Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP131

Invited Speakers

Use of hydrolized rice-based formula in cow's milk allergy

Zakiudin Munasir Department of Pediatrics, Faculty of Medicine Universitas Indonesia Dr CiptoMangunkusumo

Background Cow’s Milk Allergy (CMA) is the most common food allergy in infants and young children and typically develops in the first year of life. It is not always easy to spot the symptoms of CMA as they might be quite common in children. Cow milk allergy is a problem in children because it will affect the growth and can develop into other forms such as asthma and allergic rhinitis. The incidence of cow's milk allergy ranges from 0.5% - 7.5% of infant birth rate in Indonesia per year under the age of 1 year. Cow's milk allergy will decrease with age. The major protein components that cause allergies in cow's milk are whey and casein proteins. The more antigenic is the whey protein. Cow's milk allergy symptoms include gastrointestinal, swelling and itching at the tongue and lips until orofarings, vomiting, diarrhea, bloody stool. Skin symptoms such as urticaria (hives), eczema (atopic dermatitis), in the airways such as cough, wheezing, asthma, rhinitis and the common or systemic symptoms may include shock (shock) anaphylaxis. Cow's milk allergy diagnosis based on history, physical examination and investigations allergy symptoms such as allergy skin tests or pemerksaan specific IgE to cow's milk protein. The gold standard test for cow milk allergy is the elimination test and the provocation. Methods and results Meta-analysis, compared different formula types, and never evaluated the effect of the variation of different batches of the same time. Based on these studies, a GRADE evaluation was done on the benefits of the following substitution strategies in infant with CMA: aminoacid-based formula, extensively hydrolyzed whey or casein formula (EHF), soy formula, rice hydrolyzed formula (rHF). In this meta-analysis, each group was treated as a class and not type by type. The group of eHFs is heterogenous. The DRACMA (Diagnosis and Rationale for Action Against Cow's Milk Allergy) guidelines, based on a GRADE (Grading of Recommendations Assessment, Development, and Evaluation) meta-analysis, include the risk of reactions to eHFs in minority of CMA patients. The different types of EHFs vary for origin of the raw material (casein or the whey fraction), methods of purification of the protein fraction, type of duration of heat treatment, to denature epitopes, type and duration of enzymatic hydrolysis and ultrafiltration. Anaphylaxis has been reported even for thr more extensively hydrolyzed cow's milk formula. The rHF as alternative formula do not incur in this risk. Conclusion In general, smaller fragments is less allergenicity, but the extensivity of the protein hydrolysis is not an absolute warranty against reaction. The rHF, as they made from rice, they satisfy the first rule for every allergy : avoiding the allergen. Under these circumtances, bath-tobatch differences in the peptide composition will not affect the allergy risk.

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