From the Guidelines
Hydrolyzed infant formulas are not recommended for prevention of allergic disease in most cases, but may be considered for babies with cow's milk protein allergy or those at high risk for allergies, according to the most recent guidelines 1. When comparing hydrolyzed formulas, it's essential to consider the type of hydrolysis and the protein source. Extensively hydrolyzed formulas (EHFs) have proteins broken down into smaller peptides, making them less allergenic and easier to digest, while partially hydrolyzed formulas (PHFs) contain larger protein fragments and are suitable for mild digestive issues but not for diagnosed allergies. Some key points to consider when evaluating hydrolyzed formulas include:
- The protein source: EHFs can be made from casein or whey, while PHFs are often made from whey
- The level of hydrolysis: EHFs have a higher level of hydrolysis than PHFs, making them more suitable for babies with severe allergies
- The addition of other ingredients: some hydrolyzed formulas may contain added ingredients like prebiotics or probiotics, which can affect their suitability for certain babies It's crucial to consult with a pediatrician before switching formulas, as they can help determine which type is most appropriate based on the baby's symptoms, medical history, and nutritional requirements 1. Additionally, recent studies have shown that diet diversity during infancy may play a role in preventing food allergies, and that introducing allergenic foods like peanut and egg in the first year of life may help reduce the risk of developing allergies 1. However, the use of hydrolyzed infant formulas as a strategy for preventing food allergies is still a topic of debate, and more research is needed to fully understand their effectiveness 1.
From the Research
Comparing Hydrolyzed Formulas
- Extensively hydrolyzed casein formula (eHCF) and extensively hydrolyzed whey formula (eHWF) are two types of hypoallergenic formulas used to manage cow's milk protein allergy in infants 2.
- A study found that 77% of infants fed eHCF supplemented with Lactobacillus rhamnosus GG were successfully managed at 24 months, compared to 63% of infants fed eHWF 2.
- Another study compared the tolerance and growth of infants with cow's milk protein allergy who were fed a new extensively hydrolyzed formula (eHF) or an amino acid formula (AAF), and found no significant differences in growth measurements between the two groups 3.
- The general treatment for cow's milk protein allergy is dietary, and extensively hydrolyzed whey or casein formula is recommended as first choice for infants with mild or moderate reactions 4.
Efficacy and Safety of Hydrolyzed Formulas
- A systematic review of randomized controlled trials found that extensively hydrolyzed formulas (EHFs) appear to be well-tolerated by most children with cow's milk allergy, but the studies do not allow for any conclusion to be reached regarding the benefit of one formula over another 5.
- A study found that some children with atopic eczema/dermatitis syndrome and cow's milk protein allergy may demonstrate hypersensitivity to hydrolyzed formula, including extensively hydrolyzed casein and whey proteins 6.
- The choice of hydrolyzed formula may depend on the individual child's needs and circumstances, and healthcare professionals should consider the available evidence and individual factors when making recommendations 2, 3, 4, 5, 6.