title: Improved Tolerance to a New Amino Acid-Based Formula by Infants With Cow's Milk Protein Allergy.
abstract: BACKGROUND
  Prevalence and severity of cow's milk protein allergy (CMA) in infants are increasing. A proportion of infants with CMA still elicit signs and symptoms of CMA while ingesting commercial amino acid-based formulas (AAFs). We propose that protein in glucose polymers (GPs) derived from corn starch in the AAFs might be the cause of intolerance to AAF in some infants. We thus have produced small molecules of GPs from rice starch, eliminating the protein fraction from them, and subsequently used them as the sole source of carbohydrate in a new amino acid-based formula (NAAF).
  
  
  METHODS
  The efficacy of the NAAF was compared with that of an AAF in a double-blind, placebo-controlled food challenge (DBPCFC) in young infants with CMA aged <4 months. Infants consumed each formula for 14 days before switching to the other one. If no respiratory, dermatologic, and gastrointestinal symptom occurred, it was considered tolerance. After the challenge, infants consumed the tolerated formula for 4 weeks to prove real tolerance to that formula.
  
  
  RESULTS
  Of 46 infants, 23 were intolerant to the AAF, of whom 7 (30.4%) were also intolerant to the NAAF. Sixteen of the 23 infants who were intolerant to the AAF could tolerate the NAAF ( P < .05). The minimal important difference of decreasing percentage of intolerance to the NAAF was 34.8% compared with the infants who were intolerant to the AAF.
  
  
  CONCLUSIONS
  The NAAF is better tolerated than a commercially available AAF for the management of infants with CMA.
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pipop
authors.initials: P
authors.lastname: Jirapinyo
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Narumon
authors.initials: N
authors.lastname: Densupsoontorn
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Channagan
authors.initials: C
authors.lastname: Kangwanpornsiri
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Renu
authors.initials: R
authors.lastname: Wongarn
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Hathaichanok
authors.initials: H
authors.lastname: Tirapongporn
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Kwanjai
authors.initials: K
authors.lastname: Chotipanang
authors.affiliation: 1 Department of Pediatrics, Center for Management of Infants With Cow's Milk Protein Allergy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Phakkanan
authors.initials: P
authors.lastname: Phuangphan
mesh_terms: D000596:Amino Acids; D000818:Animals; D002417:Cattle; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D016269:Milk Hypersensitivity; D008894:Milk Proteins
chemical_list: D000596:Amino Acids; D008894:Milk Proteins
keywords: allergy; amino acid–based formula; cow’s milk protein allergy; hypersensitivity; infant formula; milk