The present study demonstrated improved weight gain and decreased allergic manifestations in suspected CMPA infants receiving an amino acid−based infant formula. Before the initiation of an AAF all study participants were below the 50th percentile of the WHO reference population for weight and were experiencing allergic symptoms while on an EHP formula. Following the 12-week feeding period, there was an increase in weight (+0.433 z score change), relative to the WHO reference population. Although not statistically significant, participant length was increased during the 12-week feeding period. These results indicate that the AAF provided adequate nutrition while managing CMPA symptoms. These findings are in agreement with previous studies, which demonstrate that AAFs provide healthy growth when provided to CMPA infants (6,11). In healthy infants, AAFs provided similar weight and growth compared to infants given EHP formula (6). A similar study demonstrated weight and length gains in infants with CMPA not responding to EHP formulas when fed AAF for 11.4 months (16).
Recommended management of CMPA includes complete elimination of cow's milk protein and the initiation of a hydrolyzed protein formula (7). Although 90% of infants exhibit healthy growth and reduced allergic symptoms on an EH formula, highly sensitive infants may require an AAF. Before initiation of an AAF, infants in the present study had not responded to various EHP formulas, including cow's milk based EHP formulas and hydrolyzed rice protein formulas. Although previous studies have demonstrated that hydrolyzed rice protein formulas are well tolerated in CMPA infants unable to tolerate other cow's milk−based EHP formulas, the findings from the present study suggest that infants with severe CMPA may require an AAF (17–19). Furthermore, it is possible that infants with non−IgE-mediated allergies, a group highly represented in the study, may be more susceptible to persistent allergic manifestations and unable to tolerate traditional EHP and hydrolyzed rice protein formulas.
Significant improvement was demonstrated in all allergic manifestations in the present study indicating that the AAF properly managed CMPA symptoms. Incidence and severity of AD and vomiting/spitting up were significantly reduced during the 12-week study period. Furthermore, all 8 infants experiencing watery stools at visit 1 had recovered after 12 weeks of receiving study formula. These results are in agreement with the demonstration that short-term feeding of AAF in infants with CMPA reduces the presence and severity of allergic manifestations (2,6,15). In a prospective, controlled study, atopic infants with CMPA receiving an AAF for 6 months demonstrated clinical improvement and growth compared with infants fed an EHP formula (20). In another study, data suggested that hypoallergenic (AAFs) formulas improved the gut barrier function and minimized gastrointestinal complications in atopic infants (14). Similarly, when fed an AAF, infants with CMPA with multiple food allergies demonstrated reduced allergic symptoms and normal growth (15,21,22). The results in the present study indicated that longer-term feeding of an AAF in infants with poorly managed CMPA, improved long-term allergy management.
There were some limitations of the present study, with 1 being the observational, nonrandomized nature of the study design. Another limitation was the relatively small sample size of study participants. Despite these limitations, the present study, however, provided support for the use of this new amino acid−based infant formula in infants with suspected CMPA not responding to EH formulas. The results of the present study build on the past literature supporting the efficacy and safety of AAFs for CMPA management. The new amino acid formula in the present study supported healthy weight gain and improvement in allergy symptoms in CMPA infants not responding to EHP formulas.
The authors would like to thank all of the participating families. The authors also thank Kaitlin Dehlin, PhD, RD, for assistance in the writing, editing, and submission of the manuscript.
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