Use of hydrolysates in the treatment of cow's milk allergy

Background: Hydrolyzed formulas (HFs) are in general well tolerated by children with cow's milk allergy (CMA), although cases of allergic reactions have been reported and residual allergenicity of HF has been demonstrated Objective: To review the most relevant studies of the HFs for residual allergenicity, tolerance, and safety in the past 20 years. Data Sources and Methods: MEDLINE searches for the years 1970 to 2001 using the following algorithm (hydrolysate and allergy; food intolerance/allergy; protein hydrolysate). Results: The literature confirmed that although some antigenicity remains, HFs are well tolerated by children with CMA. Rice HF has proven safe when tested by double-blind, placebo-controlled food challenge in a study population of 18 children allergic both to cow's milk (CM) and soy protein. Conclusions: Absolute avoidance of CM proteins means substitution by soy-, rice-, or amino acid-based formulas. As 8 to 14% of infants allergic to CM react to soy and amino acid-based formulas are expensive, scientific societies recommend the use of formulas based on extensively hydrolyzed CM proteins as first alternatives in children with CMA. Although both soy- and rice-based HFs have now been shown to be safe for these children, further nutritional and clinical studies are needed.