title: Formula selection for management of children with cow's milk allergy influences the rate of acquisition of tolerance: a prospective multicenter study.
abstract: OBJECTIVE
  To prospectively evaluate the effect of different dietary management strategies on the rate of acquisition of tolerance in children with cow's milk allergy (CMA).
  
  
  METHODS
  Otherwise healthy children (aged 1-12 months) diagnosed with CMA were prospectively evaluated. The study population was divided into 5 groups based upon the formula used for management: (1) extensively hydrolyzed casein formula ([EHCF], n = 55); (2) EHCF + Lactobacillus rhamnosus GG [LGG], n = 71); (3) hydrolyzed rice formula (RHF, n = 46); (4) soy formula (n = 55); and (5) amino acid based formula (n = 33). A food challenge was performed after 12 months to assess acquisition of tolerance.
  
  
  RESULTS
  Two hundred sixty children were evaluated (167 male, 64.2%; age 5.92 months, 95% CI 5.48-6.37; body weight 6.66 kg, 95% CI 6.41-6.91; IgE-mediated CMA 111, 42.7%). The rate of children acquiring oral tolerance after 12 months was significantly higher (P < .05) in the groups receiving EHCF (43.6%) or EHCF + LGG (78.9%) compared with the other groups: RHF (32.6%), soy formula (23.6%), and amino acid based formula (18.2%). Binary regression analysis coefficient (B) revealed that the rate of patients acquiring tolerance at the end of the study was influenced by 2 factors: (1) IgE-mediated mechanism (B -2.05, OR 0.12, 95% CI 0.06-0.26; P < .001); and (2) formula choice, such that those receiving either EHCF (B 1.48, OR 4.41, 95% CI 1.44-13.48; P = .009) or EHCF + LGG (B 3.35, OR 28.62, 95% CI 8.72-93.93; P < .001).
  
  
  CONCLUSIONS
  EHCF accelerates tolerance acquisition in children with CMA if compared with other dietetic choices. This effect is augmented by LGG.
authors.affiliation: Department of Pediatrics, University of Naples, Federico II, Naples, Italy. berni@unina.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Berni Canani
authors.forename: Rita
authors.initials: R
authors.lastname: Nocerino
authors.forename: Gianluca
authors.initials: G
authors.lastname: Terrin
authors.forename: Tullio
authors.initials: T
authors.lastname: Frediani
authors.forename: Sandra
authors.initials: S
authors.lastname: Lucarelli
authors.forename: Linda
authors.initials: L
authors.lastname: Cosenza
authors.forename: Annalisa
authors.initials: A
authors.lastname: Passariello
authors.forename: Ludovica
authors.initials: L
authors.lastname: Leone
authors.forename: Viviana
authors.initials: V
authors.lastname: Granata
authors.forename: Margherita
authors.initials: M
authors.lastname: Di Costanzo
authors.forename: Vincenza
authors.initials: V
authors.lastname: Pezzella
authors.forename: Riccardo
authors.initials: R
authors.lastname: Troncone
mesh_terms: D000596:Amino Acids; D002364:Caseins; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry; D052201:Lacticaseibacillus rhamnosus; D016015:Logistic Models; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000178:diet therapy*; D012275:Oryza; D019936:Probiotics; D011446:Prospective Studies; D041942:Soy Milk; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D002364:Caseins
keywords: AAF; APT; Amino acid based formula; Atopy patch testing; B; Binary regression analysis coefficient; CM; CMA; CMP; Cow milk; Cow milk proteins; Cow's milk allergy; DBPCFC; Double-blind placebo-controlled food challenge; EHCF; Extensively hydrolyzed casein formula; Hydrolyzed rice formula; LGG; Lactobacillus rhamnosus GG; RHF; SF; SPT; Skin prick testing; Soy formula