergic manifestation 15 years after early intervention with hydrolyzed formulas--the GINI Study. Allergy 2016; 71:210.
- Lowe AJ, Hosking CS, Bennett CM, et al. Effect of a partially hydrolyzed whey infant formula at weaning on risk of allergic disease in high-risk children: a randomized controlled trial. J Allergy Clin Immunol 2011; 128:360.
- Oldaeus G, Anjou K, Björkstén B, et al. Extensively and partially hydrolysed infant formulas for allergy prophylaxis. Arch Dis Child 1997; 77:4.
- Halken S, Hansen KS, Jacobsen HP, et al. Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study. Pediatr Allergy Immunol 2000; 11:149.
- Nentwich I, Michková E, Nevoral J, et al. Cow's milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula. Allergy 2001; 56:1144.
- von Berg A, Koletzko S, Filipiak-Pittroff B, et al. Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma: three-year results of the German Infant Nutritional Intervention Study. J Allergy Clin Immunol 2007; 119:718.
- von Berg A, Filipiak-Pittroff B, Krämer U, et al. Preventive effect of hydrolyzed infant formulas persists until age 6 years: long-term results from the German Infant Nutritional Intervention Study (GINI). J Allergy Clin Immunol 2008; 121:1442.
- von Berg A, Filipiak-Pittroff B, Krämer U, et al. Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol 2013; 131:1565.
- von Berg A, Koletzko S, Grübl A, et al. The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol 2003; 111:533.
- Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2004; :CD003741.
- Infants at high risk for developing allergy
- Types of formulas
- FORMULA SELECTION FOR THE HIGH-RISK INFANT
- Breastfeeding versus hydrolyzed formulas
- Studies comparing different formulas
- - Cow's milk formula versus partially hydrolyzed formula
- - Cow's milk formula versus extensively hydrolyzed formula
- - Partially hydrolyzed formula versus extensively hydrolyzed formula
- - Soy formula versus others
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS