Hydrolysate or Hydrolyzed Formulas vs. Amino Acid-Based Formulas

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 hydrolyzed, or hydrolysate, formulas (such as Alimentum and Nutramigen), 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 hydrolyzed or hydrolysate formula is and how they differ from amino acid-based formulas, which are sometimes called elemental formulas. The main difference is: hydrolyzed formulas have partial milk proteins in them. Amino acid-based formulas, like Neocate, are milk-free and made up of non-allergenic amino acids, which are the building blocks of protein. That means there is a very slim chance of a child having an allergic reaction to them, as a typical allergic reaction is a reaction to protein.

The reason hydrolyzed formulas can be labeled as hypoallergenic is that the milk proteins in those formulas have been 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 amino acid-based formula comes in. It is sometimes stated that amino acid-based formulas are “super” hypoallergenic, or the least allergenic option. This could be interpreted to mean that amino acid-based formulas are more hypoallergenic than hydrolyzed formulas, although both types of formulas fit the American Academy of Pediatrics’ (AAP) criteria that an infant formula must meet to be labeled hypoallergenic.

In general, studies show that amino acid-based formulas are tolerated by almost all severely food-allergic babies. Although many food allergy babies tolerate hydrolyzed formulas, there is a subset that do not – often having symptoms like severe diarrhea, vomiting, rashes and failure to thrive. If you’re concerned that your little one isn’t tolerating a hydryolyzed formula, talk to your baby’s doctor.

A review of scientific research addressed the intolerance concern with hydrolyzed 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 complex food allergies did not tolerate the hydrolyzed formula ised inthe study2. This is important to know especially if your little one (or someone else’s infant) is still displaying signs of food allergy and is currently using a hydrolyzed formula.

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

Christine Graham-Garo

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.

Published: 01/06/2011
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