An extensively hydrolysed rice protein-based formula in the management of infants with cow's milk protein allergy: preliminary results after 1 month

Arch Dis Child doi:10.1136/archdischild-2013-304727

• Original article

1. Yvan Vandenplas, 
2. Elisabeth De Greef, 
3. Bruno Hauser, 
4. Paradice Study Group

+Author Affiliations

1. Universitair KinderZiekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium

1. Correspondence toProfessor Yvan Vandenplas, Department of Pediatrics, UZ Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; yvan.vandenplas@uzbrussel.be

• Received 24 June 2013
• Revised 19 March 2014
• Accepted 9 May 2014
• Published Online First 9 June 2014

Abstract

Background Guidelines recommend extensively hydrolysed cow's milk protein formulas (eHF) in the treatment of infants diagnosed with cow's milk protein allergy (CMPA). Extensively hydrolysed rice protein infant formulas (eRHFs) have recently become available, and could offer a valid alternative.

Methods A prospective trial was performed to evaluate the clinical tolerance of a new eRHF in infants with a confirmed CMPA. Patients were followed for 1 month. Clinical tolerance of the eRHF was evaluated with a symptom-based score (SBS) and growth (weight and length) was monitored.

Results Thirty-nine infants (mean age 3.4 months, range 0.5–6 months) diagnosed with CMPA were enrolled. All infants tolerated the eRHF and experienced a normal growth.

Conclusions In accordance with current guidelines, this eRHF is tolerated by more than 90% of children with proven CMPA with a 95% CI, and is an adequate alternative to cow's milk-based eHF.

Trial registration number ClinicalTrials.gov NCT01998074.

What is already known about this topic

• Extensive cow’s milk-based hydrolysed formulas are the first choice in the treatment of cow’s milk protein allergy.
• Extensive hydrolysates are not everywhere available, are expensive, have a poor palatability, and some infants are still allergic to the cow's milk peptides present in the hydrolysate.
• Soy infant formula has been proposed as second option, but the negative perception of the high levels of phytoestrogens present in soy hampers their use. Moreover, 10–15% of the infants allergic to cow’s milk also do not tolerate soy.

What this study adds

• An extensive rice protein-based hydrolysed formula is shown to be effective in the treatment of cow’s milk protein allergy.
• Since rice is much cheaper and has a better palatability than cow’s milk-based extensive hydrolysates, and since it does not contain phytoestrogens, it may become a first option in the treatment of cow’s milk protein allergy if the efficacy and acceptability are confirmed in future studies.

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