title: Challenge confirmation of late-onset reactions to extensively hydrolyzed formulas in infants with multiple food protein intolerance.
abstract: BACKGROUND
  Many infants with cow's milk protein intolerance have adverse reactions to soy, casein and whey hydrolysate formula and to other foods. The recent development of Neocate, a hypoallergenic, nutritionally complete infant formula composed of individual amino acids and other nutrients, has enabled these infants to be stabilized.
  
  
  OBJECTIVE
  We observed the effect of food challenges in infants with reported hypersensitivity to hypoallergenic formulas.
  
  
  METHODS
  Eighteen infants (median age, 7 1/2 months) were given Neocate formula for 2 months and then underwent a 7-day double-blind placebo-controlled challenge with the formula previously best tolerated.
  
  
  RESULTS
  In 12 of the 18 infants irritability, vomiting, diarrhea, and/or eczema flares developed during the formula challenge. In two patients symptoms developed immediately, but in the remainder adverse reactions evolved within 7 days (range, 4 to 7 days). Adverse reactions were to soy formula (six patients), whey hydrolysate (two), and casein hydrolysate (four). When infants were 12 months of age, parents reported adverse reactions after the ingestion of other low allergen foods (median, six; from a panel of 10 such foods).
  
  
  CONCLUSIONS
  A group of infants with late-onset adverse reactions to soy, extensively hydrolyzed casein, and whey formulas and to other foods has been identified. Neocate formula proved to be an effective substitute formula for these patients.
authors.affiliation: Department of Allergy, Royal Children's Hospital, Melbourne, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hill
authors.forename: D J
authors.initials: DJ
authors.lastname: Cameron
authors.forename: D E
authors.initials: DE
authors.lastname: Francis
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez-Andaya
authors.forename: C S
authors.initials: CS
authors.lastname: Hosking
mesh_terms: D000596:Amino Acids; D002241:Carbohydrates; D002364:Caseins / Q000276:immunology; D004041:Dietary Fats; D004311:Double-Blind Method; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology*; D005526:Food, Formulated; D006801:Humans; D006868:Hydrolysis; D007223:Infant; D008297:Male; D008894:Milk Proteins / Q000276:immunology; D010919:Placebos; D011492:Protein Hydrolysates / Q000276:immunology; D011506:Proteins / Q000276:immunology*; D013025:Glycine max / Q000276:immunology
chemical_list: D000596:Amino Acids; D002241:Carbohydrates; D002364:Caseins; D004041:Dietary Fats; D008894:Milk Proteins; C076533:Neocate; D010919:Placebos; D011492:Protein Hydrolysates; D011506:Proteins