Food Allergy Living Blog Tagged Results

Quite often, we receive calls from families who are distraught and worried after trying five or six different infant formulas that their child with food allergies was not able to tolerate before finding Neocate (an amino acid-based formula). Often, the formulas they tried in the past were hydrolysate formulas (such as Alimentum, Nutramigen and Pregestimil), which are labeled as hypoallergenic. So I often hear the question. “If this formula is hypoallergenic, why didn’t it work for my baby with food allergies?”

In order to answer this question, I’ll need to explain exactly what a hydrolysate formula is and how they differ from elemental or amino acid-based formulas. The main difference is: hydrolysate formulas have milk proteins in them! Amino acid-based or elemental formulas, like Neocate, are 100% milk-free and made up of non allergenic amino acids (the building blocks of protein) so there is a very slim chance of a child having an allergic reaction to them.

The reason hydrolysate formulas can say they are hypoallergenic is because the milk proteins they use in the formulas are broken down (or hydrolyzed) so that the body’s immune system may not detect the proteins as being an allergen. But with the number of calls we get from families in distress over their little one not tolerating the hydrolysate formula, I can tell you that it is not always the fix all for a child facing food allergies. This is where an elemental or amino acid-based formula comes in. It is sometimes stated that amino acid-based formulas are “super” hypoallergenic compared with hydrolysate formulas. This basically means amino acid-based formulas are more hypoallergenic than hydrolysate formulas.

In general, studies show that amino acid-based formulas are tolerated by 98% of severely allergic babies. Although many food allergy babies tolerate hydrolysate formulas, there is a subset that do not - often showing with symptoms like severe diarrhea, vomiting, rashes and failure to thrive.

A relatively recent study demonstrates the intolerance concern with hydrolysate formulas by stating that “there are clinical benefits from the use of amino acid-based formulas in both symptoms and growth in infants and children with cow’s milk allergy who fail to tolerate extensively hydrolyzed formula”¹. Another study showed that up to 30% of babies with food allergies did not tolerate the hydrolysate formula². This is important to know especially if your little one (or someone else’s infant) is still having food allergy related symptoms and is currently using a hydrolysate formula.

Did your child not tolerate a hydrolyzed formula? What did you do?

- Christine

¹ Hill DJ, The efficacy of amino acid based formula in relieving the symptoms of cows milk allergy-A systematic review. Clin Exp Allergy. 2007.

² Latcham et al, A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy. J Pediatr. 2003.

Here’s an interesting article from the Potomac Gazette about a Maryland food allergy family that nicely highlights the need for better diagnosis of infant milk allergies.

However, I wish the reporter would have explained further hypoallergenic formulas and the differences between hydrolysate formulas and elemental formulas. In the article, Victoria Goldberg, mother of two boys who were allergic to milk as babies, mentions that the hypoallergenic formula she gave her oldest still caused a reaction. That’s likely because it was a hypoallergenic hydrolysate.

Hydrolysate formulas (i.e. Nutramigen, Alimentum) contain protein chains that are partially broken down, which makes it easier to digest than typical baby formula. However, sometimes that’s not enough. Some babies need elemental formula (i.e. Neocate) that contain individual amino acids (the building blocks of protein) instead of protein chains.

I think understanding this distinction is key – especially since it can mean the difference between a sick, miserable baby and a happy, healthy baby.

- Nita

Hydrolysate Formula: Nutramigen and Alimentum are hydrolysate formulas. Although these formulas are hypoallergenic, the protein in these formulas is only partially broken down. Therefore, allergic reactions can still occur when on this formula.

Amino Acid-Based Formula: Around the office, this formula has been called “super” hypoallergenic, meaning it is made from individual non-allergenic amino acids, making it easy for babies to digest. Neocate and Elecare are both amino acid-based formulas, but only Neocate is manufactured in a 100% dairy free environment.

Sometimes, babies with symptoms of milk protein allergy are given a hydrolysate formula first to see if it works. If the baby is still sick after several weeks, the doctor then recommends switching to an amino acid-based formula. However, that can mean many weeks (that feel like an eternity!) of a sick, miserable, undernourished baby and exhausted, stressed out parents.

So, some doctors recommend starting with the amino acid-based formula – which they know will provide the baby with relief fast if he or she has milk protein allergy. If the baby does well on it (for infants with milk protein allergy, symptoms usually resolve within three days of starting Neocate), after a few weeks parents can try to transition the baby to a hydrolysate. If the Neocate doesn’t help the baby, that tells the doctor right away that it is not a milk protein allergy causing the baby’s symptoms and the medical team needs to do some more investigative work to find out what’s really wrong. If you have a baby recently diagnosed with milk protein allergy, talk to your doc about the best approach.

For more information on formulas, check out this blog entry that my fellow blogger posted a few months ago.

And if you think your little one might have a milk protein allergy, but hasn’t been diagnosed yet, make an appointment with your doctor and check out http://www.testforallergy.com/ — it’s a good educational resource for potential allergy parents.

Any questions? Let me know!

- Nita

Blake was only four days old, when he began burping up blood after being breastfed by his mother Allison. A few days later, the blood appeared in his stool as well.

“Blake was so unhappy,” says Allison. “He was crying all the time, was in so much pain that he couldn’t sleep at night and had extremely dry skin.”

Blake before Neocate

After noticing the blood in both Blake’s saliva and stool, Allison rushed him to the hospital where he was diagnosed with a severe milk protein allergy.

Over the next three months, Blake saw a pediatrician, gastrointestinal specialist and an allergist about his milk allergy. In addition, he was switched from breast milk to Good Start and then to Nutramigen and Alimentum — but none of the formulas seemed to help.

Finally, the GI doctor recommended Blake try Neocate Infant — a hypoallergenic formula made up of individual amino acids (the building blocks of protein) that Blake could digest instead of the full or partial protein chains in the other formulas that caused him to have an allergic reaction.

Within three days of starting Neocate, Blake’s bleeding stopped and he began gaining weight.

Blake After Neocate

It took three long months before Blake received the treatment he needed for his milk protein allergy. Neocate relieved his pain and allowed him to sleep at night.

“After starting Neocate, Blake was like a new baby,” says Allison. “He was happy again!”