Food Allergy Living Blog Tagged Results

Childhood obesity is one of the most challenging problems facing pediatricians today. About 10% of children younger than 2 years and 21% of children between 2 and 5 years are overweight.¹ Young children with excess weight are at an increased risk of being overweight in the future.² One interesting study that just came out in the Journal of Pediatrics (Dec 2010) compared the weights of infants who were fed cows’ milk formula versus those fed hydrolyzed formulas in which the milk proteins are partially broken down. Interestingly, the study results sound that the infants who were fed the cow’s milk formula gained more weight than the infants fed hydrolyzed formulas.

This finding is similar to another study that found that infants fed a cow’s milk formula gained more weight versus infants who were breastfed. They did note that the hydrolysate-fed infants consumed less formula to satiation than the cows milk formula group. No difference was seen in the length of the infants.

This finding was surprising to researchers, especially when more and more children are becoming overweight. Researchers are still unsure what would cause this difference, but one hypothesis points to the form of the proteins, which are whole in regular cow’s milk formulas, but partially broken down in hydrolysate formulas. One study notes that free amino acids stimulate sensory receptors in the oral cavity and /or gastrointestinal tract.³ In addition, previous research has shown that partially broken down protein chains stimulate a cascade of satiation signals, interestingly. Basically, the infants may have felt full sooner with the hydrolysate formula vs. with the cow’s milk formula.

More research needs to be done on this of course, but this does raise questions in regards to amino acid-based formulas. Will infants who are fed formulas such as Neocate have better weight profiles vs. infants fed milk-based formulas? We will keep our eyes peeled for more research and data on this!

-Christine  

1. Ogden CL, et al Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303(3):242-249.
2. Baird J, et al. Being big or growing fast; systemic review of size and growth in infancy and later obesity. BMJ. 2005;331(7522):929.
3. San Gabriel A, et al. mGluR1 in the fundic glands of rat stomach. FEBS Lett. 2007:581(6):1119-1123. 

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.

To follow up on Mallory’s post on Dysphagia, GERD, and Silent Aspiration in children, I wanted to discuss the use of thickeners to help with the treatment of GERD/GER, dysphagia and aspiration.

If your little one is showing signs of GERD/GER, dysphagia or aspiration, you should always see a doctor to determine exactly what condition needs to be treated. One thing to remember is that children with Eosinophilic Esophagitis (EoE) can also have symptoms of dysphagia and often have symptoms very similar to that of GERD. EoE is caused by food allergies and can be treated effectively by eliminating the allergens in your child’s diet. Thickening their food or formula may not be needed once the allergens are removed. Be sure to check with your doctor or speech pathologist to see if a food thickener is appropriate for your little one before trying one.

Thickening Foods and Liquids

If your child does have GERD/GER, dysphagia or aspiration, altering the thickness of food and liquids can help make them easier to swallow. When fluids are too thin, some children have trouble using their tongues correctly, causing liquid to get caught in the airway passage and then get into their lungs. Thickening the formula and other fluids will help to ensure that the liquids stay together in the esophagus, decreasing the risk of aspiration.

For infants with GERD symptoms, using rice cereal in their formula to thicken it may help. The recommended amount to add to formulas is one tablespoon per 2 to 4 ounces of formula to reduce vomiting. (Rudolph et al 2001). There are also other thickeners on the market to choose from. It is important to read labels and call the company if your child has food allergies to ensure that they aren’t ingesting any allergens in the thickener. A few options include:

• Thick-It
• ThickenUp
• Simply Thick

Have you used a thickener before for your child? If so let us know which you tried and how it worked!

- Christine

I was on EBay the other day and ran across someone selling Neocate, of all things. Now I love an online bargain as much as the next gal, but baby formula? Probably not the best idea.

Of course I can understand trying to save money. I marvel sometimes at how someone as tiny as my daughter requires so much stuff and how much it all costs! However, when it comes to a medical food like Neocate the risk of not knowing where it is coming from is not worth the savings.

You see, the danger of buying from sites like eBay and Amazon is that you don’t know who is selling you the product. Did they store it properly? Is it expired? Is it really Neocate?

A few months back, there was an enraging story about a man from Omaha, Nebraska selling Neocate on eBay to unsuspecting parents. But after making the sale, he never shipped the formula. Luckily, they caught the man. He was arrested on 45 counts of theft by deception. But several families still lost as much as $4,000. To view the entire article, click here.

Remember that neocate.com and your neighborhood pharmacy are both trusted resources for Neocate. And if you have any questions, please send them my way.

- Sarah