Hydrolyzed Rice Protein-Based Formulas, a Vegetal Alternative in Cow’s Milk Allergy

Dupont, Christophe; Bocquet, A.; Tomé, Daniel; Bernard, Marie A.; Campeotto, Florence; Dumond, P.; Essex, Anna; Frelut, Marie-Laure; Guénard-Bilbault, Lydie; Lack, Gideon; Linglart, Agnès; Payot, F.; Taı̈eb, Alain; Kalach, Nicolas

doi:10.3390/nu12092654

Cited by 42 publications

(60 citation statements)

References 68 publications

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“…Rice-based HF are tolerated by at least 90% of CMA-allergic children, as recently addressed [ 29 ]. Notewothy, most of the clinical studies assessing rice-based formula were conducted on children with IgE-mediated CMA [ 30 , 31 , 32 ]. Only two studies were conducted on both IgE-mediated and non-IgE-mediated CMA, both of which confirmed the high tolerability of this formulation even in non IgE CMA [ 26 , 33 ].…”

Section: Hydrolysed Cow’s Milk and Vegetable Protein-based Formulas: Tolerance Nutritional Value And Palatabilitymentioning

confidence: 99%

“…Hence, rice HF are generally supplemented with these three amino acids [ 39 ]. Rice protein hydrolysis is required to improve water solubility and digestibility [ 30 ]. Soy formulas may have a lower absorption of minerals and trace elements due to their phytate content.…”

Section: Hydrolysed Cow’s Milk and Vegetable Protein-based Formulas: Tolerance Nutritional Value And Palatabilitymentioning

confidence: 99%

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Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

et al. 2021

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An allergy to cow’s milk requires the avoidance of cow’s milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow’s milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow’s milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow’s milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow’s milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant’s age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.

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Section: Hydrolysed Cow’s Milk and Vegetable Protein-based Formulas: Tolerance Nutritional Value And Palatabilitymentioning

confidence: 99%

Section: Hydrolysed Cow’s Milk and Vegetable Protein-based Formulas: Tolerance Nutritional Value And Palatabilitymentioning

confidence: 99%

Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

et al. 2021

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“…The nutritional quality of rice proteins is suitable to be used in infant formulas giving that it is supplemented by certain amino acids that can be lacking. 83 Infants fed a RHF for 6 months showed normal growth, normal plasma nutritional parameters and no adverse reactions. [84][85][86] No significant differences between RHF, soy infant formula and casein EHF groups were observed for the z-score for weight-for-age during the first two years of life.…”

Section: Plant-based Based Infant Formulamentioning

confidence: 85%

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Vandenplas¹,

Brough²,

Fiocchi³

et al. 2021

JAA

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Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them. Conclusion: A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.

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“…It is not a quick process to change HCP prescribing behavior, as evidenced by the length of time it has taken for HRF to become mainstream practice in some European countries. Indeed, HRF is currently marketed mainly in Italy, France, and Spain [6].…”

Section: Expert Presentation: Practical Experience Using Hrf From a Gastroenterologist's Perspectivementioning

confidence: 99%

“…Cow's milk allergy (CMA) is the most common food allergy in early childhood, and approximately 80% of children will outgrow it by 3-5 years of age [4,5]; its prevalence ranges from 1.9% to 4.9% [6]. It manifests through a variety of symptoms that place a significant burden on the infant and caregiver alike [7].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow’s Milk Allergy in the Middle East, North Africa, and Pakistan Region

et al. 2021

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Cow’s milk allergy (CMA) is the most common food allergy in early childhood, and its prevalence continues to rise. Exclusive breastfeeding is recommended for infants in the first 6 months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle East, North Africa, and Pakistan (MENAP) region. If the infant is affected by CMA, current guidelines recommend extensively hydrolyzed formulas (eHFs) or amino acid-based formulas (AAFs) in the case of severe symptoms, and hydrolyzed rice formulas (HRFs) where available. In recent years, HRFs have been proposed as a plant-based alternative to cow’s milk protein-based eHFs, and updates to current guidelines have been recommended. In 2014, a consensus statement and guidelines were published for the Middle East region on the prevention, diagnosis, and management of CMA. As new advances have been made in the extensively hydrolyzed hypoallergenic infant formula space, along with updated scientific evidence, a workshop of experts from the MENAP region focused on HRF was convened in 2021. This publication summarizes the insights from this meeting. During the consensus part of the meeting, a new approach was discussed and approved by all participants, and agreement was reached that HRF can be recommended as a first-line alternative to cow’s milk-based eHF in the dietary management of CMA.

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Hydrolyzed Rice Protein-Based Formulas, a Vegetal Alternative in Cow’s Milk Allergy

Cited by 42 publications

References 68 publications

Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

Hydrolysed Formulas in the Management of Cow’s Milk Allergy: New Insights, Pitfalls and Tips

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow’s Milk Allergy in the Middle East, North Africa, and Pakistan Region

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