Q: I’ve been breastfeeding, and would like to begin introducing formula to my milk-allergic baby. I’m confused about which types are safe to give her. Can you help?
Dr. Sharma: Your confusion is understandable since so many options are available. There are two categories of hypoallergenic cows’s milk-based formulas: extensively hydrolyzed (Alimentum, Nutramigen) and amino acid-based (Elecare, Neocate, Puramino).
The extensively hydrolyzed formulas contain milk protein that’s broken down into small segments, which makes the protein less recognizable by the immune system. Amino acid-based formulas are broken down even more, into the individual amino acids or protein building blocks.
An international group of allergy specialist has made formula recommendations for children with cow’s milk allergy, but it’s important to discuss the decision with your child’s allergist, since the choice may differ based on a child’s allergy presentation or preference, as well as cost of the formula.
For most infants with cow’s milk allergy, extensively hydrolyzed formulas are recommended since they are tolerated by about 90 percent. However, an amino acid-based formula is recommended in certain circumstances, such as infants who continue to have symptoms on extensively hydrolyzed formulas, those who are avoiding cow’s milk due to eosinophilic esophagitis, and infants with cow’s milk allergy at a high risk for anaphylaxis.
While soy formula is tolerated by about 85 percent of infants with IgE-mediated cow’s milk allergy (the form of milk allergy in which they are at risk for anaphylaxis), it is not tolerated by up to 60 percent of infants with non-IgE mediated, or gastrointestinal, form of milk allergy. So the international recommendations advise that soy formula not be given to infants under six months of age with cow’s milk allergy.
Also, in a child at risk for other allergic conditions, soy formula does not appear to offer as much preventive benefit as the hypoallergenic formulas. That said, if a child is already tolerating soy formula, or if the taste or cost of extensively hydrolyzed formula precludes its use, soy formula can be appropriate choice. Be sure to discuss with your child’s allergist to select the best formula for your daughter.
Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He co-authors “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.