A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: a multi-centre study.
BACKGROUND
Children allergic to cow's milk are fed a soy- or a hydrolysed cow's milk-based substitute. Neither can rule out a sensitization risk. Previous studies have shown that hydrolysed rice is tolerated by animals and children with multiple food hypersensitivities.


OBJECTIVE
A prospective clinical assessment of tolerance to a rice-based hydrolysed formula was carried out in children allergic to cow's milk. Patients and methods One hundred children (42 girls and 58 boys, mean age 3.17+/-2.93 years, median 2.20, range 0.18-14.6 years) with a history of immediate reactions to cow's milk and confirmed at double-blind, placebo-controlled food challenge (DBPCFC) when not contraindicated were assessed for clinical tolerance to cow's milk proteins. Their allergy work-up included skin prick tests with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG) and total caseins, and specific IgE determinations using CAP technology were performed against whole milk, ALA, BLG and casein. Sensitization to rice and rice-based hydrolysed formula was similarly investigated. Patients' sera were evaluated at immunoblotting for specific IgE to cow's milk proteins, rice and rice-based hydrolysed formula. DBPCFC was carried out with increasing doses of a rice-based hydrolysed formula.


RESULTS
All patients were sensitized to cow's milk and/or at least one cow's milk protein fraction. Eighty-seven out of 99 were positive to cow's milk and/or a cow's milk protein fraction at skin prick test. Positive (>0.35 kUA/L) specific IgE determinations were found for cow's milk and/or milk fractions (92/95), rice (21/91) and hydrolysed rice infant formula (4/91). At immunoblotting, sera from 96 children were positive to alpha-casein (n=54), beta-casein (n=38), ALA (n=57), BLG (n=37) and bovine serum albumin (n=61). Similarly, although patients' sera often contained specific IgE against rice proteins at CAP (21/91) and immunoblotting (70/96), only six very weakly positive responses were observed against rice-based hydrolysed formula. All DBPCFC with rice-based hydrolysed formula were negative.


CONCLUSIONS
Rice-based hydrolysed formula is a possible alternative not only for children with multiple allergies, but also for children with cow's milk allergy.
Fiocchi
A
A
Melloni Paediatria, Milan, Italy. allerg@tin.it
Restani
P
P
Bernardini
R
R
Lucarelli
S
S
Lombardi
G
G
Magazzù
G
G
Marseglia
G L
GL
Pittschieler
K
K
Tripodi
S
S
Troncone
R
R
Ranzini
C
C
D000293:Adolescent; D000818:Animals; D002364:Caseins / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004591:Electrophoresis, Polyacrylamide Gel / Q000379:methods; D005260:Female; D005526:Food, Formulated; D006801:Humans; D006868:Hydrolysis; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000096:biosynthesis; D007223:Infant; D041943:Infant Formula; D008297:Male; D008892:Milk / Q000276:immunology; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000178:diet therapy*; D041941:Milk Substitutes; D012275:Oryza / Q000276:immunology*; D011446:Prospective Studies; D012882:Skin Tests / Q000379:methods
D002364:Caseins; D007073:Immunoglobulin E