casein-hydrolysate and Food-Hypersensitivity

To determine whether feeding infants with hydrolysed formula reduces their risk of allergic or autoimmune disease.. Systematic review and meta-analysis, as part of a series of systematic reviews commissioned by the UK Food Standards Agency to inform guidelines on infant feeding. Two authors selected studies by consensus, independently extracted data, and assessed the quality of included studies using the Cochrane risk of bias tool.. Medline, Embase, Web of Science, CENTRAL, and LILACS searched between January 1946 and April 2015.. Prospective intervention trials of hydrolysed cows' milk formula compared with another hydrolysed formula, human breast milk, or a standard cows' milk formula, which reported on allergic or autoimmune disease or allergic sensitisation.. 37 eligible intervention trials of hydrolysed formula were identified, including over 19,000 participants. There was evidence of conflict of interest and high or unclear risk of bias in most studies of allergic outcomes and evidence of publication bias for studies of eczema and wheeze. Overall there was no consistent evidence that partially or extensively hydrolysed formulas reduce risk of allergic or autoimmune outcomes in infants at high pre-existing risk of these outcomes. Odds ratios for eczema at age 0-4, compared with standard cows' milk formula, were 0.84 (95% confidence interval 0.67 to 1.07; I(2)=30%) for partially hydrolysed formula; 0.55 (0.28 to 1.09; I(2)=74%) for extensively hydrolysed casein based formula; and 1.12 (0.88 to 1.42; I(2)=0%) for extensively hydrolysed whey based formula. There was no evidence to support the health claim approved by the US Food and Drug Administration that a partially hydrolysed formula could reduce the risk of eczema nor the conclusion of the Cochrane review that hydrolysed formula could allergy to cows' milk.. These findings do not support current guidelines that recommend the use of hydrolysed formula to prevent allergic disease in high risk infants.. PROSPERO CRD42013004252.

Topics: Autoimmune Diseases; Caseins; Dietary Proteins; Food Hypersensitivity; Humans; Immune Tolerance; Infant; Infant Formula; Infant Nutritional Physiological Phenomena; Infant, Newborn; Prospective Studies; Risk

Around 2.5% of neonates experience hypersensitivity reactions to cow's milk protein during the first year of life, which is highly associated with early exposure to cow's milk. To prevent early allergy development, cow's milk proteins in infant formulas were modified by hydrolyzation processes for use in children at high atopic risk who need milk supplementation in the first months of life. Dependent on the degree of modification, hydrolyzed cow's milk formulas are differentiated into extensively and partially hydrolyzed whey or casein hydrolysates (pHF, eHF). However, their allergy-preventive potential seems not only to dependent on the degree but also on the process of hydrolysis. pHF and eHF can be used for primary prevention of allergy in infants at high atopic risk, while only eHFs are indicated for secondary prevention in patients with manifest cow's milk allergy. In clinical trials a consistent trend to a reduction in atopy, mainly atopic eczema and food allergy, by certain pHFs and eHFs could be demonstrated in children with a familial risk of atopy until the age of 6 years. Because more than 50% of allergic children do not have a family history of atopy, it would be worthwhile to consider primary allergy prevention with hydrolysates for all children who need supplementation to breastfeeding.

Topics: Animals; Caseins; Child; Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Food Hypersensitivity; Humans; Hypersensitivity; Immune Tolerance; Infant; Infant Formula; Infant, Newborn; Milk Hypersensitivity; Milk Proteins; Models, Animal; Nutrition Policy; Protein Hydrolysates