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Dietary management of mild-to-moderate cow's milk allergy

Extensively hydrolysed formulas (eHFs) with proven efficacy are usually the first-choice hypoallergenic formula for at least 90% of formula-fed infants with mild to moderate cow’s milk allergy.1-3 


Dietary management of severe cow's milk allergy

Amino acid-based formulas (AAFs) are reserved for the remaining 10% who have severe cow’s milk allergy for example.  AAFs are also recommended if a child does not settle on an eHF or as a top-up to breast milk.1,4

Short-term objective = avoidance of complete cow’s milk protein to manage symptoms

- eHFs contain cow’s milk proteins (CMPs) broken down into short chains and 'individual' amino acids

This means that eHFs don’t contain whole CMP.  The short chains and amino acids are usually not recognised as harmful and therefore do not trigger allergic reactions in most cases.

- AAFs contain 100% individual amino acids

This means that only amino acids are present, which are not recognised as harmful and therefore very unlikely to trigger allergic reactions.

- In weaned infants, all other food containing CMP should be strictly avoided 
 
Comparison of eHF with AAF
 
 
  Intensively hydrolysed formula (eHF) Amino-acid based formula (AFF) 
Indication Mild to moderate cow’s milk allergy4 Severe cow’s milk allergy, example indication4
- Not settling on eHF
4
- As a top-up formula to breast milk4
Multiple food allergies1
Suitability At least 90% of infants with cow’s milk allergy1 10% of infants with cow’s milk allergy1
Content
- Very short peptides and amino acids not     usually recognised by the immune system
- Less likely to trigger an allergic reaction
- Contains single amino acids
- Unlikely to trigger a reaction, even in
   severely allergic infants
Visual identity





















Longer-term objective = to acquire oral tolerance to cow’s milk3

- Acquired tolerance to cow’s milk means children can drink whole milk and eat dairy food again
  and enjoy the same meals as family and friends

 
- Tolerance also relieves parental anxiety about avoiding dairy products and allows the child to
  participate in social activities without the worry of cow's milk allergy

 
Low dose exposure to cow’s milk protein (CMP) such as that experienced when using an eHF based
  on cow’s milk protein, rather than strict avoidance of CMP and the use of probiotic LGG is thought to
  be key to building oral tolerance5 


 
  1. Vandenplas 2007
  2. DuPont 2012
  3. Koletzko 2012
  4. Venter 2013
  5. Canani 2013
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Introducing new formulas