We believe breast milk is the best food for infants. When in consultation with their healthcare professional, mothers and families find that optimal breastfeeding is not possible due to their infant’s medical condition, formulas for special medical purposes play a vital role in providing essential nutrients to infants. We have a global commitment to market breast-milk substitutes responsibly.
This website is about the management of cow’s milk protein allergy and nutritional solutions intended for infants. By continuing on this website, you accept that Nestlé supplies the information at your own request.
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Our range of nutritional solutions: Althéra®, Alfaré®, and Alfamino®

Nestlé Heath Science has developed a range of nutritional solutions to help meet the needs of infants and children with food allergies and intolerances. Althéra®, Alfaré®, and Alfamino® provide adequate nutrients to support normal infant growth and development.1-4


Nutritional solutions for the management of cow’s milk protein allergy (CMPA)
There are two types of formulas recommended for the management of CMPA: extensively hydrolyzed formulas and amino acid-based formulas There are two types of formulas recommended for the management of CMPA: extensively hydrolyzed formulas and amino acid-based formulas

Following diagnosis, CMPA is managed through the complete removal of cow’s milk proteins (CMPs) from the infant’s diet. CMPA can also occur among exclusively breastfed infants. When a breastfed infant is diagnosed with CMPA, the mother must exclude all CMP from her diet.

 

Mothers should be encouraged to continue breastfeeding, but in case this is not an option, specialty formulas are available for infants and young children with CMPA to reduce or completely remove the allergenic potential. These formulas contain the adequate nutrients to support healthy infant growth and development. There are two different types of formulas for the management of CMPA:

 

Extensively hydrolyzed formulas,* or “eHFs,” in which CMPs have been extensively hydrolyzed into peptides. As a result, they are less allergenic than whole milk formulas and are very well tolerated by most children with cow’s milk or soy protein allergies.

 

Amino acid-based formulas (AAFs) contain free amino acids, which are non-allergenic. They are recommended when a baby does not tolerate an extensively hydrolyzed formula or as first-line management when the baby has extremely severe or life-threatening symptoms (anaphylaxis or immediate type reactions).1

 

*Note: Partially hydrolyzed formulas (pHFs) are also sometimes referred to as hypoallergenic; however, pHFs are not intended for dietary management of diagnosed CMPA.

Our range of tailor-made nutritional solutions

Choosing the right nutritional solution

Mothers should be encouraged to continue breastfeeding, but in case this is not an option, Nestlé Health Science has developed a decision tree to support healthcare professionals in the dietary management of food allergies and intolerances. Following diagnosis, this decision tree will help you to consider the possible options for your patients based on their symptoms and will help you in selecting the right solution at the right time.

Choosing the right nutritional solution for cow’s milk protein allergy
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.
Safety by design
Safety by design is the leading principle in the development of Nestlé Health Science’s product portfolio. Safety is a fundamental consideration for developing all formulas: from the formula design and manufacturing set-up to clinical testing and production. In the development of hypoallergenic formulas for use in infants with CMPA, one of the fundamental processes is the removal of allergenic epitopes so that they no longer cause an immune reaction. Epitope removal is achieved through hydrolysis, after which post-hydrolysis processing, e.g. ultrafiltration, takes place. Studies have demonstrated the safety of Althéra®, Alfaré® and Alfamino® in cases of CMPA, and other GI disorders, in infants and young children.1-4,6,7
Hydrolysis of proteins to reduce allergenicity
Hydrolysis is an important procedure in the breakdown of antigens or allergens that cause allergic reactions. The production of a hypoallergenic formula is based on the destruction of cow’s milk protein epitopes through different technologies (heat treatment and extensive enzymatic hydrolysis). Increasing the degree of hydrolysis of milk proteins results in the removal of the larger peptides, which significantly reduces the allergenicity and increases the safety of the formulas. Althéra® and Alfaré® have the lowest amount of peptides above 1200 Daltons compared with several other competitors.5

Importance of lactose in infants’ diet

Nutrition plays an essential role for healthy development during the first years of life. Lactose is an important component of breast milk, representing up to 40% of the total energy content.8 Lactose is important for supporting calcium absorption and inhibiting putrefactive bacteria in the gut, which promotes the growth of healthy gut microbiota.9 Lactose also has another benefit: it improves the taste of the specialty formulas, facilitating acceptance for infants. Except in rare cases of severe enteropathies, infants with CMPA tolerate and benefit from a lactose-containing formula.
Importance of taste and taste development
Nestlé Health Science not only develops products that are hypoallergenic/non-allergenic and contribute toward improving infant health, but also places a high priority on creating products that are neutral tasting. Easier acceptance owing to pleasant taste and a natural milk aroma most likely contributes to improved compliance in the management of food allergies such as CMPA and other gastrointestinal disorders, especially among infants and young children. Althéra® and Alfaré® have been specifically developed with taste in mind, making the long-term management of CMPA easier.
REFERENCES

  1. Vandenplas Y, et al. Safety and adequacy of an optimized formula for pediatric patients with cow’s milk-sensitive enteropathy. Minerva Pediatr. 2010;62(4)339–45.
  2. Vandenplas Y, et al. Safety and adequacy of a semi-elemental formula for children with gastro-intestinal disease. Amino Acids. 2010;38(3):909–14.
  3. Niggemann B, et al. Safety and efficacy of a new extensively hydrolyzed formula for infants with cow’s milk protein allergy. Pediatr Allergy Immunol. 2008;19(4):348–54.
  4. Nowak-Wegrzyn A, et al. Evaluation of hypoallergenicity of a new, amino acid-based formula. Clin Pediatr (Phila). 2015;54(3) 264–72.
  5. Rapp M, et al. Characterization of an extensively hydrolyzed whey infant formula with a low bitterness. Clin Transl Allergy. 2013; 3(Suppl 3): P132.
  6. Schappi M, et al. Omega 3PUFA enriched semi-elemental diet for protracted diarrhoea (abstract). ESPGHAN. 2006. Abstract PG3-14.
  7. Milla P, et al. A new semi-elemental diet for small intestinal inflammatory disease (abstract). ESPGHAN. 2004. Abstract PO583.
  8. Infant nutrition and feeding. A guide for use in the WIC and CSF programs. March 2009:14.
  9. 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):420–7.


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.