Advancing cow’s milk protein allergy management

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EVERY BABY MAKES A UNIQUE MARK IN THE WORLD.


JUST LIKE HMO* MAKE OUR FORMULAS UNIQUE.


Our nutritional solutions


Our range of immune-nurturing specialty formulas with 2’-fucosyllactose (2’FL) and lacto-N-neotetraose (LNnT) are tailored to the needs of infants with cow’s milk protein allergy (CMPA) and/or multiple food allergies. Explore our products here.




The Burden of CMPA Symptoms


Symptoms are wide ranging and vary in severity. Many are also seen in healthy babies and are completely normal (e.g. spitting up and loose stools), making CMPA difficult to diagnose. Infants with CMPA typically have more than two symptoms, affecting more than two organ systems, and it may impact growth and development if not diagnosed early or properly managed:1-4


Skin symptoms

(e.g. eczema, urticaria...)

Gastrointestinal symptoms

(e.g. vomiting, diarrhoea...)

Respiratory symptoms

(e.g. wheezing...)

General symptoms

(e.g. failure to thrive, inconsolable crying...)


Disruption to the Immune System


Cow’s milk protein allergy is an immune-mediated disease resulting from an abnormal immune response to cow’s milk proteins. CMPA is also associated with an increased gut permeability and altered gut microbiota composition (dysbiosis), which affects the maturation of infants’ immune systems and increases their risk of developing infections and future allergies:5-12


Recurrent ear infections

during childhood 11,12

Respiratory tract infections in

first two years of life 10

Asthma, eczema, allergic

rhinitis 12


Our Solutions for Effective Symptom Relief


CMPA is managed by eliminating cow’s milk proteins from the diet. When a breastfed infant is diagnosed with CMPA, the mother should be encouraged to continue breastfeeding while excluding cow’s milk from her diet.1,2 If breastfeeding for any reason is not an option, there are specialty hypoallergenic infant formulas available:


Extensively hydrolysed formulas (eHFs) are formulas in which the cow’s milk proteins have been extensively hydrolysed or “broken down” into peptides, so that they are hypoallergenic.1-3 Althéra® HMO and Alfaré® HMO are tolerated by >98% of infants with CMPA.13-15


Amino acid-based formulas (AAFs) contain free amino acids. As it contains no cow’s milk protein, AAFs such as Alfamino® HMO are recommended in infants with severe symptoms of CMPA and/or multiple food allergies.1-3



HMO: Breast Milk’s Immune-Nurturing Components


Human milk oligosaccharides (HMO) are the third most abundant solid component in breast milk.16,17 2’-fucosyllactose (2’FL) and lacto-N-neotetraose (LNnT) are two of the most significant HMO.18



Our Solutions Now Contain 2’FL & LNnT*


Althéra® HMO, Alfaré® HMO and Alfamino® HMO are now supplemented with 2’FL and LNnT, structurally identical to two significant HMO*.18 Our clinical trials have shown that supplementation of infant formulas with 2’FL and LNnT resulted in :19-21


Reduction in upper and lower

respiratory tract infections

Reduction in antibiotic and antipyretic use

Gut microbiota composition closer to that of healthy infants


OUR RANGE OF SOLUTIONS


Althéra® HMO is the first choice for infants and young children with CMPA.



Meet Edward
Exclusively formula-fed
Symptoms: eczema, diarrhoea, inconsolable crying
Diagnosis: Suspected CMPA


Alfaré® HMO is the first choice for GI impaired infants and young children with CMPA and/or food intolerance.



Meet Emma
Exclusively formula-fed
Symptoms: severe diarrhoea indicating enteropathy, eczema, vomiting, inconsolable crying
Diagnosis: Suspected severe CMPA



Alfamino® HMO is the first choice for infants and young children with severe CMPA and/or multiple food allergies.



Meet Harry
Exclusively formula-fed and complementary feeding
Symptoms: unsettled, persistent crying, vomiting,
severe diarrhoea, faltering growth
Diagnosis: Suspected multiple food allergies including CMPA


*Structurally identical Human Milk Oligosaccharides are not sourced from human milk.



REFERENCES

  1. Koletzo S, et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr 2012;55(2):221-229.
  2. Luyt D, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy 2014;44(5):642-672.
  3. Muraro A, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy 2014;69(8):1008–1025.
  4. Host A and Halken S. Cow's milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets 2014;14(1):2-8.
  5. Crittenden RG and Bennett LE. Cow’s Milk Allergy: A Complex Disorder. J Am Coll Nutr 2005;24(6suppl):582S–591S.
  6. Francavilla R, et al. Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy. Pediatr Allergy Immunol 2012;23(5):420-427.
  7. Azad MB, et al. Infant gut microbiota and food sensitization: associations in the first year of life. Clin Exp Allergy 2015;45(3):632-643.
  8. Chin AM, et al. Morphogenesis and maturation of the embryonic and postnatal intestine. Semin Cell Dev Biol 2017;66:81-93.
  9. Tanaka M and Nakayama J. Development of the gut microbiota in infancy and its impact on health in later life. Allergol Int 2017;66(4):515-522.
  10. Woicka-Kolejwa K, et al. Food allergy is associated with recurrent respiratory tract infections during childhood. Postepy Dermatol Alergol 2016;33(2):109-113.
  11. Juntti H, et al. Cow’s Milk Allergy is Associated with Recurrent Otitis Media During Childhood. Acta Otolaryngol 1999;119(8):867-873.
  12. Tikkanen S, et al. Status of children with cow’s milk allergy in infancy by 10 years of Age. Acta Paediatr 2000; 89(10):1174-1180.
  13. Niggemann B, et al. Safety and efficacy of a new extensively hydrolysed formula for infants with cow’s milk protein allergy. Pediatr Allergy Immunol 2008;19(4):348-354.
  14. Nowak-Wegrzyn A, et al. Confirmed Hypoallergenicity of a Novel Whey-Based Extensively Hydrolyzed Infant Formula Containing Two Human Milk Oligosaccharides. Nutrients 2019;11(7):E1447.
  15. Nowak-Wegrzyn A, et al. Hypoallergenicity of a whey-based, extensively hydrolysed infant formula prepared with nonporcine enzymes. Allergy 2019;74(8):1582-1584.
  16. Kunz C, et al. Influence of Gestational Age, Secretor, and Lewis Blood Group Status on the Oligosaccharide Content of Human Milk. Pediatr Gastroenterol Nutr 2017;64(5):789-798.
  17. Bode L. Human milk oligosaccharides: Every baby needs a sugar mama. Glycobiology 2012;22(9):1147–1162.
  18. Azad MB et al. Human Milk Oligosaccharide Concentrations Are Associated with Multiple Fixed and Modifiable Maternal Characteristics, Environmental Factors, and Feeding Practices J Nutr 2018;148(11):1733-1742.
  19. Puccio G, et al. Effects of Infant Formula With Human Milk Oligosaccharides on Growth and Morbidity: A Randomized Multicenter Trial. J Pediatr Gastroenterol Nutr 2017; 64(4):624-631.
  20. Nestlé Health Science, data on file. CINNAMON study.
  21. Vandenplas Y, et al. Growth, tolerance and safety of an extensively hydrolyzed formula containing two human milk oligosaccharides in infants with cow’s milk protein allergy. Abstract presented at PAAM. Florence, Italy, October 19, 2019.

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.