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How to Choose the Best Formula for a Child with Food Allergies

Approximately 8% of children have a food allergy with cow’s milk protein allergy being the most common food allergy affecting between 1.9% and 4.9% of children worldwide. (Source: Journal of Allergy and Clinical Immunology, March-April 2018).

Because a food allergy diagnosis requires avoidance of the food allergen, choosing a formula for a child with food allergies can be overwhelming and should be considered with care.  Healthcare providers can offer guidance on the appropriate formula but understanding the characteristics of different formulas can help a parent feel confident in choosing the best formula for allergies.

Most commonly, children with food allergies or cow’s milk allergy will start experiencing symptoms when they are younger than a year old. Symptoms of cow’s milk protein allergy can include atopic dermatitis, diarrhea, vomiting, spitting up or even more severe reactions such as anaphylaxis.

Management of food allergy usually requires a change in the child’s formula in order to avoid their allergens.  For children on breast milk, a formula may be recommended if symptoms are not improved with elimination of the child’s allergen(s) from the breastfeeding mother’s diet. While some children with cow’s milk allergy can have improvement of symptoms with an extensively hydrolyzed formula, others may need an amino acid-based formula.

While the most common formulas for children are cow’s milk-based formulas, these are not appropriate for most children with food allergies.  Understanding the difference between the types of formulas available can make choosing the appropriate formula much easier.  It is important to get the advice of your child’s doctor or a registered dietitian when making changes to a child’s formula or diet.

Formulas Available for Children with Food Allergies

Below is an overview of the types of formulas that are available:

  • Soy-based formulas are made using protein from soy and they do not contain lactose. Because as many as 60% of children with cow’s milk allergy can be allergic to soy as well, soy-based formulas are often not recommended for children with food allergies.
  • Low lactose or lactose-free formulas are sometimes used for children who have increased gas or fussiness with lactose (the carbohydrate in milk). Infants and children with lactose intolerance may show improvements with a low lactose or lactose-free formula, however these formulas still contain milk protein so they are not appropriate for children diagnosed with cow’s milk allergy.
  • Partially hydrolyzed formulas contain proteins that have been partially broken down to make it easier for children to digest. Because a large part of the protein remains intact, these formulas are not suitable for children with cow’s milk allergy.
  • Hypoallergenic formulas can be either extensively hydrolyzed formulas or amino acid-based formulas. These formulas are intended for children with a cow’s milk protein allergy or other food allergies.
    • Extensively hydrolyzed formulas contain proteins that are mostly, but not fully, broken down. They are often recommended when a cow’s milk protein allergy is suspected. However, studies have shown that an average of 10% of children will react to extensively hydrolyzed formulas if they are known to have immediate, IgE-mediated food allergies.
    • Amino acid-based formulas provide a protein source that is completely broken down into the simplest form, amino acids. These formulas, also known as elemental formulas, are used because they are the least likely to cause an allergic response and are the easiest to absorb. This type of formula may help alleviate a wide range of symptoms. These formulas provide your child with amino acids – the building blocks of protein – so that your child has the nutrients needed to thrive without the risk of exposure to allergens or proteins that may cause gastrointestinal irritation or a food allergic reaction.

Choosing an Amino Acid-Based Formula Over an Extensively Hydrolyzed Formula for Hypoallergenic Needs

When a hypoallergenic formula is required, research suggests these possible reasons for choosing an amino acid-based formula over an extensively hydrolyzed formula:

  • Eosinophilic Esophagitis: Eosinophilic Esophagitis (EoE) is a chronic, inflammatory medical condition that affects the esophagus.  Common symptoms include reflux, difficulty swallowing, nausea and vomiting, abdominal or chest pain, poor appetite, feeding refusal, and poor growth.  With EoE, all current recommendations support the use of an amino acid-based formula as a first step. Read more about EoE by checking out this blog post.
  • Failure on an extensively hydrolyzed formula: In some cases, symptoms can persist in children on extensively hydrolyzed formulas. These formulas can be sufficient for symptom resolution in many cases, but some children may still experience allergic symptoms. In a study looking at infants who were switched to amino acid-based formulas due to poor response to extensively hydrolyzed formulas, these infants experienced fewer gastrointestinal complications, atopic dermatitis symptoms, and improved growth rates following a 12-week period in which they were tracked (Source: Journal of Pediatric Gastroenterology and Nutrition, November 2016).
  • Growth Faltering: Children may be diagnosed with failure to thrive if their weight or rate of weight gain is below children who are the same gender and similar age. If poor weight gain and growth is occurring in conjunction with other symptoms of the gastrointestinal tract or skin, as well as multiple food eliminations, amino acid-based formulas should be considered for use.
  • Anaphylaxis: Anaphylaxis is a severe allergic reaction that can potentially be life-threatening. It occurs when the immune system releases chemicals in response to food proteins that can cause severe symptoms in more than one body system. Symptoms can include a red rash or hives, a swollen throat or trouble swallowing, chest tightness, trouble breathing, nausea and vomiting. It is important to treat severe cases of anaphylactic shock immediately, as it can be fatal. While research on the use of amino acid formulas in this population is limited, these formulas are recommended due to the reduced risk of a potential severe allergic reaction with an amino acid-based formula.

In summary, while many children tolerate extensively hydrolyzed formulas, there is sometimes a need to use amino acid formulas. Children with food allergies who may benefit most from amino acid-based formulas are those who lack improvement of symptoms on extensively hydrolyzed formulas, children with eosinophilic esophagitis, those who experience poor growth in conjunction with gastrointestinal symptoms, skin symptoms and multiple food eliminations as well as those at risk for anaphylaxis.  Being informed and having a discussion with your child’s healthcare provider are the most important factors in making a decision about which formula is best for your child.

How Our Formulas Can Help Children with Food Allergies

While milk allergy is often outgrown in early childhood, research suggests that food allergies may be outgrown more slowly than previously suggested.  For this reason, children with food allergies may need a formula to supplement their restricted diet past the age of 1 year.  EquaCare Jr. provides an affordable amino acid-based formula option for those over 1 year of age and Essential Care Jr. is an amino acid-based formula for children over 1 year of age with value-added ingredients, that may support healthy digestion.  Learn more about each of these beneficial products by visiting us online today or calling 1-833-377-2773.