PEDIATRICS Vol. 106 No. 2 August 2000, pp. 346-349
AMERICAN ACADEMY OF PEDIATRICS:
Hypoallergenic Infant Formulas
Committee on Nutrition
The American Academy of Pediatrics is committed to breastfeeding as the ideal source of nutrition for infants. For those infantswho are formula-fed, either as a supplement to breastfeeding orexclusively during their infancy, it is common practice for pediatriciansto change the formula when symptoms of intolerance occur. Decisionsabout when the formula should be changed and which formula shouldbe used vary significantly, however, among pediatric practitioners.This statement clarifies some of these issues as they relate toprotein hypersensitivity (protein allergy), one of the causesof adverse reactions to feeding during infancy.
Symptoms of food protein allergy include those commonly associated with immunoglobulin E (IgE)-associated reactions, such as angioedema, urticaria, wheezing, rhinitis, vomiting, eczema, and anaphylaxis.1 Non-IgE-associated, immunologically mediated conditions have also been associated with the ingestion of cow’s milk, soy, and other dietary proteins in infant feedings. These disorders include pulmonary hemosiderosis,2 malabsorption with villous atrophy,3 eosinophilic proctocolitis,4 enterocolitis,5 and esophagitis.6 Finally, some infants may experience extreme irritability or colic as the only symptom of food protein allergy.7 The prevalence in infancy of milk protein allergy is low 2% to 3%.8-10 Thus, the use of hypoallergenic-labeled infant formulas, which cost as much as 3 times more than standard formulas, should be limited to infants with well-defined clinical indications. Adverse reactions to cow’s milk associated with other conditions suchas phenylketonuria and lactose intolerance may also be alleviatedby the use of alternative formulas, although not necessarily thoseintended to treat infants with protein allergy.
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