A partially hydrolyzed 100% whey formula and the risk of eczema and any allergy: an updated meta-analysis

Abstract

BackgroundRecently, the role of using hydrolyzed formula for the prevention of allergic disease has been questioned. However, not all hydrolyzed formulas are equal. The efficacy of each hydrolyzed formula should be established separately. We updated evidence on the effectiveness of using partially hydrolyzed 100% whey formula (pHF), manufactured by a single manufacturer, for reducing the risk of eczema and allergy in healthy infants at high risk for allergy.MethodsThe Cochrane Library, MEDLINE, and EMBASE databases were searched in June 2016 for randomized and quasi-randomized controlled trials (RCTs); additional data were obtained from reviewed articles and the authors of included trials.ResultsThirteen publications reporting on eight RCTs were included. Use of pHF compared to cow’s milk formula reduced the risk of eczema and all allergic diseases among children at high risk for allergy. Both intention-to-treat analyses and per-protocol analyses showed that the reduction was statistically significant at some, albeit not all, time points.ConclusionsThere is evidence to consider use of pHF as an option for reducing the risk of any allergic diseases, particularly eczema. However, the certainty of the evidence is low. One characteristic that makes our meta-analysis distinct from other reviews is that it focuses exclusively on only one type of pHF.Electronic supplementary materialThe online version of this article (doi:10.1186/s40413-017-0158-z) contains supplementary material, which is available to authorized users.

Partially Hydrolyzed Whey Infant Formula: Literature Review on Effects on Growth and the Risk of Developing Atopic Dermatitis in Infants from the General Population

“…Interestingly, the effect size observed with pHF-W supplementation is similar to what was observed in trials performed in populations selected with a first-degree relative with allergic disease [2][3][4][5][6]. On explanation could be that, in the general infant population with the genetic bias being weaker than in infants with a first-degree relative with allergic disease, the effect of a change like pHF-W versus CMF may have a better or similar effect due to being less confounded by genetic factors that would favor the development of allergic symptoms regardless of nutritional or environmental pressures.…”

“…2). Indeed, the effect size (a 30-40% risk reduction at 1 year of age) is comparable to what has been described in a meta-analysis of infants with a family history of AD [2][3][4]6]. However, due to the variability of study design, the different allergic outcomes, the various infant ages at which allergic outcomes were measured, and the possible study selection bias identified in this review, the relevance of the meta-analysis remains low.…”

“…The bias in the studies was assessed using methods similar to those recently published [6]. A low, medium, or high risk of bias was assigned to each study regarding selection, detection, performance, reporting, and other biases.…”

“…AD etiology is now associated with genetic variants involved in skin barrier function defect and inflammation, leading/predisposed to a dry skin with increased susceptibility to environmental triggers [1]. While there are multiple specific etiologic factors for AD, partially hydrolyzed whey-based formula (pHF-W) has been shown to be efficacious in reducing the risk of developing AD in the first years of life in infants with a first-degree relative affected by allergy [2][3][4][5][6]. Indeed, this population of infants is at a higher risk of developing allergy than the general population, and has been selected for numerous clinical trials to be sufficiently powered to demonstrate a significant effect of formula without recruiting massive numbers of infants.…”

Food Allergy Prevention and Treatment by Targeted Nutrition

“…However, pooling of data on hydrolyzed formulas in meta-analyses may be problematic due to significant heterogeneity of PHF products. A more recent meta-analysis addressed this issue and only included studies using 100%-whey PHF [97]. That study found a preventive effect for all allergies and eczema, but acknowledged limitations in the certainty of available data.…”