Year: 2021
Type: review
Abstract: ABSTRACT: 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.
Source: Journal of Asthma and Allergy
DOI: 10.2147/jaa.s276992
Institutions: Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, King's College London, Guy's and St Thomas' NHS Foundation Trust, Evelina London Children's Healthcare, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Khalifa University of Science and Technology, Shaikh Khalifa Medical City, University of Indonesia, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, University of Insubria, Ospedale Filippo Del Ponte Varese, Children's Health Queensland Hospital and Health Service, Children's Hospital Colorado, University of Winchester, Imperial College London
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W3206411602