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Sunday, September 30, 2007

Managing Dairy Allergy in Infants

Archives of Disease in Childhood has to be one of the saddest names for a medical journal, but at least it publishes invaluable information for doctors.

Their October issue contains a study of major interest to us, "Guidelines for the diagnosis and management of cow’s milk protein allergy in infants," by Yvan Vandenplas, Martin Brueton, Christophe Dupont, David Hill, Erika Isolauri, Sibylle Koletzko, Arnold P Oranje, and Annamaria Staiano. Arch Dis Child 2007; 92: 902-908. doi:10.1136/adc.2006.110999. (Full text available here.

This is the full review mentioned in my earlier post, UK Sets Standards for Allergy Formulas.

That had a fair amount of jargon in it and didn't have a direct link to the review itself. I found a plain English summary by Crystal Phend at that's easier reading.

Allergic infants should be given only extensively hydrolyzed formula or an amino-acid based formula rather than a soy-based product as a first line substitute for cow's milk...


The new guidelines are reasonable but more conservative than American Academy of Pediatrics recommendations, commented Paul V. Williams, M.D., of the Northwest Allergy and Asthma Center in Seattle, who has been involved in developing the new AAP guidelines on the infant feeding, due out soon.

"Economics are always an issue," he said, "and extensively hydrolyzed formulas and amino-acid formulas are extremely expensive."

Both sets of guidelines recommend breastfeeding as the ideal option for these infants, but the Taskforce recommended only documented hypoallergenic formulas for infants who need formula.


Other recommendations in the guidelines include:

● Infants with failure to thrive because of allergic symptoms should be given amino acid based-formula for rapid weight gain.

● Pediatricians should take a comprehensive history with careful physical examination to exclude other causes of the infant's distress, identify concurrent conditions, and determine allergy severity.

● Diagnostic tests may include skin prick, specific IgE blood tests (CAP-RAST), and the atopy patch test, which is not approved for use in the U.S., but the gold standard is elimination diets and challenges.

● Cows' milk challenge under medical observation should be done to establish if the allergy persists through childhood.

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