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.

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

When my wife and I were expecting our first child, a lot of questions went through our minds, such as “My God, what have we done!”

Just kidding, we knew from the first kick Vincent would be awesome.

But we did ask ourselves a lot of big questions, including just how many ways are there to manufacture a sippy cup? And how do two people choose one from the entire wall of sippy cups at Babies R Us? What exact temperature should the bath water be? And how many IQ points is the kid going to lose if we paint the nursery the wrong color?

When you find out your baby has a food allergy, there’s a whole new set of questions. And just what exactly do you feed the little guy or gal is at the top of the list.

If you’re a breastfeeding mother, you’ll need to work with your healthcare team to identify everything the baby is allergic to and remove all those foods from your diet. If the baby relies on formula for some or all of his diet, you’ll need to make a formula change. But what do you change to?

Here’s the 411 on the different types of formula and what you should know about them if you’re a food allergy family.

Cow’s milk formula
This is most of the formula you’ll find in the grocery story aisle. It’s based on cow’s milk and fine for most healthy babies. But milk allergy is the most common food allergy among babies. So that milk, which contains full protein chains, is bad news for a food allergy baby.

Soy formula
This formula is based on soy instead of cow’s milk so it is dairy-free, but it is still not recommended for a food allergy baby, since as many as 70% of babies with a milk allergy also have a soy allergy.

Hydrolysate formula
Instead of the full protein chains in cow’s milk formula, hydrolysate formulas have protein chains that are broken into smaller pieces. This makes the formula easier for some food allergy babies to digest, but it doesn’t help everyone.

Amino acid-based formula
This formula doesn’t contain any protein chains at all. Instead it contains the individual amino acids that make up a protein. Essentially, it is baby’s nutrition in its simplest form and the absolute easiest thing for a milk allergy baby (or any baby with gastrointestinal issues) to digest. Using an amino acid-based formula like Neocate typically clears up a milk allergy baby’s gastrointestinal symptoms in 3-5 days and any skin rash associated with the food allergy within 2 weeks.

This is the basic rundown. If you have any further questions, feel free to post a comment below.

Be well,
Dr. Y

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


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