Allergy to protein hydrolysates in 30 infants

Aim of the study.- To describe the population sf children allergic to cow's milk protein and their usual substitutes made of protein hydrolysates, and who are efficiently taken care of by using Neocate(R), an amino acid based formula. Patients and methods. - Allergy to protein hydrolysates was diagnosed in 30 infants, aged from 15 d to 13 months (median = 3 months), who remained sym ptomatic while receiving a protein hydrolysate for 15 d to 12 months (media n = 1.8 months). After a complete clinical and Biological evaluation, an am ino acid based diet using Neocate was attempted, followed after one month b y an oral challenge test with the protein hydrolysate. Results. - Symptoms occurred mainly in the digestive tract (25 cases) in th e form of regurgitations (18 cases), diarrhea (17 cases) and colicky pain ( 10 cases); failure to thrive was seen in ten cases. Neocate(R) improved the clinical condition rapidly (within 3-10 d), and allowed the children to ga in weight (27.5 +/- 10.8 g/d). Skirt prick rests with coa's milk hydrolysat es were positive in 13 out of 26 children; total IgE was raised ill cases o f cutaneous symptoms (sir cases), and associated with increased specific Ig E for cow's milk. During the intestinal permeability test, the lactitol/man nitol ratio which initially increased decreased following Neocate(R) (6.58 +/- 2.92% vs. 3.47 +/- 1.58%, P = 00004). Multiple food allergies were pres ent in 22 cases. During challenge with a hydrolysate, the clinical reaction was immediate in 13 cases, partially delayed in 13 cases and delayed in fo ur cases. Conclusion. - Allergy to cow's milk hydrolysates map occur and has to be co nsidered in the presence of anaphylaxis and also chronic digestive symptoms such as regurgitations, diarrhea and colicky pain, when these symptoms per sist during cow's milk free diet. (C) 1999 Elsevier, Paris.