E S P G H A N 32nd Annual Meeting; Warsaw, Poland, June 2-5, 1999
Aim. Early onset of atopic symptoms in infants (2-3 months of age) can lead to increased risk of growth failure. The aim of this multicentre randomised study was to compare the early feeding of an amino acid-based formula to an extensively hydrolysed formula and its effect on the clinical outcome of infants with proven cow milk allergy.
Method. 73 children were enrolled (mean age 5 months, range 2-10 months) with symptoms suggestive of cow milk allergy - atopic dermatitis (n=71) measured by SCORAD, digestive symptoms (n= 32), respiratory symptoms (n=2). Infants were randomly assigned to receive amino acid-based formula (n= 33) or extensively hydrolysed formula (n=40) and cow milk allergy was confirmed after 1 month by double blind placebo-controlled cow milk challenge. Nine patients randomised to extensively hydrolysed formula suffered continued symptoms and were subsequently changed onto amino acid-based formula. Growth, clinical symptoms, plasma biochemical measures and dietary intake were monitored over a six month follow-up period.
Result. There was a significant improvement in SCORAD score in both groups from 25 (20-29) to 13 (9-18), mean (95 % confidence interval); p<0.0001. Plasma biochemical measures (albumin, prealbumin, alkaline phosphatase, zinc) were improved in both groups and there were no differences in total dietary intakes (protein/energy). Catch-up growth (improvement in length standard deviation score, SDS) was achieved in the amino acid-based formula group (black circles) during treatment compared to extensively hydrolysed formula (grey circles) (Figure).
We conclude that feeding of an amino acid-based formula in infants with early onset of symptoms of cow milk allergy results in improved growth compared to feeding extensively hydrolysed formula despite similar dietary intakes and improvement in clinical symptoms.