The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance

doi:10.1016/S0022-3476(99)70341-0

The Journal of Pediatrics

Volume 135, Issue 1, July 1999, Pages 118-121

https://doi.org/10.1016/S0022-3476(99)70341-0 Get rights and content

Abstract

Infants (n = 18) with intolerance to extensively hydrolyzed formulas and soy who responded to an L-amino acid–based elemental formula (AAF) were studied until 3 years of age. By 2 years of age most tolerated non-formula foods, and by 3 years only 3 required AAF. Growth normalized during AAF feeding in 4 infants with failure to thrive. (J Pediatr 1999;135:118-21)

Section snippets

PATIENTS AND METHODS

Detailed clinical features of the 18 infants in this cohort have been previously described.¹ In summary, there were 11 boys and 7 girls (mean age at presentation, 7.3 ± 0.76 months; SE) who presented with irritability (n = 13), vomiting (n = 13), diarrhea (n = 5), atopic dermatitis (n = 6), and growth failure (n = 4). In 16, symptoms developed while they were receiving only breast milk and persisted during ingestion of extensively hydrolyzed casein formula (n = 18), soy (n = 15), and

RESULTS

In the initial study all 18 patients were ingesting EHCF and were clinically intolerant. These patients had a history of intolerance to cow’s milk formula (n = 17), soy formula (n = 15), and EHWF (n = 13). Adverse symptoms resolved within 2 weeks of commencement of AAF feeding.¹ After a median period of 3.6 months (range, 2 to 7 months), DBPC challenges in 6 infants demonstrated tolerance to soy milk (n = 1), cow’s milk (n = 1), EHCF (n = 2), and EHWF (n = 2). The remaining 12 infants were

DISCUSSION

All infants with MFPI and intolerance to EHCF, EHWF, and soy formula responded to treatment with AAF. Most tolerated low-allergen foods such as grains, vegetables, fruits, and meats in the second year of life. Vanderhoof et al² reported transient intolerance to EHCF, which remitted within 2 weeks of commencing AAF feeding in 8 of 25 patients. We found that 2 of 6 children who were initially intolerant to EHCF became tolerant to it within 3 months of commencing AAF feeding. Subsequently, another

Acknowledgements

The assistance of Dr Clifford Hosking, Ms Gerry Ball, Ms Jenny Brown, and Ms Penny Millar is gratefully acknowledged.

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Citation Excerpt :
Over the past 25 years useful experience of AAF use in infants with allergic diseases, including gastrointestinal manifestations of multiple food protein allergy/intolerance and ineffectiveness of EHFs, has been accumulated in many European countries. The positive effect of AAFs was described in studies of Vanderhoof et al. [29], Hill et al. [30, 31] Estep and Kulczycki [32] and others. Our data as well as the findings of other clinical studies allow us to recommend the inclusion of AAFs into the diet of infants with severe food allergies, including but not limited to AD and allergic gastrointestinal disorders.
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^☆: Supported in part by a research grant from SHS, Liverpool, to the Department of Allergy, Royal Children’s Hospital, Melbourne.

^☆☆: Reprint requests: David Hill, FRACP, Department of Allergy, Royal Children’s Hospital, Flemington Rd, Parkville, Victoria 3052, Australia.

^★: 0022-3476/99/$8.00 + 0 9/22/98950

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The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance☆,☆☆,★

Abstract

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

J Allergy Clin Immunol

J Pediatr

J Pediatr

Am J Clin Nutr

J Pediatr

J Pediatr