Partially Hydrolyzed Whey Formula for Prevention of Allergic Disease

Expert Commentary

The increased prevalence of childhood allergic diseases over recent decades in western societies, together with the health burden they create, has prompted vigorous efforts to identify strategies to prevent the development of these conditions. The use of various infant formulae has been the key among these prevention strategies, including partially hydrolyzed whey. Despite over 30 years of research on this topic, the use of these formula remains controversial, and the best advice we can provide mothers is to maintain breastfeeding for the first 4–6 months of the child's life.

Table 1. Selected recommendations and statements concerning the role of hydrolyzed formulae for the prevention of allergic disease.
Organization	Recommendation/statement	Ref.
US FDA^† (May 2011)	"For healthy infants who are not exclusively breastfed and who have a family history of allergy, feeding a 100% whey protein partially hydrolyzed infant formula from birth up to 4 months of age instead of a formula containing intact cow's milk proteins may reduce the risk of developing atopic dermatitis throughout the first year of life and up to 3 years of age. FDA has concluded that the relationship between 100% whey protein partially hydrolyzed infant formulas and the reduced risk of atopic dermatitis is uncertain, because there is very little scientific evidence for the relationship."	[102]
AAP (January 2008)	"In studies of infants at high risk of atopy and who are not exclusively breastfed for 4–6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis."	[11]
ASCIA (2010)	"If infant formula is required in the first months of life before solid foods are introduced, there is some evidence that hydrolyzed formulas may reduce the risk of allergic disease in high-risk infants, with a history of allergy in their parents or siblings …. In Australia and New Zealand only partially hydrolyzed formulas (usually labeled 'HA' or Hypoallergenic) are recommended for allergy prevention."	[101]
ESPACI and ESPGHAN	"In bottle fed infants with a documented hereditary atopy risk (affected parent or sibling), the exclusive feeding of a formula with a confirmed reduced allergenicity is recommended because it can reduce the incidence of adverse reactions to food, especially to cows' milk protein. There is no conclusive evidence to support the use of formulas with reduced allergenicity for preventive purposes in healthy infants without a family history of allergic disease."	[77]
Section on Pediatrics, EAACI	"A dietary regimen is effective for prevention of allergy to the avoided food, in high-risk infants, particularly in early infancy regarding food allergy (cow's milk allergy) and eczema (atopic or nonatopic). Evidence that such avoidance affects the later allergic manifestations such as asthma and rhinitis is lacking. The most effective dietary regimen is exclusively breastfeeding for at least 4–6 months or, in case of lack of breast milk, formulas with documented reduced allergenicity for at least 4 months, combined with avoidance of solid food and cow's milk for the same period may be considered."	[12]

Table 1. Selected recommendations and statements concerning the role of hydrolyzed formulae for the prevention of allergic disease.

Organization

Recommendation/statement

Ref.

US FDA^† (May 2011)

"For healthy infants who are not exclusively breastfed and who have a family history of allergy, feeding a 100% whey protein partially hydrolyzed infant formula from birth up to 4 months of age instead of a formula containing intact cow's milk proteins may reduce the risk of developing atopic dermatitis throughout the first year of life and up to 3 years of age. FDA has concluded that the relationship between 100% whey protein partially hydrolyzed infant formulas and the reduced risk of atopic dermatitis is uncertain, because there is very little scientific evidence for the relationship."

[102]

AAP (January 2008)

"In studies of infants at high risk of atopy and who are not exclusively breastfed for 4–6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis."

[11]

ASCIA (2010)

"If infant formula is required in the first months of life before solid foods are introduced, there is some evidence that hydrolyzed formulas may reduce the risk of allergic disease in high-risk infants, with a history of allergy in their parents or siblings …. In Australia and New Zealand only partially hydrolyzed formulas (usually labeled 'HA' or Hypoallergenic) are recommended for allergy prevention."

[101]

ESPACI and ESPGHAN

"In bottle fed infants with a documented hereditary atopy risk (affected parent or sibling), the exclusive feeding of a formula with a confirmed reduced allergenicity is recommended because it can reduce the incidence of adverse reactions to food, especially to cows' milk protein. There is no conclusive evidence to support the use of formulas with reduced allergenicity for preventive purposes in healthy infants without a family history of allergic disease."

[77]

Section on Pediatrics, EAACI

"A dietary regimen is effective for prevention of allergy to the avoided food, in high-risk infants, particularly in early infancy regarding food allergy (cow's milk allergy) and eczema (atopic or nonatopic). Evidence that such avoidance affects the later allergic manifestations such as asthma and rhinitis is lacking. The most effective dietary regimen is exclusively breastfeeding for at least 4–6 months or, in case of lack of breast milk, formulas with documented reduced allergenicity for at least 4 months, combined with avoidance of solid food and cow's milk for the same period may be considered."

[12]