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Journal of Vaccines and Immunology

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Review Article PTZAID: JVI-1-105

Immunogenicity of Hydrolysate Formulas in Children (Part 1). Review of 202 Reactions

Arnaldo Cantani*

Cow’s milk (CM) protein hydrolyzed formulas (HFs) appeared in the 40’s with the aim of decreasing or eliminating the allergenicity of CM proteins, and in addition of red¬ucing the risk of sensitization. In recent years the so-called “hypoallergenic” (HA) formulas have been devel¬oped. The use of such HFs is based on the premise that predi¬gested pro¬teins, when fed as amino acids and peptides, provide nutrients in a not antigenic form. Thus, pro¬tein HFs have been classified as HA. These formulas are pro¬ces¬sed by heat and enzymatic hydrolysis, and the conforma¬tional and se¬quential structu¬res are more or less changed. The formulas contain pep¬tides of lower molecular wei¬ght (MW) than the nati¬ve protein source, which are thought to be less immuno¬genic. HFs appear to be nu¬triti¬onally adequate and infants gen¬erally gain weight until they refuse the formu¬labe¬cause of its bad taste. However, caution should be taken when such formulas are given for prolonged peri¬ods since no data is available on nutritio¬nal assessment of in¬fants ex¬clusively fed HFs for several months. In this paper we report and discuss > 202 re¬actions to different HFs, including cases of anaphylactic shock and of apparent life-threatening events. The cross-reactivity betw¬een dif¬ferent HFs and CM proteins,and the potential immunoge¬n¬icity of such for¬mulas are dis¬cussed. We con¬clude that none of the HFs are non-aller¬genic, both for al¬lergic children and for high-risk (HR) babies. Moreover we suggest that double-blind placebo-con¬trolled food challenges (DBPCFC) stud¬ies in larger cohorts of babies valuat¬ed with well-defined and -val¬idateddiag¬nos¬tic methods may establish a more reliable prevalence of HF allergy.

Published on: Aug 7, 2015 Pages: 14-24

Full Text PDF Full Text HTML DOI: 10.17352/jvi.000005