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.

If your little one uses any of the Neocate products, you’ve probably heard the term “elemental diet.”  And if your son or daughter has eosinophilic esophagitis (EoE), you’ve probably also heard of an “elimination diet.”  These two aren’t always the same, so here’s a quick primer on the two.


Elemental Diet

The term “elemental diet” is a historic term that was used to refer to diets where the component nutrients were broken down into their “elements.”  Another term is “semi-elemental.”  In terms of nutrition, a semi-elemental formula, or hydrolysate, is one that has proteins that are partly broken down, or hydrolyzed.  These can be partially or extensively hydrolyzed.  An elemental formula, then, is one that contains only amino acids, the building blocks of protein.  Elemental formulas can also have some fats which are easier for the body to absorb than those found in the standard diet.

Now, technically speaking, elements are atoms, like you would see on the Periodic Table of the Elements.  So, technically, Neocate is not elemental, because it’s made of molecules, not individual atoms.  So in the strictest sense Neocate isn’t elemental: no formula is!  But, many health care professionals still use this term.  The more accurate term for Neocate, which you’ll see on our website, is amino acid-based formula.


Elimination Diet

An elimination diet is one in which one or several foods are eliminated from the diet.  There is no one “elimination diet:” it often varies from patient to patient.  Elimination diets can be based on the results of specific allergy testing (a tailored elimination diet), or more loosely based on common food allergies.  For instance, a six-food elimination diet is often used.  The idea behind an elimination diet, commonly used with EoE, is that you give the body a break from certain offending foods so that inflammation can calm down.  This works best if ALL foods that are causing a response are eliminated, which is why the six-food elimination diet isn’t quite as effective as a tailored elimination diet.

Where the lines get blurry between these two terms is that sometimes an elemental diet is used as a total elimination diet (so ALL food is eliminated!).  Basically a child might go on an elemental diet for a period of weeks, after which they usually start adding foods back to the diet one at a time.  That way there is no mistaking an allergic response to a specific food.  On top of this, an elemental formula like E028 Splash might be added to a six food or tailored elimination diet, to help make sure a child gets all of his/her essential nutrients when foods like dairy are removed.  What’s interesting is that studies have shown that the best response in EoE is to a fully amino acid-based diet.

Do you have any questions about the differences between elemental and elimination diets?

- Rob


[Image source]