Cow's milk allergy (CMA) affects 1.8 to 2% of the pediatric population. Non-breastfed children with CMA must receive a cow's milk substitute of adequate nutritional value up to two years. The current standard of care indicates extensively hydrolyzed cow's milk formulae (eHF) as the best choice in the majority of situations.
A GRADE evaluation on the benefits of the following substitution strategies in infants with CMA:
1. amino acid-based formula (AAF)
3. soy formula (SF)
4. rice hydrolyzed formula (rHF)
generated the DRACMA guidelines on milk substitution. We review here the following literature (2010 – 2018) on rHF.
In the DRACMA guidelines, eHFs are indicated as first-line treatment of CMA in the majority of situations for their nutritional safety. The risk of reactions to eHFs in a minority of CMA patients is extant, as the extensivity of the protein hydrolysis is not an absolute warranty against reactions. Anaphylaxis has been reported even for the more extensively hydrolyzed CMFs. AAFs are reserved to most severe cases due to their costs. SF are considered of 2nd choice for their uncertain nutritional adequacy.
Produced by rice proteins, rHF do not incur in the risk of allergic reactions in CMA. They satisfy the first rule for every allergy treatment - allergen avoidance. Under these circumstances, batch-to-batch differences in the peptide composition will not affect their allergenicity. Several studies witness their nutritional adequacy in infants.
In the DRACMA guidelines, rHFs are considered equivalent to eHFs for their allergologic safety and nutritional value. They are recommended as 1st choice where available. The review of the literature reinforces the wisdom of nutritional adequacy and allergic safety of hRFs.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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