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hypoallergenic

Food Protein-Induced Entercolitis Syndrome (FPIES): Roland’s Story

Posted 7.29.10 | Guest Blogger

Our post today is a guest blog entry from Lorelei Alvarez, one of the founders of the Reflux Rebels, a support group for parents of children with reflux, MSPI and other GI issues. You can also find the Reflux Rebels on BabyCenter, where they have an active group of over 1,800 parents. We’d like to thank her for guest blogging for us.

Roland Edward Alvarez

Born December 6, 2008 Roland is an 18 month old toddler who is now perfectly happy and healthy (although fairly small for his age). To be around him now, you would never know the rough start he had in life or the struggles that he still has with certain foods. Due to a traumatic delivery, Roland spent some time at birth in the hospital. He wasn’t able to nurse, and was tube-fed pumped breastmilk. Within just a few days, he began showing signs of dairy protein intolerance, including excess fussiness and gassiness just after eating, arching, vomiting, mucus in his stools and diarrhea. His mom eliminated dairy from her diet and that seemed to improve his condition some and he started gaining a little weight. After a couple weeks, Roland was weaned from the tube and sent home. Unfortunately, once at home, his symptoms continued to get worse. He had difficulty gaining weight, vomited after most bottles of expressed breastmilk, had constant mucus in his stools, frequent diarrhea and it was often extremely acidic. He had frequent weight checks with his pediatrician, and was diagnosed with reflux at around 4 or 5 weeks and started on Zantac, which did nothing to improve his symptoms. In the mean time, his mother started researching about milk protein intolerances and discovered that many babies with issues with milk are also soy intolerant so she eliminated all soy from her diet as well.

Roland at 3 months, Pre-Neocate

Unfortunately, the elimination of soy did little for Roland and his overall health continued to decline. He began projectile vomiting after every bottle of pumped breastmilk and the acidic diarrhea became constant and multiple times each day. In desperation, his mother attempted a total elimination diet, eating only a handful of different foods and eliminating all possible allergenic foods. Nothing seemed to work for poor Roland.

Not All Hypoallergenic Formulas are the Same

His mother’s supply of breastmilk began to dwindle, and it became necessary to supplement with formula. His parents first tried a hypoallergenic formula. Roland was just a little over 3 months at that point and weighed less than 8 pounds. After less than a week supplementing with Nutramigen, Roland took a turn for the worse. He began completely refusing to eat other than in his sleep, vomiting everything, losing weight, having horrible, acidic diarrhea up to 10 times per day and had blood in his stools. His mother again researched and discovered that the hypoallergenic formulas do contain dairy proteins even though they are very broken down and learned about elemental formula through Nutricia’s website and through moms with a group called the Reflux Rebels. Roland’s parents took him once again to the pediatrician and during that visit, it was decided to move him completely to an elemental diet. Roland began a Neocate only diet at a little over 3 months along with a PPI to heal the damage from the reflux and vomiting. Within 2 weeks of the Neocate, most of Roland’s lower GI issues resolved. His stools became fairly normal, gassiness and painful stomach cramping began to clear, and chronic diaper rash began to clear. And, he finally began gaining weight. He remained small, but at least began following the growth curve.

Roland at 5 months, Post-Neocate

Food Protein-Induced Entercolitis Syndrome (FPIES)

The elemental formula likely saved his life, as it became clear later that Roland probably suffers from a condition known as FPIES (Food Protein-Induced Entercolitis Syndrome). Usually this syndrome doesn’t really become clear until solids introduction, but unfortunately Roland’s condition was severe enough that he reacted to the proteins in his mother’s milk. Solids introductions for Roland were difficult and he reacted to several other foods including rice and corn. Eventually he was able to handle very broken down dairy proteins and could tolerate first the hypoallergenic formula and eventually a toddler formula that is not quite as broken down. His issues with soy are less severe as well. Fortunately for Roland, FPIES reactions are typically outgrown around age 3, but until he is able to tolerate the whole proteins in dairy, soy, rice, and corn, his parents need to monitor his diet closely to prevent horrible flu-like reactions. After about 6 weeks on the elemental formula and PPI, Roland went from an exceptionally uncomfortable, clingy, miserable infant who never smiled or slept to a completely independent, fun-loving, easy to care for baby. It was literally a night/day transition. His parents were also able to take him off of the reflux medication fairly early as his issues with reflux and vomiting were due to the protein intolerance. Unfortunately for Roland, living the first 4 months of his little life in chronic pain created an oral aversion that has continued well into his second year of his life. Eating is generally a struggle for him and could be for years.

- Lorelei Alvarez

Roland today at 18 months


What does Hypoallergenic Mean?

Posted 3.30.17 | Nutrition Specialist

Most consumers today believe that a product labeled as hypoallergenic will not cause an allergic reaction, but is this really true?

Let’s start with the basics. The technical definition of “hypoallergenic” is that a product is less likely to cause an allergic reaction, or will cause fewer allergic reactions. There are few federal standards that regulate the use of this term for consumer goods. For many products, like cosmetics, the term “hypoallergenic” may be used without ANY evidence or support. Some companies will use certain tests for a product to support that it’s hypoallergenic.

For infant formulas, however, you can rest assured that the term “hypoallergenic” can ONLY be used when certain criteria are met.

What is a Hypoallergenic Infant Formula?

When it comes to infant formulas, based on calls our nutrition specialists receive on a regular basis, many people think the term hypoallergenic means the product is totally void of any and all things that could trigger an allergic reaction. The reality is a bit more complex.

For an infant formula to claim hypoallergenicity it needs to go through study in a clinical trial. The requirements have been based on recommendations by the According to the American Academy of Pediatrics (AAP). According to the AAP, a hypoallergenic infant formula must:

  • Be studied in a clinical trial
  • Be studied in patients with documented cow milk allergy
  • Have been shown to be tolerated by at least 90% of the patients

“Tolerated” means that the formula did not cause an allergic reaction, or that those with cow milk allergy did not have defined symptoms, such as hives, anaphylaxis, or other symptoms of a food allergy.  Only infant formulas made with free amino acids – like Neocate – or extensively hydrolyzed protein, also called peptides, have met the necessary criteria in these studies and can be classified as hypoallergenic. 

Other infant formulas are NOT hypoallergenic. These include formulas made with whole dairy protein, formulas made with soy protein, and formulas made with partially hydrolyzed protein. (Hydrolyzed protein comes from dairy protein, but partially hydrolyzed protein is not broken down as much as extensively hydrolyzed protein.)

Difference Between a Hydrolyzed Formula and Amino Acid-Based Formula

Hydrolyzed formulas are made using protein from dairy, but the milk proteins in those formulas have been broken down into smaller fragments. The body’s immune system may not detect the smaller protein fragments as being an allergen. In some patients with a cow milk allergy, the body still reacts to the protein fragments in extensively hydrolyzed formula, resulting in allergic reactions.

Amino acid-based formulas, which used to be called elemental formulas, use only amino acids as the source of protein. Amino acids are the building blocks of protein, and are too small for the body to recognize as being foreign. They are the least allergenic form of protein.

To help you visualize the difference between these two types of formulas, picture a pearl necklace. In this example our necklace represents the strand of amino acids that make a protein.  If you take the necklace and break it into smaller length strands where several pearls are connected, this would look like the peptides used in partially-hydrolyzed formulas. Even shorter strands of a few pearls will look like the smaller peptides used in an extensively hydrolyzed formula.

If you start with individual pearls, then you have a visual example of an amino acid-based formula. In an amino acid-based formula like Neocate, none of the amino acids are attached to each other. In Neocate, the amino acids are NOT derived from dairy protein. The amino acids in Neocate are synthetic, meaning they’re not derived from meat. Most of them are made from plant sugars, and some are completely synthetic.

Here’s another way to look at infant formulas and their potential for triggering an allergic reaction:

Can a Child React to a Hypoallergenic Infant Formula?

It is possible for a child with food allergies react to formulas made with hydrolyzed protein, or peptides. Amino acid-based formulas, on the other hand, are the least allergenic type of formula, meaning they’re least likely to cause a food allergy reaction.

While two types of infant formulas can claim to be hypoallergenic, based on the information above you can see that the term alone doesn’t guarantee that there will NOT be an allergic reaction. It’s important to look at your child’s individual case and discuss with your healthcare professional the type of hypoallergenic formula – amino acid-based or extensively hydrolyzed - that would best fit your needs.

Here are some additional resources that can be helpful if you are currently evaluating various formula types


Neocate Nutra – The First Hypoallergenic Semi-Solid Medical Food

Posted 6.9.09 | Sarah O'Brien

I’m excited to let everyone know about a new product Neocate just launched called Neocate Nutra – the first hypoallergenic semi-solid medical food for children and infants over 6 months of age. The product is great as a snack for a toddler with cow’s milk allergy and also for transitioning infants onto solid foods.

To learn more about the product check out the product description on the Neocate Web site. Do you think this is a product that will be useful for children with milk allergies? We’d love to hear your thoughts. Let us know by commenting on the blog, or join the discussion on Facebook by visiting Neocate’s Fan Page.

- Sarah


Milk Allergies in the News

Posted 4.29.09 | Nutrition Specialist

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


What is a “Super” Hypoallergenic Formula?

Posted 3.10.09 | Nutrition Specialist

Recently, I’ve received a lot of questions regarding the different types of hypoallergenic formulas that are out there. Often, babies with milk protein allergies will try several formulas before finding one that actually works. Here’s a run-down of formulas for you.

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.

If you think your little one might have a milk protein allergy, but hasn’t been diagnosed yet, make an appointment with your doctor.

Any questions? Let me know!

- Nita


Neocate Junior – Neocate Fan Favorite Election

Posted 10.10.12 | Nutrition Specialist

 Hi everyone, I’m Neocate Junior, candidate for the upcoming Neocate Fan Favorite election!  

I am a hypoallergenic, 100% free amino acid-based, and nutritionally-complete medical food for children age 1-10!  I provide an excellent source of nutrition for kids with food allergies and related gastrointestinal conditions. I can be used as the sole source of nutrition or as a supplement to a limited diet!

Best of all, I come with or without prebiotic fiber and I’m available in 4 different flavor varieties!

Say NO to allergens! Say NO nutritional inadequacy! And say NO to boring flavors! Vote for me, Neocate Junior, for the Neocate Fan Favorite election!

-I’m Neocate Junior and I approved this message


Neocate'es E028 Splash - Neocate Fan Favorite Election

Posted 10.11.12 | Rob McCandlish, RDN


Hi everyone, I’m Neocate’s E028 Splash and it is my honor to run for Neocate Fan Favorite!  

As the very first (and still the only!) ready-to-drink, hypoallergenic elemental formula for toddlers and children, I’ve been committed to keeping severely allergic children well and safe. I am a 100% dairy-free and gluten-free formula. I have decades of experience in helping to successfully manage food allergies (such as cow’s milk allergy) and other food allergy-related GI conditions.  

Aside from these great features, I’m also 100% easy to use – no measuring or mixing required! Children can take me just about anywhere. My kid-friendly packaging and color-coordinated straws helps my 100% specialized nutrition look 100% normal. My broad appeal has been gaining interest among teenagers and adults who need an elemental formula to provide balanced, supplemental nutrition. I am also unique because I come in three delicious flavors: Grape, Tropical Fruit, and Orange-Pineapple!

Therefore, I urge you to vote for me, Neocate’s E028 Splash, in the Neocate Fan Favorite Election!

Thank you!

Neocate’s E028 Splash


Do Hypoallergenic Pet Breeds Exist?

Posted 11.15.12 | Rob McCandlish, RDN

Group of different dog breeds
When it comes to allergies, many Neocate families have to deal with environmental allergies as well as food allergies. Even among folks who don’t have food allergies, environmental allergies are pretty common. In fact, as many as 1 in 5 Americans are allergic to dogs! But have you ever wondered whether any of the breeds of dog that are labeled as “hypoallergenic” really are? Read on to learn more!
 

Pet Allergen

Most of us guess that a hairless pet, such as the comical Chinese crested dog or the Sphynx cat, would be a safe bet for people with allergies. This is because we naturally figure that people who are allergic to pets are reacting to a pet’s hair, but we would be wrong. As with all true allergies, a pet allergy is really a protein allergy. The allergy is actually to the protein in pets’ skin, or dander. Dander is those tiny scales of skin cells that pets shed naturally. So if hairless breeds also shed skin cells, are there really any breeds of pet that are truly hypoallergenic?
 

New Research

A study that was published recently in the Journal of Allergy and Clinical Immunology reviewed a lot of interesting information related to dog breeds. For instance, some people with pet allergies say that certain breeds trigger their allergic symptoms less or more than other breeds. Breeders took to calling these dogs “hypoallergenic,” often claiming that they shed less than other breeds. Of note, where Neocate formulas have to undergo clinical trials to support the hypoallergenic claim, dog breeds do not have to undergo similar research!

The authors begin their article by explaining that very little research has been done to date into hypoallergenic dog breeds, with conflicting results. Even within one breed, some dogs produce much higher amounts of allergens than other dogs. And the main reason the scientists conducted this research was that no evidence for any dog breed being hypoallergenic had ever been reported.

The researchers compared the levels of a major dog allergen in the hair and coat of both normal dog breeds (like Labrador retrievers) and breeds marketed as hypoallergenic, including Labradoodles and Poodles. They also looked at the levels of the allergen in the homes of the same dogs, both in settled dust and floating in the air.
 

The Results

Surprisingly, the researchers actually found the allergen levels were much higher in the hair and coats of the hypoallergenic breeds! Interestingly, they found bigger differences between dogs of the same breed than when they compared one breed to another. When they looked at settled dust, the levels of allergens from Labradoodles were lower than other breeds. However, when they looked at allergen levels in the air, there was no difference between breeds. This is probably the most meaningful result since allergen levels in the air we breathe matter more than levels in the dust on the floor or within dogs’ fur. You can find the full results and complete study here.

The researchers conclude that “No evidence was found for a reduced production of allergen by hypoallergenic dogs.” They also found no evidence of lower allergens in the coats or the home. This supports the position the American Academy of Allergy Asthma & Immunology (AAAAI) has taken that there is no such thing as a 100% hypoallergenic pet breed. AAAAI suggests that some allergic folks may do better with one breed over another, and provides some tips in this helpful fact sheet about pet allergies.
 

Do you or any members of your family have pet allergies that seem better around some pet breeds than others?

- Rob
 

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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.