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The gold standard amino acid formula for infants with cow’s milk allergy

24 Jul 2019
Cow’s milk allergy in the first year of life
Cow’s milk allergy (CMA) is one of the most common forms of childhood food allergy, affecting 2% to 3% of infants in the first year of life.1 Although more prevalent in formula-fed infants, exclusively breast-fed infants can also develop CMA due to exposure to cow’s milk protein via the maternal diet.2,3 In general, up to 80% to 90% of children with CMA develop tolerance by three years of age.2

CMA may be immunoglobulin E (IgE)-mediated with acute onset of symptoms within minutes of ingestion of cow’s milk protein, or non-IgE mediated with delayed onset symptoms between two to 72 hours. Typical clinical presentation of CMA involve different organ systems, including the skin (in 5% to 90% of cases) and gastrointestinal tract (in 32% to 60% of cases); 0.8% to 9% of individuals may present with anaphylaxis; respiratory complaints are also common.4 Confusion between CMA and lactose intolerance is common as the gastrointestinal (GI) symptoms of CMA can mimic symptoms of the latter, which are non-immune reactions to cow’s milk.3

Amino acid-based formula as the first-line treatment for severe presentations of CMA
Dietary interventions are crucial in the management and diagnosis of CMA, with maternal avoidance of cow’s milk for breast-fed infants or choosing an appropriate formula for formula-fed infants. While most children with CMA improve on an extensively hydrolysed formula (eHF), current international guidelines recommend the use of an amino acid-based formula (AAF) as the first-line treatment in children with severe presentations of CMA i.e., anaphylaxis, Heiner syndrome, eosinophilic eosophagitis, and severe GI and/or skin presentations – particularly if accompanied by faltering growth.4,5 Meanwhile, it has also been found that GI symptoms may also dominate and persist in infants with allergic reactions to eHF – a condition commonly associated with CMA – with a prevalence of up to 19% in those with CMA.6,7 Therefore, AAF is recommended for infants who exhibit symptoms of CMA whilst exclusively breast-fed and require a top-up formula, and for formula-fed infants with persistent symptoms, e.g. symptoms that do not resolve within 2–4 weeks on eHF.2,3

A systematic review8 has shown that the use of an AAF in infants with confirmed or suspected CMA and intolerance to eHF to be well tolerated and efficacious. Infants with severe non-IgE mediated CMA were also found to be more likely to demonstrate catch-up growth (increase in relative length and weight) from AAF than from eHF.9-11 In general, symptom resolution was reported within 2–3 days or within 2 weeks.8

Neocate® LCP for fast and effective relief of CMA and GI symptoms
Nutricia’s Neocate® LCP is a hypoallergenic amino acid-based formula with 100% non-allergenic amino acids and containing no residual peptides derived from cow’s milk – designed for infants aged 0–12 months with CMA, multiple food protein intolerances or other food allergy-related conditions.12

Infants fed with Neocate® LCP have been shown to have fast and effective relief of both CMA and GI symptoms within 3 days7 and 14 days.13 In a cohort of 16 infants, 13 were identified with chronic digestive symptoms due to eHF allergy and prescribed Neocate® LCP.7 All infants showed GI symptom relief (e.g., from vomiting and diarrhoea) within three days on Neocate® LCP and significant improvement of eczema compared to baseline (scoring atopic dermatitis, SCORAD: 16 ± 12 vs 35 ± 13, p<0.05).7 Weight gain was also observed in these infants, with a significant increase in body weight index (97.9% ± 5.1% vs 90.2% ± 7.2%, p<0.001) possibly due to improved digestive symptoms.7

In another study, the clinical response to Neocate® LCP was evaluated in 28 infants between 22–173 days of age.13 Despite a prior dietary intervention with casein hydrolysate formula for an average of 40 days, the infants had persistent symptoms of bloody stools, vomiting, diarrhoea, irritability, or failure to gain weight. Upon study enrollment, all 28 infants received Neocate® LCP as the only source of nutrition, and resolution of CMA-related symptoms was reported in 25 of the infants within 14 days. The mean number of stools per day reduced from 0.73 per day to 0.5 per day (p=0.041); crying episodes reduced from 2 hours per day to 1 hour per day (p=0.003); and vomiting episodes from 0.35 per day to 0.21 per day (p=0.028). Weight gain was also reported in all 28 infants, with a mean gain of 30 g/day.

Neocate® LCP contains a balanced 1:1 long chain polyunsaturated fatty acids (LCPs) ratio of 0.35% docosahexaenoic acid (DHA) and 0.35% arachidonic acid (ARA) – a ratio that is seen in breast milk and is recommended by experts.14,15 This ratio has been shown to be important for the physiologic functioning of the immune system, and is beneficial in modulating inflammatory responses.16-18 The anti-inflammatory effect of LCPs may confer benefits for infants with allergies. Furthermore, Neocate® LCP is supplemented with nucleotides which help maintain and enhance the immune function of infants.19

Neocate® LCP supports optimal growth
Growth reduction is often observed in infants with allergy, highlighting the importance of dietary interventions.9 Neocate® LCP has been clinically proven to support infant growth optimally, and is preferred over an eHF particularly in those with CMA and multiple food allergies.9 A prospective study comparing eHF and AAF (Neocate® LCP) demonstrated that the high protein content (13 g/100 g) in the latter prevents growth reduction and helps infants with CMA to achieve optimal growth.9 The relative body weight and length of infants continued to rise after the commencement of Neocate® LCP (Figure 1).

Gold_Fig01
Neocate® LCP is also supplemented with DHA in line with the European Food Safety Authority (EFSA) guidance (i.e., around 0.36% of total fatty acids) to support visual development and improve cognitive function in infants from birth to 12 months.20,21 DHA- and ARA-supplemented infant formulae in the first 17 weeks of life have been associated with improved visual acuity and cognitive outcomes at four years of age.21

Conclusion
Neocate® LCP is the gold standard AAF for infants from birth to 12 months with moderate-to-severe CMA. Its hypoallergenic and nutritionally complete formula is a suitable sole source of nutrition and has been clinically proven to confer fast and effective relief of CMA and GI symptoms, as well as to support optimal growth in infants.
_Neocate-LCP
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Most Read Articles
Prof. Vincent Wong, Prof. Ray Kim, Dr. Tan Poh Seng, 10 Sep 2019
Chronic hepatitis B (CHB) remains a major public health concern because of its worldwide distribution and potential adverse sequelae, including cirrhosis and hepatocellular carcinoma (HCC). At a recent symposium held during the GIHep Singapore 2019, Professor Vincent Wong from the Chinese University of Hong Kong and Professor Ray Kim from the Stanford University School of Medicine, Stanford, California, US, discussed antiviral treatments for CHB, with a focus on the novel agent tenofovir alafenamide (Vemlidy®). Dr Tan Poh Seng from the National University Hospital, Singapore, chaired the symposium.
Pearl Toh, 6 days ago
Adding a LAMA* to the double combination therapy of ICS** plus LABA*** in a single inhaler improves lung function and reduces exacerbations in patients whose asthma is inadequately controlled with the combination treatment, according to the TRIMARAN and TRIGGER# studies presented at ERS 2019.
Elvira Manzano, 09 Oct 2019
Final overall survival (OS) results from the double-blind phase III FLAURA study reinforce osimertinib as the standard frontline treatment for epidermal growth factor receptor-mutated (EGFRm) non–small cell lung cancer (NSCLC), say leading oncologists at ESMO 2019.
10 Oct 2019
Individuals with glaucoma are more likely to experience increased night-time blood pressure (BP) independent of known risk factors such as age, obesity and diabetes as compared with those who do not have the eye disease, a study reports.