Food Allergy Living Blog

Ask the Nutritionist

About Neocate

Posted 8.27.15 | Nutrition Specialist

Have you ever wondered what makes Neocate different than standard nutritional formulas? This is a very good question and definitely worth sharing.

All of our Neocate products are “elemental” formulas, or to be more specific “amino acid-based” formulas. The term ‘amino acids’ may bring back some memories from high school biology or chemistry class. Amino acids are essentially the building blocks of protein. The reason free amino acids are so important in some medical conditions is due to the fact that intact protein, in most cases, is what is responsible for triggering a food allergic response. Neocate is considered to be a hypoallergenic formula, as it does not contain any intact protein. In addition to the hypoallergenic nature of an elemental formula, the free amino acids make digestion and absorption easier as the protein is already in its most broken down form. It’s also important to mention that our bodies are able to use the amino acids in the same way that they use intact protein for healthy growth and development.

There are a number of reasons why an individual might need an elemental formula such as Neocate, such as:

  • Cow milk allergy (CMA) and/or soy milk allergy
  • Multiple food protein allergy
  • Short bowel syndrome (SBS)
  • Eosinophilic esophagitis (EoE)

This isn’t a complete list. Neocate products are sources of essential nutrients, and are often used as a sole source of nutrition (meaning they are used to meet all of an individual’s nutritional needs with no other source of nutrition). Of course, the amount of a Neocate product needed should be prescribed by a healthcare professional to ensure a patient consumes an amount needed to meet specific nutritional goals.

What makes Neocate products unique? Many reasons, but one that stands out to me the most is that Neocate powdered products are made in our own, dedicated facility that is 100% dairy-protein free. We also know that none of the ingredients in the Neocate products are derived from wheat, barley, rye, fish, shellfish, tree nuts, peanuts, or eggs; removing the risk of cross contamination with those allergens.

If you would like to read a little more about what makes Neocate products different, check out a page on our Neocate web site that I think you’ll find to be pretty helpful:

The various types of formulas available can be overwhelming and definitely cause some confusion. Please don’t hesitate to let us know if you have any questions by leaving a comment below!

- Kendra Valle, RDN

Mixing Neocate: A Simple How-To Guide

Posted 8.4.15 | Nutrition Specialist

Are you mixing Neocate correctly? It is important to mix Neocate appropriately to ensure your little one is receiving the nutrition she needs to thrive. My goal with today’s post is to make your life just a little easier by providing tips on how to properly prepare Neocate. If others help in your little one’s care (i.e. grandparents, day care providers, home health nurse, etc.), feel free to share this blog so that they are also aware of the necessary steps to take.

First and foremost, let’s discuss the basic steps for preparing Neocate:

  1. To begin with, wash your hands thoroughly and clean the preparation area.
  2. Pour the required amount of cooled, boiled water into a sterilized feeding bottle/container (or just warm or cool water – not boiled - for Neocate Junior).
  3. Next, add the prescribed amount of scoops of Neocate to the water (all scoops should be leveled and unpacked).
  4. Lastly, place the cap on the bottle/container and shake until the powder dissolves.

We are occasionally asked whether or not the cooled, boiled water (a.k.a. sterilized water) is a must when preparing Neocate Infant DHA/ARA. We suggest using sterile water for safety reasons, a recommendation that’s been made by several large healthcare professional groups (such as the American Academy of Pediatrics and Center for Disease Control and Prevention) in relation to the preparation of powdered infant formula. For standard bottled waters or for tap water, you can easily sterilize the water by bringing it to a rolling boil for 3- 5 minutes. You should then remove it from the heat and allow the water to cool for about 20-30 minutes to bring it down to a cooler temperature that would be safe for mixing with Neocate Infant formula (below 122’F/50'C). This ensures it is not so hot that it affects nutrients in the formula. Neocate should never be mixed with boiling or recently boiled water. For caregivers who prefer not to sterilize the water, we suggest checking with your little one’s healthcare team for their guidance. As long as they don’t require it, it isn’t absolutely necessary that Neocate Infant DHA/ARA be prepared with sterile water: it’s just our recommendation.

Below you will find various recipes for our Neocate products at their standard dilutions (20 calories per fluid ounce for Neocate Infant DHA/ARA and 30 calories per fluid ounce for Neocate Junior and Neocate Junior with Prebiotics). Occasionally, your healthcare professional may recommend mixing Neocate to be more dilute or more concentrated. If this is the case, your healthcare team will provide the appropriate recipe to meet your child’s needs.

Neocate Infant DHA/ARA:

Neocate Junior, Unflavored:

Neocate Junior with Prebiotics, Unflavored:

Neocate Junior with Prebiotics, Vanilla:

Neocate Junior with Prebiotics, Strawberry:

Neocate Junior, Tropical and Chocolate:

We also have some great mixing demonstrations available on our YouTube page, Here you will find videos of my colleagues demonstrating how to properly prepare our Neocate products.

If you have any questions at all regarding how to mix Neocate, please don’t hesitate to contact our Nutrition Services team at 1-800-NEOCATE, option 2 or

Do you have any questions on preparing or mixing Neocate products?

-Kendra Valle, RDN

Orange you glad you read this post?

Posted 7.31.15 | Nutrition Specialist

Our guest blog today comes from Raquel Durban, a Registered Dietitian specializing in immediate and delayed food allergies in Charlotte, NC.  Raquel is a medical advisory board member for the Food Allergy and Anaphylaxis Connection Team (FAACT) and an active participant in the American Academy of Asthma, Allergy and Immunology (AAAAI), American Partnership for Eosinophilic Disorders (APFED) and International Network for Diet and Nutrition in Allergy (INDANA).  We would like to thank Raquel for this post. 

Think oranges are only for juicing? Think again! Oranges can provide a fun and educational experience to practice using auto-injectable epinephrine! While in clinic one afternoon, a mother pulled out a bag of citrus fruits (oranges and grapefruits work best because of their large size) and her expired auto-injectable epinephrine.

To my surprise and delight, she wanted to inject the oranges with her expired epinephrine devices so that I could "see" her practice and validate her administration. What makes this such a great idea? While the training devices for auto-injectable epinephrine are great teaching aids, the actually devices are heavier than the test devices, as they are filled with epinephrine. Also, the skin and flesh of the citrus fruits mimics a thigh very well.

I wanted to pass along this great idea to other families who might like to practice using expired auto-injectable epinephrine. If practicing with a little one, make sure you give them a helping hand. And after your practice session, please ensure that you dispose of the expired auto-injectable epinephrine correctly by checking with your doctor’s office or pharmacy. Some cities also have household hazardous waste programs that accept medical waste.


Image source: Debbie

Guidance when Cooking with Neocate

Posted 7.23.15 | Nutrition Specialist

We get emails and phone calls almost daily from parents, caregivers, patients and clinicians asking questions like "What happens if we cook with Neocate?" We know that there are a lot of creative ways that some families use Neocate, such as a replacement for cow milk in baked recipes. We've developed a handy one-page document to answer the most common questions that Neocate families want answers to. You can find your own copy of 'Cooking with Neocate' on the 'Recipes and Guides' page of the Neocate website, along with lots of other helpful materials.

As always, we recommend that you check with your healthcare team, because some forms of cooking can affect some nutrient levels in Neocate.

How have you gotten creative in using Neocate products in recipes?


Eosinophilic Esophagitis (EoE) and the Six Food Elimination Diet

Posted 5.15.15 | Christine Graham-Garo

Eosinophilic Esophagitis (EoE) is a condition that is continuing to get more and more attention in the medical community, which means the public is learning more about it too. Unfortunately though, the management options for EoE are not black and white. EoE may be managed either with medication, which has known long-term side effects, or nutrition therapy, which has been shown extremely effective, but may be difficult to follow for some families.

Medications used to manage EoE are all steroids, and at this point no medication has FDA approval for EoE. Steroids have been shown to be effective in managing EoE for more than half of patients. However, steroids may not be the best long-term solution for everyone. Many families who choose to use steroids may mix the medication recommended by their physician with Neocate Nutra. This is because Neocate Nutra thickens, so can help to coat the esophagus with the steroid. This use of Neocate Nutra was even studied by a medical team and you can read about their published research here.

As EoE is a chronic condition, management with nutrition therapy is often discussed and preferred by many families over steroids. Here are nutritional therapy options for EoE:

  • Elemental Diet – A diet consisting almost exclusively of amino acid-based (or elemental) products
  • Elimination Diets – The removal of allergens from the diet.
    1. Tailored Elimination – Elimination of specific allergens based on allergy testing
    2. Six Food Elimination – Elimination of 6 top allergens based on the most common allergens seen in EoE patients

The Six Food Elimination Diet

The 6 Food Elimination diet has been gaining in popularity because it bypasses extensive food allergen testing needed for the Tailored Elimination diet. As you may know, allergy tests (skin prick tests and blood tests) are not perfect. There are often false positives which can make the treatment plan more complicated and time consuming, and some allergens may be missed ('false negatives'). So what the 6 Food Elimination diet proposes is that, off-the-bat, patients eliminate the top 6 allergens seen in EoE patients. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study1 confirms there is a 74% success rate when using this type of nutrition therapy for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies.) Researcers are also looking into 4 Food Elimination diets.

Advantages and Disadvantages to consider

The advantages of using the 6 Food Elimination diet approach are that you can still eat solid foods. It also eliminates the need for extensive skin and blood tests to check for food allergies. Important disadvantages to this diet therapy are that it may unnecessarily remove foods from the diet, and many process foods are out, meaning the diet often involves a lot of preparation and careful reading of ingredient lists. Eliminating so many foods can increase the risk of patients being deficient in one or more nutrients. Also, as many of you may know, it is hard just to remove milk and soy from your diet. Try eliminating SIX different allergens that are found in many foods while maintaining your nutritional status! For this reason, many medical teams that manage patients with EoE encourage their patients to supplement the 6 Food Elimination diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®. This can help ensure the patient is getting all the protein, vitamins and minerals they need per day while ensuring that no allergic reactions will occur with the elemental products. It is vital that EoE patients are monitored by a dietitian. The dietitian will help calculate how much of the elemental product the patient will need per day and also make sure the nutritional status of the patient is maintained.

Again, since research has found a 74% success rate for the 6 Food Elimination diet, it's possible that symptoms will persist after starting the 6 Food Elimination diet. If this happens, your medical team can help you decide the next best step, which may include a careful review of your diet, possibly eliminating more foods, or starting with a more “allergen safe” diet therapy such as an Elemental diet. After a few weeks on the Elemental diet, most teams will work with you to start reintroducing solid foods to figure out which ones may be contributing to your symptoms.

I hope this helped to shed some light on this nutritional therapy options for EoE. Every person will have their own treatment plan that works for them. Is anyone following an elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?


1 Kagawalla AF et al, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006:4(9):363-8

Corn Allergy 101

Posted 4.9.15 | Nutrition Specialist

As a Nutrition Specialist here at Nutricia North America, I spend a lot of time talking to patients, parents, and health care professionals. Some of the questions I receive most often are “Do Neocate products contain any ingredients derived from corn?” and “Are Neocate products safe for an individual with a corn allergy?” Before we delve into these questions, let’s discuss the basics of a corn allergy.

Allergic reactions to corn are rare and often difficult to diagnose using standard skin or blood tests. Because a corn allergy can be difficult to diagnose through traditional methods, your allergist may recommend a food elimination diet in which you avoid corn and any derivatives of corn, for a specific period of time (normally two to four weeks). During this time, symptoms will be monitored, specifically to determine if there is an improvement in symptoms while corn is eliminated from the diet, and if symptoms reoccur when corn is reintroduced. If a corn allergy is identified by the allergist, treatment would involve avoidance of corn and ingredients derived from corn.

Corn is not among the top eight food allergens in the United States, for which special label information is required by the Food Allergen Labeling and Consumer Protection Act of 2004. Because corn is not required to be called out on the label, it is important for an individual with a diagnosed corn allergy to become familiar with ingredients that are derived from corn. Some common sources of corn are:

  • Corn starch
  • Corn syrup
  • Maltodextrin
  • Vegetable oil
  • Cellulose
  • Caramel

Please note, these are just a few examples and not a comprehensive list of ingredients derived from corn. If you are ever unsure as to whether an ingredient is derived from corn, it is best to contact the manufacturer.

Now that we have a basic understanding of a corn allergy, let’s address these frequently asked questions as mentioned earlier. The primary carbohydrate source in each of our Neocate products is derived from corn: The primary carbohydrate source in powdered Neocate products is corn syrup solids, while the primary carbohydrate source in liquid Neocate products is maltodextrin. Corn syrup solids are derived from corn starch, and maltodextrin is structurally similar to corn syrup solids. These ingredients are often used in nutritional formulas as a carbohydrate source because they offer a blend of simple and complex carbohydrates. In Neocate products, they are used in proportion with amino acids and fat to provide a balanced nutritional profile. No Neocate products are completely free of corn-derived ingredients.

That being said, the carbohydrates used in all Neocate products undergo extensive refinement in a multi-step process that includes purification, distillation and drying. This process is designed to remove impurities, including protein and fat that are naturally present in corn. As proteins are what the body responds to in a typical allergic reaction, this removes the trigger for patients with a corn protein allergy. With that said, we cannot make the claim that our Neocate products are completely “corn protein free”. In order to make such a claim, each and every batch would need to be tested for the presence of corn protein, which we do not do.

We cannot say with certainty that Neocate is “safe” for anyone – that’s a question for your healthcare team. It is important to note that leaders in food allergy diagnosis and management, such as those at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine, find a majority of patients with corn protein allergies tolerate refined corn syrup solids with no allergy symptoms. In practice they do not restrict corn syrup solids in the diets of patients who are allergic to corn. If you have questions about the safety of the corn syrup solids or maltodextrin in Neocate, it would be best to discuss this with your healthcare team, especially the allergist, to see if they recommend a supervised trial or other testing to see if Neocate is appropriate.

Since we’re on the topic of corn, I figured I would mention two facts that are of importance to many Neocate families. The corn from which Neocate's carbohydrate ingredients are sourced is certified by the suppliers not to be genetically modified. In addition, the corn syrup solids used in Neocate products would not be expected to contain fructose and are not the same as “high fructose corn syrup” or “HFCS”. HFCS is produced from corn starch in which about half of the glucose molecules have been chemically converted to fructose. Many consumers prefer to avoid HFCS for a number of reasons, and we do not use this ingredient in Neocate products.

-Kendra Valle, RDN


Image source: Liz West


How to Travel with Neocate

Posted 2.27.15 | Rob McCandlish, RDN

by Kathleen Smith, RDN, LDN

As the weather starts to warm up and you start to consider travelling, you have lots to consider: where to go, how to get there, and what to pack. Whether you travel by car, bus, train or plane, an advance plan for the transportation and amount of Neocate you or your family member will need for your trip will save you from additional trip stress.

First things first, calculate exactly how much formula you will need for the entire trip. You don’t want to underestimate and run out of formula, as the chances of a local pharmacy having Neocate are small! (Check here if you find yourself in that situation.) We recommend packing an extra can just in case your travel plans change unexpectedly.

Next you will want to plan the amount of prepared formula to bring with you. Neocate powdered formulas can be prepared ahead of time and kept in a refrigerator for up to 24 hours. Neocate can be kept at room temperature for up to 4 hours as long as the bottle or container has not been “touched” (i.e. no formula has been consumed). So if you have a long flight or car trip, consider bringing a little cooler for your bottles; the cooler should be maintained at a temperature of less than 40°F. Also, pack some extra Neocate powder in your formula bag in case of lost luggage or spillage of formula.

If you are flying, the Transportation Security Administration (TSA) has regulations about flying with liquids for you or your family member. Formula, breast milk and juice for infants or toddlers are permitted to be brought on board the aircraft. Older individuals (older child, teen or adult) may also travel with Neocate. Travelers must tell the TSA officer at the beginning of the screening process that they wish to bring formula, breast milk and juice in excess of 3.4 ounces in their carry-on bag. These liquids do not have to fit within a quart-sized bag like other liquids. The formula, breast milk and juice are typically screened by X-ray, and any of these liquids in excess of 3.4 ounces will receive additional screening.

Travelers are encouraged to travel with only the amount of formula, breast milk and juice needed to reach their destination. Ice packs and other accessories required to cool formula, breast milk and juice are also permitted through the screening checkpoint but may be subject to additional screening. We’ve learned from Neocate families that some TSA officers may not have encountered an older individual requiring a medical food like Neocate before. If you or your loved one is older, it may also help to bring a doctor’s note explaining that Neocate is medically necessary. TSA recommends that if you plan to travel with large quantities of medically necessary liquids you should coordinate your screening by contacting a Passenger Support Specialist prior to your flight.

For more detailed information from TSA about flying with formula, visit prior to your flight.

For more information about the screening of passengers with disabilities and medical conditions, go to Here, passengers will find information about the TSA Cares program, how to secure the services of a Passenger Support Specialist (who is trained in assisting passengers with disabilities and medical conditions through the checkpoint screening process), and what to expect during the security screening process. In addition, passengers may ask to speak to a Passenger Support Specialist or a Supervisory TSO while at the checkpoint if they need assistance. Passengers also may report concerns by emailing TSA’s Disability and Multicultural Division at

We hope you and your family have a safe and wonderful trip!


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Neocate Shipping and Storage

Posted 2.24.15 | Rob McCandlish, RDN

It’s a cold, blustery evening on your drive home from a long day at the office. As you approach your front door you notice the Nutricia North America box sitting at your doorstep. Your initial thought is, “Oh no, can we use this after it’s been sitting here in these cold temperatures all day?”

During these cold winter months (as well as those hot summer days that will soon be upon us) it is not uncommon to wonder if our products are safe after the temperatures they have been exposed to during shipping and delivery.

Short-term exposure to temperature extremes that our products experience during shipping (e.g. being left on a porch in cold or hot weather) typically does not pose a risk to product quality or stability. Those extreme temperatures would become a concern if the product is left at those temperatures for an extended period of time, for example several days or weeks.

The temperatures that are printed on our product labels are recommended storage temperatures, which cover long-term storage of the product. They are based on the effects that extreme temperatures can have on the products over extended periods of time, typically much longer than those experienced during shipping. (With this said, Nutricia’s products are not required to be shipped in a temperature-controlled environment.)

Of note, freezing Nutricia's liquid products may affect the product's consistency, as the thawing process can affect the ability of emulsifiers to maintain a stable solution. In addition, freezing of our liquid products could also have an impact on the water-soluble vitamins (specifically Vitamin C and the B vitamins) which is certainly important to take into consideration for those individuals who rely on our products as their sole source of nutrition.

If you are ever unsure as to whether or not the Nutricia product you have received is safe to use, please do not hesitate to call a member of our Nutrition Services team to discuss your concerns.

-Kendra Valle, RDN, LDN


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Tube Feeding: Troubleshooting Tips

Posted 2.3.15 | Mallory West

Many Neocate babies and children receive their formula through a feeding tube. Common Neocate formulas that are received through feeding tubes include Neocate Infant DHA/ARA, Neocate Junior, Unflavored, and Neocate Splash, Unflavored. Enteral tube feeding provides nourishment to individuals who are unable to consume adequate nutrition by mouth. If your child uses a feeding tube, you know that there may be some occasional tube feeding complications. This blog will provide some general troubleshooting tips for the most common tube-feeding problems.

Clogging of the Feeding Tube:

Sometimes a feeding tube will become blocked so that no food can go through.

How to Fix Clogs:

  • First, using a syringe to gently remove the liquid on top of the blockage, if possible (throw away the fluid removed).
  • Next, gently flush the tube using lukewarm water, using at least a 30 mL (1 oz) syringe. Gently plunge the water back and forth to clear the blockage.
  • Unless directed by a healthcare professional, do not use acidic solutions such as fruit juices or cola as they may curdle the formula.
  • If the tube is still clogged, clamp the tube for around 10 minutes and then try flushing it again.
  • If the tube the clog remains, gently squeeze the tube between your fingers along the length of the tube as far as possible.
  • If you are still unable to clear the blockage, contact your healthcare professional for advice. Sometimes, the physician will prescribe a special enzyme which can dissolve the clog. If the clog cannot be cleared, the tube will have to be replaced.

How to Avoid Clogs:

  • Tube flushing is the most important factor for preventing the feeding tube from clogging. Use a syringe to flush 20 mL of warm water through the feeding tube before and after feedings and medications (or as directed by your healthcare team). If your child receives a continuous feed, your healthcare provider may recommend flushing with water during the feed to prevent clogging.
  • Use liquid medications whenever possible. If pills are necessary, crush them well and mix them with a small amount of warm water. Use a syringe to draw up the solution and insert it into the feeding tube. If pills are coated or time-released, discuss this with the physician because these types of pills are typically not meant to be crushed.
  • Do not mix medications together and do not mix medications in formula unless instructed to do so by your healthcare provider.

Tube Site Irritation or Infection:

Redness, pain, swelling or unusual/excessive drainage, as well as fever, can all be signs of an infection at the stoma site (the surgical opening through which a gastrostomy tube (g-tube) or jejunostomy tube (j-tube) enters the stomach or small intestine).

How to Avoid Irritation or Infection:

To avoid infection, it’s important to keep the stoma site clean and dry. Your healthcare provider should give you specific recommendations for how to clean the stoma site each day. For more information on keeping the stoma site clean (from a parent’s point of view), check out this informative article from Complex Child E-Magazine.

A Dislodged Feeding Tube:

If the feeding tube comes out, call the doctor and go to the hospital right away. The stoma can close up very quickly so the tube needs to be replaced promptly. Cover the site with clean dressing or bandage to prevent leakage and immediately seek medical attention.

Sometimes the healthcare provider will train you to replace the feeding tube yourself (temporarily or permanently) but you should ONLY do this if directed and properly trained by your child’s physician.

How to Avoid:

Young children occasionally pull the tube out themselves. Keep the tube covered with clothing to prevent this. Onesies work well for infants and toddlers. It’s also important to secure the tube during activities so that it doesn’t get pulled out. You can use various methods to secure the tube. Some companies make special wraps and clothing for protecting and accessing the feeding tube:

Do you have any troubleshooting tips to share with other tube-feeding families? What problems have you encountered and what tricks have you learned?

- Mallory

Understanding Expiration Dates

Posted 1.27.15 | Nutrition Specialist

Is the expiration date really that important? Can we use Neocate after the expiration date? What will happen if my child consumes Neocate after it’s expired? These are questions we hear often here at Nutricia North America. In today’s post, we’re hoping to clear up any confusion regarding expiration dates.

An expiration date on any product, not just Neocate products, is based on several factors. One being the durability of the packaging materials. We want to ensure the packaging will keep the contents safe until the expiration date.

Another is the stability of the ingredients. For example, some ingredients break down over time which can affect the smell or taste of the product. We want to ensure that the product is at the highest possible quality during the duration of the shelf life.

A final factor which is probably the most important is to ensure that the nutrients in the product are present at the levels on the label. Nutrients, particularly vitamins, have a tendency to naturally break down over time, some faster than others. Especially since many individuals use our products to meet a large portion of their nutritional needs, it’s very important that the right amount of each nutrient is in the product. We conduct extensive testing under a number of conditions to ensure that the nutrients hold up through the expiration date.

Federal regulations require a "use-by" date on the product label of infant formula under FDA inspection(1), and rightfully so.  The ultimate intent of an expiration date is to keep our customers safe and ensure they receive the nutrients that they expect. With that being said, we cannot recommend using any of our products past the expiration date. If you still have questions, the best thing to do is to share this information with your healthcare team for their guidance.

-Kendra Valle, RDN, LDN

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About Us

Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.