Controlled trials investigating the use of one partially hydrolyzed whey formula for dietary prevention of atopic manifestations until 60 months of age: An overview using meta-analytical techniques

doi:10.1016/S0271-5317(98)00120-1

Nutrition Research

Volume 18, Issue 8, August 1998, Pages 1425-1442

https://doi.org/10.1016/S0271-5317(98)00120-1 Get rights and content

Abstract

As much as 30% of the pediatric population is reported to be affected by atopic symptoms, at least temporarily. Therefore, efforts at prevention at an early age are of paramount importance. A meta-analysis was undertaken with the aim of combining the results of 15 prospective, controlled trials which measure the effect of exclusive feeding (minimum of three months) of a moderately hydrolyzed whey formula (Nestlé HA formula) on the development of atopic symptoms between 3–6 and 60 months of age in children at high risk for allergy. Odds ratios, statistical methods of meta-analysis (Mantel-Haenszel, Bayesian approach), and “the number needed to treat” analysis at specific time intervals are reported. The meta-analysis of clinical data at 3–6 months of age indicates that the proportion of infants developing atopic symptoms when fed with HA is about one-fourth of the proportion of those fed with the standard cow milk formula (OR 0.25, 95% CI 0.18–0.36). For the 12 months data, the proportion with HA is about one-third of the proportion in the cow milk formula group (OR 0.29, 95% CI 0.19–0.44). The odds ratios between 12–24 and 60 months of age also showed a significant influence of the HA formula. No significant differences were found when the HA group was compared with breastfed infants. Computation of the “number needed to treat” resulted in an estimate that feeding three to five high risk infants HA formula rather than cow milk formula, will protect one infant from atopic symptoms. Breastfeeding or exclusive feeding of a moderately hydrolyzed formula (Nestlé HA formula) for at least three months in infants at high risk for the development of allergic disease, decreases the incidence of atopic manifestations until 60 months of age.

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L’allergie correspond à l’ensemble des tableaux cliniques résultant d’un mécanisme physiopathologique d’ordre immunologique, développé vis-à-vis d’allergènes alimentaires ou respiratoires. Sa fréquence et sa sévérité augmentent. La modalité de prévention de l’allergie la plus réalisable est la réduction de la charge allergénique qui, pour l’arachide, doit débuter dès la vie intra-utérine. La prévention primaire de l’allergie alimentaire repose d’abord sur la détection des enfants à risque ayant des antécédents familiaux au 1^er degré d’allergie. Pour cette population ciblée comme pour la population générale, l’allaitement maternel exclusif est recommandé jusqu’à l’âge de 6 mois. L’éviction du régime de la mère des trophallergènes majeurs potentiellement transmis par le lait de mère est discutée au cas par cas, sauf pour l’arachide, systématiquement exclue. À défaut d’allaitement maternel ou en cas de biberons de complément, la prévention consiste, chez les enfants à risque, à donner une formule hypoallergénique jusqu’à 6 mois, en choisissant une de celles dont l’efficacité a été démontrée par des études contrôlées. Les formules à base de soja n’ont pas leur place en prévention. La diversification alimentaire ne doit pas débuter avant l’âge de 6 mois. L’introduction de l’œuf et du poisson peut débuter après 6 mois, mais celle des aliments à fort pouvoir allergénique (kiwi, céleri, arachide, fruits à coque, crustacés) doit être retardée après 1 an. Ces précautions ne modifient pas sensiblement la marche allergique ultérieure, en particulier dans ses expressions respiratoires. L’intérêt des probiotiques, prébiotiques et des acides gras polyinsaturés de la série n-3 reste à confirmer.
Allergy consists in the different manifestations resulting from immune reactions triggered by food or respiratory allergens. Both its frequency and severity are increasing. The easiest intervention process for allergy prevention is the reduction of the allergenic load which, for a major allergen such as peanuts, has to begin in utero. The primary prevention strategy relies first on the detection of at risk newborns, i.e. with allergic first degree relatives. In this targeted population, as well as for the general population, exclusive breastfeeding is recommended until the age of 6 months. The elimination from the mother's diet of major food allergens potentially transmitted via breast milk may be indicated on an individual basis, except for peanut, which is systematically retrieved. In the absence of breastfeeding, prevention consists in feeding at-risk newborns until the age of 6 months with a hypoallergenic formula, provided that its efficiency has been demonstrated by well-designed clinical trials. Soy based formulae are not recommended for allergy prevention. Complementary feeding should not be started before the age of 6 months. Introduction of egg and fish into the diet can be made after 6 months but the introduction of potent food allergens (kiwi, celery, crustaceans, seafood, nuts, especially tree nuts and peanuts) should be delayed after 1 year. This preventive policy seems partially efficacious on early manifestations of allergy but does not restrain the allergic march, especially in its respiratory manifestations. Probiotics, prebiotics as well as n-3 fatty polyunsaturated acids have not yet demonstrated any definitive protective effect.
Baby milk in 2005
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Les laits infantiles se distinguent en trois catégories.
(1^er âge) destinées à la période d’alimentation exclusivement lactée, à défaut d’allaitement maternel, c’est-à-dire jusqu’à 4 ou mieux 6 mois. À coté des préparations classiques, dont la teneur en protéines a été diminuée et que l’on peut distinguer entre elles selon la teneur en caséines et protéines solubles et en lactose et la présence éventuelle de pré- ou probiotiques, différents types de préparations sont disponibles selon l’existence d’antécédents atopiques (laits HA), de régurgitations (formules épaissies, laits AR), ou un objectif thérapeutique (hydrolysat poussé, diète semi-élémentaire, laits pauvres en lactose…). L’utilisation de formules à base de soja est rarement recommandée en dehors de cas précis.
(2^e âge), destinés à la période de transition correspondant à l’introduction progressive d’une alimentation diversifiée, au plus tôt après 4 mois et au mieux vers 6 mois.
après 9-12 mois, quand l’alimentation étant quasiment de type adulte.
Bottle-feeding can be achieved with three types of commercially prepared formulas.
intended for satisfying by themselves the nutritional requirements of infants during the first 4-6 months of life, as an alternative to breast-feeding. Several types of formulas are available beside standard cow's milk formula with recently reduced protein level and which vary in their ratio of casein to whey, their lactose content and the possible adding of pre- or probiotics. Hypoallergenic (HA) formula are especially indicated for infants at risk of developing an allergy, according to a family history of atopy. Thickened formulas (AR) are devoted to regurgitating infants whereas others formula such as semi-elemental diet extensively hydrolysed ones or lactose free formulas are for therapeutic use. The use of soy formulas is discouraged and limited to very few cases.
are intended to constitute the milk element in a progressively diversified diet of infants over 4 months and better around 6 months of age.
can be used over 9-12 months when the infant's diet is diversified on the family pattern.
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The therapy of food allergies depends upon an accurate diagnosis, which remains a challenge in non—IgE-mediated cases. Dietary exclusion remains the mainstay of therapy, with medications reserved for exceptional patients. Preliminary evidence suggests that pancreatic enzyme supplementation may be of benefit for cases with multiple food allergies and severe eczema. Hydrolysate formula use is currently recommended for dietary allergy prevention in infants at an increased risk when maternal milk is insufficient or unavailable. The use of partially hydrolyzed formulas to prevent allergic disorders, including atopic dermatitis, is supported by clinical studies, but cannot be used in the already sensitized, milk-allergic child. Probiotics show enormous potential in preventing food allergic disorders as well.
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Citation Excerpt :
Both extensively hydrolyzed formulas (eHF) and partially hydrolyzed formulas (pHF) reduce the incidence of allergy in infants, particularly among those with a family history of atopy. The consensus of opinion and the results of all the studies to date have been summarized by Baumgartner et al [31] and by Exl [45]. We have published the results of our propsective randomized studies in which either an extensive casein hydrolysate [22] or a partial whey hydrolysate [11] was used.
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Controlled trials investigating the use of one partially hydrolyzed whey formula for dietary prevention of atopic manifestations until 60 months of age: An overview using meta-analytical techniques

Abstract

Journal of Pediatrics

The Lancet

Journal of Allergy and Clinical Immunology

The Lancet

Journal of Allergy and Clinical Immunology

Allergy and Clinical Immunology

Controlled Clinical Trials

Nutrition Research

Evidence of an increase in atopic disease and possible causes

Clinical and Experimental Allergy

Changes in asthma prevalence: two surveys 15 years apart

Archives of Diseases of Childhood

In Switzerland pollinois has really increased in the last decade

ACJ News

The effect of genetic and environment factors on the prevalence of allergic disorders at the age of two years

Clinical and Experimental Allergy

Prävälenz atopischer Erkrankungen in Deutschland

Münchner Medizin

Occurrence of acute diarrhea in atopic and nonatopic infants: The role of prolonged breast-feeding

Journal of Pediatric Gastroenterology and Nutrition

Five year follow-up of high risk infants fed partial whey hydrolysate, soy and conventional cow milk formulas

Journal of Ped Gastr and Nutr

The effect of hypo-allergenic formulae in infants at risk of allergic disease

European J. of Clinical Nutrition

The long-term effect of a whey hydrolysate formula on the prophylaxis of atopic disease

European Journal of Pediatrics

Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic disease in high risk infants

Annals of Allergy

Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents: a prospective randomized study of food allergen avoidance

Pediatric Allergy and Immunology

Preventive effect of feeding high-risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula

A prospective, randomized, comparative clinical study

Pediatric Allergy and Immunology

Allergen avoidance in infancy and allergy at 4 years of age

Allergy

Extensively and partially hydrolysed infant formulas for allergy prophylaxis

Archives of Diseases of Childhood

Use of infant formulas in infants with cow's milk allergy

Pediatr Allergy Immunology

Hydrolysed cow's milk formulae

Allergenicity and use in treatment and prevention. An ESPACI position paper

Pediatric Allergy and Immunology

Determination of milk formula allergenicity in the rat model by in-vitro mast cell triggering and in-vivo IgE induction

Int Arch Allergy Appl Immunol

Evaluation of cow's milk formula allergenicity and tolerogenicity by intestinal mast cell protease release in the rat model

J. Allergy Clin Immunology

Induktion einer immunologischen toleranz auf Kuhmilchproteine durch ernährung mit hydrolisiertem lactoserum

Monatsschrift für Kinderheikunde, Supplement

Atopy at 3 years in high-risk infants fed whey hydrolysate or conventional formula

Lancet

Influence of hypoallergenic milk formula on the incidence of early allergic manifestations in infants predisposed to atopic diseases

Annals of Allergy

Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: Three years' follow-up

Acta Paediatrica

A dietary prevention program including whey hydrolyzed formula for high risk atopic babies: 0-24 Months follow-up

Developmental Physiopathology and Clinics

Infant formulas and allergic disease

FDA Contract 223-86-2117

Report of the Scientific Committee for Food and Infant Formulae Claimed to be Hypoallergenic or Hypoantigenic, EU-Reports Food Science and Techniques

Comment on antigen-reduced infant formulae

Acta Paediatrica

Adverse reactions to food

Allergy

Commission Directive of 14 May 1991 on infant formula and follow-on formulae

Official Journal of the European Communities

Meta-analysis: Reconciling the results of independent studies

Statistics in Medicine