Children with CMPA and/or multiple food allergies over 1 year of age are at a higher risk of nutritional deficiencies21 (e.g. calcium, iron, vitamin D, vitamin B12 and Iodine) as well as impaired growth.22 Without professional dietetic support and advice, children with food allergies, including CMPA, have been shown to have significantly lower growth parameters than those without.22-23

Alfamino® Junior HMO is a hypoallergenic amino acid-based formula that is nutritionally tailored for the healthy growth and development of children over 1 year of age, supporting the intake of key nutrients at risk in CMPA:1-2620

Daily recommended intake at 1-3 yrs of age by EFSA20 Met by Alfamino® Junior HMO (300ml/day)6
Calcium (mg) 450 67%
Iron (mg) 7 69%
Vitamin D (µg) 15 38%
Vitamin B12 (µg) 1.5 60%
Iodine (µg) 90 37%

Immune-nurturing benefits

CMPA is an immune-mediated disease. It is associated with gut microbiota dysbiosis, which impacts immune system maturation and leaves infants at an increased risk of infections and future allergies. 24-32

Alfamino® HMO and Alfamino® Junior HMO are the only amino acid-based formulas to contain 2’-fucosyllactose (2’FL) and lacto-N-neotetraose (LNnT), which are structurally identical to two significant human milk oligosaccharides (HMO)). 33

HMO support the growth of beneficial bacteria in the gut

HMO strengthen the gut barrier by promoting intestinal cell maturation

HMO eliminate pathogens through a decoy effect

HMO guide the maturation of the immune system, leading to a more balanced Th1/Th2 response


Infants fed formula with 2’FL and LNnT  had fewer upper and lower respiratory tract infections 6-8

Infants fed formula with 2’FL and LNnT  had lower antibiotic and antipyretic use 6-8



Formula-fed with Alfamino ® HMO and complementary feeding


Persistent allergies to cow`s milk protein and soy


15 months old

Fictional patient profile for illustrative purpose only



The World Health Organization recommends exclusive breastfeeding up to 6 months along with appropriate complementary feeding up to 2 years of age or longer. As such, for infants on an amino acid-based formula, with persistent CMPA and/or multiple food allergies beyond one year of age, continued use of an age-adapted amino acid-based formula, such as Alfamino® Junior HMO, should also be considered to help meet their nutritional needs. 3 ,34 35

Alfamino® Junior HMO is suitable as a sole source of nutrition or as part of a complementary feeding diet from 1 year of age.
Alfamino ® Junior HMO is nutritionally tailored for children with CMPA and/or food allergies aged one year and above. It supports the intake of key vitamins and minerals at risk in CMPA, such as Calcium, Iron, vitamin D, vitamin B12 and Iodine, and is suitable as a sole source of nutrition or as part of a complementary feeding diet.

After infancy, It is becoming increasingly popular to replace speciality formulas, such as amino acid-based formulas, with fortified plant-based milks for the management of CMPA. However, this practice is not supported by most scientific societies as their protein, vitamin and mineral levels are generally not tailored for early childhood and/or those on an elimination diet. Furthermore, they do not offer any immune-nurturing properties to support a developing immune system.
The development of the immune system of those with CMPA is affected by gut microbiota dysbiosis and increased gut permeability. 24-26,33,36
Alfamino ® Junior HMO contains 2’FL and LNnT which have been shown to reduce the risk of infections and associated medication use: 9-11

Mean trial duration: 12 months
Mean trial duration: 8.8 months
Ear infections -46% -71%
Lower respiratory tract infections 55% * -34%
Bronchitis -70% **
Gastrointestinal infections -40%
Frequency of upper respiratory tract infections -42% *
Antibiotic use -53% * 6%
Antipyretic use -56% *** 11%

* p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.05 at 4 months only; ‡ p = N.S.


Our range of immune-nurturing formulas
for cow’s milk protein allergy

The Nestlé Health Science range of nutritional solutions is tailor-made for infants and young children with cow’s milk protein allergy and other food allergies/intolerances. This complete range has been specifically designed to help manage cow’s milk protein allergy earlier, with the right product from the beginning.

Althéra® HMO

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

View product

Alfaré® HMO

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

View product

Alfamino® HMO

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

View product

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


  1. Nowak-Węgrzyn A, et al. Evaluation of Hypoallergenicity of a New, Amino Acid–Based Formula. Clin Pediatr (Phila) 2015;54:264–272. 

  2. 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.  

  3. Cekola P, et al. Clinical use and safety of an amino acid-based infant formula in a real world setting. Abstract presented at NASPGHAN. Chicago, IL, USA, October 2019. 

  4. Koletzko 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. 

  5. Luyt D, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy 2014;44(5):642-672. 

  6. Muraro A, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy 2014;69(8):1008–1025. 

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  8. Donovan SM and Comstock SS. Human Milk Oligosaccharides Influence Neonatal Mucosal and Systemic Immunity. Ann Nutr Metab 2016;69(suppl 2):42-51. 

  9. Nestlé Health Science, data on file. CINNAMON study. 

  10. Vandenplas Y, et al. Growth, tolerance and safety of an extensively hydrolysed formula containing two human milk oligosaccharides in infants with cow’s milk protein allergy. Abstract presented at PAAM. Florence, Italy, October 19, 2019. 

  11. 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. 

  12. Heine RG, et al. Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited. World Allergy Organ J 2017;10(1):41. 

  13. Delplanque B, et al. Lipid Quality in Infant Nutrition: Current Knowledge and Future Opportunities. J Pediatr Gastroenterol Nutr 2015;61(1):8-17. 

  14. Bach AC, et al. Medium-chain triglycerides : an update. Am J Clin Nutr 1982;36(5):950-962. 

  15. Kennedy K, et al. Double-blind, randomized trial of a synthetic triacylglycerol in formula-fed term infants: effects on stool biochemistry, stool characteristics, and bone mineralization. Am J Clin Nutr 1999;70(5):920-927.  

  16. Koletzko B. Human milk lipids. Ann Nutr Metab 2016;69(suppl 2):28-40. 

  17. Mazzocchi A, et al. The Role of Lipids in Human Milk and Infant Formulae. Nutrients 2018;10(5):E567. 

  18. American Academy of Pediatrics, Committee on Nutrition. Pediatrics 1976;57:278-285. 

  19. Nestlé Health Science, data on file. Alfamino® product composition. 

  20. Corkins M, et al. Assessment of Growth of Infants Fed an Amino Acid-Based Formula. Clin Med Insights Pediatr 2016;10:3–9. 

  21. Vandenplas Y, et al. Growth in infants with cow’s milk protein allergy fed an amino acid-based formula. Abstract N-O-013 presented at ESPGHAN, 2019. J Pediatr Gastroenterol Nutr 2019;68(Suppl 1). 

  22. Nestlé Health Science, data on file. Alfamino® versus Neocate® competitive benchmarking test. 

  23. 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. 

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  30. Woicka-Kolejwa K, et al. Food allergy is associated with recurrent respiratory tract infections during childhood. Postepy Dermatol Alergol 2016;33(2):109-113. 

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Mothers should be encouraged to continue breastfeeding even when their infants 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 give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect dilution can all lead to illness. Formula for special medical purposes intended for infants must be used under medical supervision.