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Rapid Resolution of Milk Protein Intolerance in Infancy

Lazare, Farrah B.*; Brand, Donald A.; Marciano, Tuvia A.*; Daum, Fredric*

Journal of Pediatric Gastroenterology & Nutrition: August 2014 - Volume 59 - Issue 2 - p 215–217
doi: 10.1097/MPG.0000000000000372
Original Articles: Gastroenterology

Objectives: Infants with milk protein intolerance are usually switched to a casein hydrolysate or amino acid–based formula, which they continue to receive until 1 year of age, when they are rechallenged with a cow's-milk or soy protein formula. To investigate whether some of these infants actually become tolerant sooner, this study gathered preliminary data for establishing an empirical timetable for the resolution of milk protein intolerance.

Methods: This prospective, longitudinal cohort study enrolled infants <4 months of age receiving either breast milk or a cow's-milk or casein hydrolysate formula who presented to a pediatric subspecialty practice during an 18-month period and had a positive stool guaiac test. After having been successfully switched to a casein hydrolysate or amino acid formula, infants who had guaiac-negative stools for at least 2 consecutive months were rechallenged with the formula that had necessitated the most recent switch.

Results: Of the 25 patients enrolled in the study, 16 completed the food challenge and data collection protocol. Negative stool guaiac tests following rechallenge indicated resolution of milk protein intolerance by the time subjects reached an average age of 6.7 ± 1.0 months (mean ± standard deviation). By the age of 7 months, milk protein intolerance was resolved in 12 of the 16 infants, the remainder having resolved by 10 months.

Conclusions: It may be reasonable to treat infants with milk protein intolerance for 2 to 3 months with a hypoallergenic formula, then rechallenge them at 6 months of age, usually without causing recurrence of the hematochezia. Rechallenging before 12 months old could result in cost savings to families and insurers.

*Division of Pediatric Gastroenterology, Hepatology and Nutrition

Office of Health Outcomes Research, Winthrop University Hospital, Mineola, NY.

Address correspondence and reprint requests to Farrah B. Lazare, DO, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Winthrop University Hospital, 120 Mineola Blvd, Suite 210, Mineola, NY 11501 (e-mail:

Received 28 June, 2013

Accepted 13 March, 2014

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,