Allergy to cow's milk protein hydrolysate formulas: a retrospective study of eight cases.

Background.- The use of extensively hydrolyzed protein formulas is the best alternative for children with cow's milk allergy, though cases of allergie s to hydrolyzed proteins have been reported The aim of this study was to cl arify from our experience the diagnostic, evolutive and therapeutic aspects of allergies to extensively hydrolyzed protein formulas. Patients and methods. - We report eight cases of allergy to extensively hyd rolyzed protein formulas seen between 1985 and 1998. The diagnostic criteri a for allergy were either the appearance of immediate anaphylactic reaction s after the ingestion of protein hydrolysate or a positive challenge test w ith the protein hydrolysate. Results, - Four children developed immediate anaphylactic symptoms after in gesting protein hydrolysate, and four children demonstrated subacute or chr onic gastrointestinal symptoms. All children who developed acute anaphylact ic symptoms had positive skin tests and specific IgE antibodies (RAST) to c ow's milk and/or hydrolyzed proteins. Conversely in the four children with chronic gastrointestinal symptoms, skin tests and specific IgE antibodies w ere negative in three cases, but intestinal histology was abnormal in all o f them when they were fed with a protein hydrolysate; this became normal af ter excluding the hydrolysate (data available ill only two cases). Three ch ildren tolerated another protein hydrolysate form (whey vs. casein), four c hildren had a favourable outcome when fed with human milk, and an aminoacid -based formula was successfully used in the most recent case. Nonhydrolyzed cow's milk proteins were tolerated after the age of 18 months in six child ren. Other atopic symptoms were observed in six children. Conclusion. - Allergy to cow's milk protein hydrolysate is rare. The diagno sis is usually easy in children who develop acute anaphylactic symptoms. th ough intestinal histology is generally necessary for the diagnosis of aller gy with chronic gastrointestinal symptoms. Treatment is based on the use of either another protein hydrolysate form (whey vs. casein) or an aminoacid- based formula. (C) 1999 Editions scientifiques et medicales Elsevier SAS.