title: Extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow's milk allergy.
abstract: OBJECTIVE
  Cow's milk protein allergy (CMPA) is treated using an elimination diet with an extensive protein hydrolysate. We explored whether a thickened or nonthickened version was best for infants with suspected CMPA, which commonly causes regurgitation/vomiting.
  
  
  METHODS
  Diagnosis of CMPA was based on a positive challenge test. We compared the efficacy of two casein extensive hydrolysates (eCH), a nonthickened version (NT-eCH) and a thickened version (T-eCH), using a symptom-based score covering regurgitation, crying, stool consistency, eczema, urticarial and respiratory symptoms.
  
  
  RESULTS
  A challenge was performed in 52/72 infants with suspected CMPA and was positive in 65.4%. All confirmed CMPA cases tolerated eCH. The symptom-based score decreased significantly in all infants within a month, and the highest reduction was in those with confirmed CMPA. Regurgitation was reduced in all infants (6.4 ± 3.2-2.8 ± 2.9, p < 0.001), but fell more with the T-eCH (-4.2 ± 3.2 regurgitations/day vs. -3.0 ± 4.5, ns), especially in infants with a negative challenge (-3.9 ± 4.0 vs. -1.9 ± 3.4, ns).
  
  
  CONCLUSIONS
  eCH fulfilled the criteria for a hypoallergenic formula, and the NT-eCH and T-eCH formulas both reduced CMPA symptoms. The symptom-based score is useful for evaluating how effective dietary treatments are for CMPA.
authors.affiliation: Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Vandenplas
authors.forename: E
authors.initials: E
authors.lastname: De Greef
mesh_terms: D000818:Animals; D002417:Cattle; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D057045:Laryngopharyngeal Reflux / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D016269:Milk Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy*; D008894:Milk Proteins / Q000009:adverse effects* / Q000276:immunology; D011446:Prospective Studies; D011492:Protein Hydrolysates / Q000627:therapeutic use*; D014839:Vomiting / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control
chemical_list: D008894:Milk Proteins; D011492:Protein Hydrolysates
keywords: (Extensive) hydrolysate; Cow's milk protein allergy; Infant nutrition