Amino acid formulas in patients with food allergy

The article presents modern approaches to the use of balanced formulas for nutrition and diet correction in children with various forms of food allergies. The guidelines are based on all available up to date evidence on the efficacy, safety and utility of using such innovative medical technology as specialized amino acid formulas. This formula is the targeted medical intervention for food allergies and confirmed cow's milk protein allergy, and particularly for patients with reduced physical growth and development (growth rates included). The material is based on methodological guidelines on the amino acid formulas usage previously developed by specialist experts of the Union of pediatricians of Russia in 2020.

1. Pishchevaya allergiya: klinicheskie rekomendatsii. Moscow: Soyuz pediatrov Rossii; 2018. 50 p. (In Russ).

2. Koletzko S, Niggemann B, Arato A, 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. doi: 10.1097/MPG.0b013e31825c9482

3. Fiocchi A, Brozek J, Schünemann H, et al. World allergy organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. Pediatr Allergy Immunol. 2010;21(Suppl 21):1–125. doi: 10.1111/j.1399-3038.2010.01068.x

4. Allergiya k belkam korov’ego moloka u detei: klinicheskie rekomendatsii. Moscow: Soyuz pediatrov Rossii; 2016. 52 p. (In Russ).

5. Monaci L, Tregoat V, van Hengel AJ, Anklam E. Milk allergens, their characteristics and their detection in food: A review. Eur Food Res Technol. 2006;223(2):149–179. doi: 10.1007/s00217-005-0178-8

6. Pampura AN, Borovik TE, Zakharova IN, et al. Is the use of goat’s milk justified in infants with cow’s milk protein allergy? Rossiyskiy Vestnik Perinatologii i Pediatrii = Russian Bulletin of perinatology and pediatrics. 2012;57(4–1):138–145. (In Russ).

7. Namazova-Baranova LS. Allergiya u detei: ot teorii k praktike. Moscow: Soyuz pediatrov Rossii; 2011. 668 c. (In Russ).

8. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User’s Guide. Pediatr Allergy Immunol. 2016;27(Suppl 23):1–250. doi: 10.1111/pai.12563

9. Venter C, Brown T, Meyer R, et al. Better recognition, diagnosis and management of non-IgEmediated cow’s milk allergy in infancy: IMAP — An international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. 2017;7:26. doi: 10.1186/s13601-017-0162-y

10. Novik GA, Khaleva EG, Zdanova MV, Bychkova NV. Evaluation of efficacy and safety of longterm feeding with amino acid-based formula in infants with cow’s milk protein allergy: results of the open-label prospective controlled post-registration trial. Vestnik Rossiiskoi akademii meditsinskikh nauk = Annals of the Russian academy of medical sciences. 2016;71(6):446–457. (In Russ). doi: 10.15690/vramn757

11. Høst A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999;81(1):80–84. doi: 10.1136/adc.81.1.80

12. Boissieu D de, Matarazzo P, Dupont C. Allergy extensively hydro-lyzed cow milk proteins in infants: Identification and treatment with an amino acid-based formula. J Pediatr. 1997;131(5):744–747. doi: 10.1016/s0022-3476(97)70104-5

13. Caffarelli C, Plebani A, Poiesi C, et al. Determination of aller-genicity to three cow’s milk hydrolysates and an amino acid-derived formula in children with cow’s milk allergy. Clin Exp Allergy. 2002;32(1):74–79. doi: 10.1046/j.0022-0477.2001.01262.x

14. Isolauri E, Sütas Y, Mäkinen-Kiljunen S, et al. Efficacy and safety of hydrolyzed cow milk and amino acid-derived formulas in infants with cow milk allergy. J Pediatr. 1995;127(4):550–557. doi: 10.1016/s0022-3476(95)70111-7

15. Latcham F, Merino F, Lang A, et al. A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy. J Pediatr. 2003;143(1):39–47. doi: 10.1016/S0022-3476(03)00193-8

16. Vanderhoof J, Moore N, Boissieu D. De Evaluation of an amino acid-based formula in infants not responding to extensively hydrolyzed protein formula. J Pediatr Gastroenterol Nutr. 2016;63(5):531–533. doi: 10.1097/MPG.0000000000001374

17. Błażowski ŁKR. Alergia na białka mleka krowiego – teoria i prak-tyka. Stand Med Pediatr. 2017;14:695–712

18. Lozinsky AC, Meyer R, Anagnostou K, et al. Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents. Children (Basel). 2015;(2):317– 329. doi: 10.3390/children2030317

19. Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI Food Allergy and Anaphylaxis Guidelines: Diagnosis and management of food allergy. Allergy. 2014;69(8):1008–1025. doi: 10.1111/all.12429

20. Vanderhoof JA, Murray ND, Kaufman SS, et al. Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants. J Pediatr. 1997;131(5):741– 744. doi: 10.1016/s0022-3476(97)70103-3

21. Luyt D, Ball H, Makwana N, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy. 2014;44(5):642–672. doi: 10.1111/cea.12302.

22. Lambers TT, Gloerich J, van Hoffen E, et al. Clustering analyses in peptidomics revealed that peptide profiles of infant formulae are descriptive. Food Sci Nutr. 2015;3(1):81–90. doi: 10.1002/fsn3.196

23. Meyer R, Groetch M, Venter C. When Should Infants with Cow’s Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. J Allergy Clin Immunol Pract. 2018;6(2):383–399. doi: 10.1016/j.jaip.2017.09.003

24. Niggemann B, Binder C, Dupont C, et al. Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow’s milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol. 2001;12(2):78–82. doi: 10.1034/j.1399-3038.2001.012002078.x

25. Hill DJ, Murch SH, Rafferty K, et al. The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: A systematic review. Clin Exp Allergy. 2007; 37(6):808–822. doi: 10.1111/j.1365-2222.2007.02724.x

26. Boissieu D de, Dupont C. Time course of allergy to extensively hydrolyzed cow’s milk proteins in infants. J Pediatr. 2000;136(1):119–120. doi: 10.1016/s0022-3476(00)90063-5

27. Boissieu D de, Dupont C. Allergy to extensively hydrolyzed cow’s milk proteins in infants: Safety and duration of amino acid-based formula. J Pediatr. 2002;141(2):271–273. doi: 10.1067/mpd.2002.126299

28. Berry MJ, Adams J, Voutilainen H, et al. Impact of elimination diets on growth and nutritional status in children with multiple food allergies. Pediat Allergy Immunol. 2015;26(2):133–138. doi: 10.1111/pai.12348

29. Meyer R. Nutritional disorders resulting from food allergy in children. Pediatr Allergy Immunol. 2018;29(7):689–704. doi: 10.1111/pai.12960

30. Flammarion S, Santos C, Guimber D, et al. Diet and nutritional status of children with food allergies. Pediatr Allergy Immunol. 2011;22(2):161–165. doi: 10.1111/j.1399-3038.2010.01028.x

31. Mehta H, Groetch M, Wang J. Growth and nutritional concerns in children with food allergy. Cur Opin Allergy Clin Immunol. 2013;13(3):275–279. doi: 10.1097/ACI.0b013e328360949d

32. Meyer R, De Koker C, Dziubak R, et al. Malnutrition in children with food allergies in the UK. J Hum Nutr Diet. 2014;27(3):227–235. doi: 10.1111/jhn.12149

33. Caubet J-C, Szajewska H, Shamir R, Nowak-Węgrzyn A. Non-IgE-mediated gastrointestinal food allergies in children. Pediatr Allergy Immunol. 2017;28(1):6–17. doi: 10.1111/pai.12659

34. Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non-IgE-mediated gastrointestinal food allergy. J Allergy Clin Immunol. 2015;135(5):1114–1124. doi: 10.1016/j.jaci.2015.03.025

35. Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary — Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111–1126.e4. doi: 10.1016/j.jaci.2016.12.966

36. Papadopoulou A, Koletzko S, Heuschkel R, et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr. 2014;58(1):107–118. doi: 10.1097/MPG.0b013e3182a80be1

37. Ridolo E, Melli V, De’Angelis G1, Martignago I. Eosinophilic disorders of the gastro-intestinaltract: an update. Clin Mol Allergy. 2016;14;17. doi: 10.1186/s12948-016-0055-y

38. McLeish CM, MacDonald A, Booth IW. Comparison of an elemental with a hydrolysed whey formula in intolerance to cows’ milk. Arch Dis Child. 1995;73(3):211–215. doi: 10.1136/adc.73.3.211

39. Beck C, Koplin J, Dharmage S, et al. Persistent Food Allergy and Food Allergy Coexistent with Eczema Is Associated with Reduced Growth in the First 4 Years of Life. J Allergy Clin Immunol Pract. 2016;4(2):248–256.e3. doi: 10.1016/j.jaip.2015.08.009

40. Katz Y, Goldberg MR, Rajuan N, et al. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: A large-scale, prospective population-based study. J Allergy Clin Immunol. 2011;127(3):647–653.e1-3. doi: 10.1016/j.jaci.2010.12.1105

41. Caubet JC, Ford LS, Sickles L, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134(2):382–389. doi: 10.1016/j.jaci.2014.04.008

42. Järvinen KM, Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome (FPIES): Current management strategies and review of the literature. J Allergy Clin Immunol Pract. 2013;1(4):317–322. doi: 10.1016/j.jaip.2013.04.004

43. Blanc S, Deboissieu D, Kalach N, et al. Half Cow’s Milk-Induced Food Protein Induced Enterocolitis Syndrome (FPIES) Require Amino Acid Feeding. J Allergy Clin Immunol. 2016;137(2):AB229 doi: 10.1016/j.jaci.2015.12.881

44. Vila Sexto L. Latest insights on food protein–induced enterocolitis syndrome: An emerging medical condition. J Investig Allergol Clin Immunol. 2018; 28(1):13–23. doi: 10.18176/jiaci.0192

45. Macdougall CF, Cant AJ, Colver AF. How dangerous is food allergy in childhood? The incidence of severe and fatal allergic reactions across the UK and Ireland. Arch Dis Child. 2002;86(4):236– 239. doi: 10.1136/adc.86.4.236

46. Sotto D, Tounian P, Baudon JJ, et al. Allergy to cow’s milk protein hydrolysates: apropos of 8 cases. Arch Pediatr. 1999;6(12):1279–1285. doi: 10.1016/s0929-693x(00)88889-2

47. Sova C, Feuling M, Baumler M, et al. Systematic review of nutrient intake and growth in children with multiple IgE-mediated food allergies. Nutr Clin Pract. 2013;28(6):669–675. doi: 10.1177/0884533613505870

48. Vieira MC, Morais MB, Spolidoro JVN, et al. A survey on clinical presentation and nutritional status of infants with suspected cow’ milk allergy. BMC Pediatr. 2010;10:25. doi: 10.1186/1471-2431-10-25

49. Crookston BT, Schott W, Cueto S, et al. Postinfancy growth, schooling, and cognitive achievement: Young lives 1–4. Am J Clin Nutr. 2013;98(6):1555–1563. doi: 10.3945/ajcn.113.067561

50. Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr. 2011;7 Suppl 3(Suppl 3):5–18. doi: 10.1111/j.1740-8709.2011.00349.x

51. Arvola T, Moilanen E, Vuento R, Isolauri E. Weaning to hypoallergenic formula improves gut barrier function in breast-fed infants with atopic eczema. J Pediatr Gastroenterol Nutr. 2004;38(1):92–96. doi: 10.1097/00005176-200401000-00020

52. Borschel MW, Antonson DL, Murray ND, et al. Two single group, prospective, baselinecontrolled feeding studies in infants and children with chronic diarrhea fed a hypoallergenic free amino acid-based formula. BMC Pediatr. 2014;14:136. doi: 10.1186/1471-2431-14-136

53. Borschel MW, Ziegler EE, Wedig RT, Oliver JS. Growth of healthy term infants fed an extensively hydrolyzed casein-based or free amino acid-based infant formula: A randomized, double-blind, controlled trial. Clin Pediatr. 2013;52(10):910–917. doi: 10.1177/0009922813492883

54. Colson D, Kalach N, Soulaines P, et al. The Impact of Dietary Therapy on Clinical and Biologic Parameters of Pediatric Patients with Eosinophilic Esophagitis. J Allergy Clin Immunol Pract. 2014;2(5):587–593. doi: 10.1016/j.jaip.2014.05.012

55. GP Infant Feeding Network (GPIFN) UK and the MAP Guideline team The Milk Allergy in Primary Care (MAP) Guideline; 2019.

56. South East London Guideline for the Management of cows’ milk protein allergy in Primary Care. South East London Area Prescribing Committee; 2021. pp 1–14

57. Kemp AS, Hill DJ, Allen KJ, et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: An Australian consensus panel opinion. Med J Aust. 2008; 188(2):109–112

58. Sicherer SH, Noone SA, Koerner CB, et al. Hypoallergenicity and efficacy of an amino acid-based formula in children with cow’s milk and multiple food hypersensitivities. J Pediatr. 2001;138(5):688– 693. doi: 10.1067/mpd.2001.113007

59.