Q: I’ve been breastfeeding, and would like to begin introducing formula to my milk-allergic baby. I’m confused about which type of formula is safe to give her. Can you help?
Dr. Sharma: Your confusion is understandable, since there are so many options.
There are two categories of hypoallergenic formula available: extensively hydrolyzed (Alimentum, Nutramigen) and amino acid-based (Elecare, Neocate, Puramino).
The extensively hydrolyzed type of formula contains milk protein that’s broken down into small segments, which makes the protein less recognizable to the child’s immune system. Amino acid-based products are broken down even more, into the individual amino acids or protein building blocks.
An international group of allergy specialists has made formula recommendations for children with cow’s milk allergy, but it’s important to discuss the decision with your child’s own allergist. This is because 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 of these children.
However, an amino acid-based formula is recommended in certain circumstances. These include infants who continue to experience symptoms on an extensively hydrolyzed type of formula, those children who are avoiding cow’s milk due to eosinophilic esophagitis, and those with cow’s milk allergy who are at a high risk for anaphylaxis.
Soy formula is another type of formula that is tolerated by about 85 percent of babies with IgE-mediated cow’s milk allergy (the form of milk allergy in which they are at risk for anaphylaxis). However, it is not tolerated by up to 60 percent of infants with the 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 options.
That said, if a child is already tolerating soy formula, or if the taste or cost of an extensively hydrolyzed formula precludes its use, soy formula can be appropriate choice.
Be sure to discuss options for which type of formula to use with your child’s allergist to select the best solution for your milk-allergic baby.
Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is 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 e-magazine.
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