Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics

Prompted by the accumulating evidence on bioactive moieties of milk-derived peptides, novel methods were applied to compare the peptide composition among commercially available hydrolysate formulations and to determine batch-to-batch variations of protein hydrolysate products. Despite the availability of general methods to measure, for example, the degree of hydrolysis and peptide mass distribution at a high level, the objective of this study was to more qualitatively compare peptide sequences and composition. By a comprehensive approach combining peptidomics technologies and multivariate clustering analyses, the peptide profiles of different hydrolyzed milk protein formulations were compared. Moreover, peptide profiles of various hydrolysate batches that had been produced over a period of 5 years were included. Coupling of identified peptide sequences to the position in their corresponding milk proteins produced numerical datasets that subsequently were utilized for multivariate data analyses. These analyses revealed that batch-to-batch variation in the peptide profiles of a specific extensively hydrolyzed casein preparation was low. Moreover, extensive multivariate evaluations revealed that the peptide profiles of different commercially available hydrolyzed milk protein formulations provided a descriptive and distinct signature. Overall, the described methodology may contribute to the field of peptide research as observed dissimilarities in peptide profiles of similar products may be related to differences in their overall functionality.

show abstract

“…Many of these formulae contain extensively hydrolyzed protein sources to decrease overall allergenicity (Dupont et al. 2012; Ludman et al. 2013).…”

Section: Resultsmentioning

confidence: 99%

Clustering analyses in peptidomics revealed that peptide profiles of infant formulae are descriptive

Lambers¹,

Gloerich

Hoffen³

et al. 2014

Food Science & Nutrition

View full text Add to dashboard Cite

show abstract

“…Over 90% of the infants in our study had food allergy. Numerous studies have reported that AAF supports growth and alleviates diarrhea due to food allergies [7,8], and they are preferable to extensively hydrolyzed formulas for certain patients [7-10]. An additional incentive to use AAF is that allergic responses can occur with extensively hydrolyzed formulas because they may contain residual peptides that can elicit an allergic response in sensitized children [11-14].…”

Section: Discussionmentioning

confidence: 99%

Two single group, prospective, baseline-controlled feeding studies in infants and children with chronic diarrhea fed a hypoallergenic free amino acid-based formula

Borschel

Antonson

Murray³

et al. 2014

BMC Pediatr

View full text Add to dashboard Cite

BackgroundInfants and children with chronic diarrhea (CD) often require specialized foods or parenteral nutrition (PN) to achieve adequate nutrient intakes to support growth and development. We assessed the efficacy of an amino acid-based formula (AAF) in supporting growth and improving symptoms in infants and children with CD from multiple etiologies.MethodsTwo studies were conducted: CD study in children (CD-C) and CD study in infants (CD-I). Each was a single group, baseline-controlled study in which each subject served as his/her own control. At enrollment, all subjects had CD lasting > 2 weeks and had ≥ 4 stools/day. Subjects were fed an AAF for 80 days starting at SD5, and were assessed at SD 28 and 84.ResultsCD-C: 18 of 19 subjects completed the study. At enrollment, the mean age was 5.6 ± 0.7 years, the most common diagnosis was short bowel syndrome (SBS) (n = 13), and 5 subjects with SBS were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.026). Over 50% of subjects achieved improvements in clinical outcomes targeted most frequently by their physicians. Of the five subjects on PN at enrollment, four had substantial weight gain and four had their PN requirements decreased. CD-I: 22 of 27 subjects completed the study. At enrollment, the mean age was 3.3 ± 0.3 months, the most common diagnosis was food allergy (n = 20), and no subjects were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.0023), significant decreases in the number of stools/day (p = 0.0012), and improvements in stool consistency (p = 0.0024). Over 80% of subjects achieved improvements in the clinical outcomes targeted most frequently by their physicians.ConclusionsInfants and children with CD fed an AAF for three months displayed significant improvements in weight-for-age z-scores and clinical symptoms. Children dependent on PN also grew well and four of five decreased their dependence on PN.Trial registrationBoth trials were registered on ClinTrials.gov (CD-C, NCT01812629; CD-I, NCT01820494).

show abstract

“…In some cases choosing a soya or an extensively hydrolysed formula (eHF), which the infant may also react to, may lead to a false negative diagnosis. Alternatively, choosing an amino acid formula (AAF) when not indicated increases the cost burden of managing CMA and may affect development of tolerance (albeit the data is very preliminary at this time) [19,20]. …”

Section: Reviewmentioning

confidence: 99%

Diagnosis and management of non‐IgE‐mediated cow's milk allergy in infancy ‐ a UK primary care practical guide

Venter

Brown

Shah

et al. 2013

Clinical & Translational All

119

144

View full text Add to dashboard Cite

The UK NICE guideline on the Diagnosis and Assessment of Food Allergy in Children and Young People was published in 2011, highlighting the important role of primary care physicians, dietitians, nurses and other community based health care professionals in the diagnosis and assessment of IgE and non-IgE-mediated food allergies in children. The guideline suggests that those with suspected IgE-mediated disease and those suspected to suffer from severe non-IgE-mediated disease are referred on to secondary or tertiary level care. What is evident from this guideline is that the responsibility for the diagnostic food challenge, ongoing management and determining of tolerance to cow’s milk in children with less severe non-IgE-mediated food allergies is ultimately that of the primary care/community based health care staff, but this discussion fell outside of the current NICE guideline. Some clinical members of the guideline development group (CV, JW, ATF, TB) therefore felt that there was a particular need to extend this into a more practical guideline for cow’s milk allergy. This subset of the guideline development group with the additional expertise of a paediatric gastroenterologist (NS) therefore aimed to produce a UK Primary Care Guideline for the initial clinical recognition of all forms of cow’s milk allergy and the ongoing management of those with non-severe non-IgE-mediated cow’s milk allergy in the form of algorithms. These algorithms will be discussed in this review paper, drawing on guidance primarily from the UK NICE guideline, but also from the DRACMA guidelines, ESPGHAN guidelines, Australian guidelines and the US NIAID guidelines.

show abstract

Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics

Cited by 60 publications

References 93 publications

Clustering analyses in peptidomics revealed that peptide profiles of infant formulae are descriptive

Clustering analyses in peptidomics revealed that peptide profiles of infant formulae are descriptive

Two single group, prospective, baseline-controlled feeding studies in infants and children with chronic diarrhea fed a hypoallergenic free amino acid-based formula

Diagnosis and management of non‐IgE‐mediated cow's milk allergy in infancy ‐ a UK primary care practical guide

Contact Info

Product

Resources

About