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The 1st step

Breast feeding is always best for babies but when you suspect a bottle fed or combination fed child has mild to moderate cows’ milk allergy (CMA), what should the first step be in managing the allergy?

The iMAP guidelines1 recommend that an extensively hydrolysed formula (EHF) be trialled to initiate a strict cows’ milk protein free diet and the diagnosis confirmed by a home reintroduction of cows’ milk protein 2-4 weeks later.

Aptamil Pepti is an EHF that has been formulated to support the effective dietary management of CMA and is proven to relieve CMA symptoms2. In an independent taste panel of 100 dietitians and GPs, Aptamil Pepti was ranked the first EHF in the UK for palatability3* and is the first and only EHF to contain GOS/FOS prebiotic oligosaccharides which have been shown to reduce the risk of developing allergic manifestations for up to five years4-6.

Palatability is key to managing cows’ milk allergy in infants, and it is reassuring for parents and healthcare professionals (HCPs) to know that Aptamil Pepti is considered the UK’s most palatable EHF3*. This was confirmed in a recent independent taste panel of 100 dietitians and GPs which found Aptamil Pepti was the most liked EHF on the UK market3.

Factors contributing to Aptamil Pepti being the most palatable EHF include it being a whey-based, lactose-containing formula. It is widely accepted that the palatability of whey-based EHF is superior to casein-based EHF7 and studies have also shown that formulas containing lactose are more palatable than lactose-free formulas8.

Lactose is the primary carbohydrate in breastmilk. It provides benefits for the gut microbiota9, and helps to stimulate the absorption and retention of calcium, which is key for bone mineralisation10. Diets without lactose may have disadvantages for the composition of the infant’s colonic microflora11.

In a recent publication by Meyer et al. (2016) it was concluded that “lactose intolerance is not common in non-IgE mediated cows’ milk protein allergy and that hypoallergic formulas containing lactose, in the absence of breast milk, should be considered, especially as lactose has other benefits”12.

Aptamil Pepti is the first and only EHF to contain GOS/FOS prebiotic oligosaccharides. Our unique prebiotic GOS/FOS blend has a clinically proven long-lasting effect in reducing the risk of developing allergic manifestations and severity of symptoms up to 5 years, after six months of use4-6.

Formulas containing GOS/FOS also create intestinal microflora closer to that of a breastfed baby14, and support the reduction of potential pathogens in the gut after six weeks15. Aptamil Pepti also significantly reduces the use of anti-inflammatory medication like glucocorticosteroids, zinc-containing agents and antihistamines4.

Aptamil Pepti is for the dietary management of cows’ milk allergy symptoms with 97% efficacy13, offering fast-acting symptom relief in 2–4 weeks4. It also significantly reduces the need for additional anti-inflammatory medication like glucocorticosteroids, zinc-containing agents and antihistamines4. ESPGHAN guidelines recommend that infants with cows’ milk allergy should be managed with a hypoallergenic formula which is as close as possible to a standard infant formula composition11. That’s why Aptamil Pepti:

• Is the first and only EHF to contain GOS/FOS prebiotic oligosaccharides

• Contains lactose (also the primary carbohydrate in breastmilk)

• Contains adequate levels of calcium

• Is the only EHF to contain nucleotides

†For the management of mild to moderate cows’ milk allergy, the iMAP guideline1recommends an Extensively Hydrolysed Formula (EHF) as the first step for formula feeding or mixed feeding (if symptoms only with introduction of top-up feeds) infants.

‡Galacto-oligosaccharides and fructo-oligosaccharides.

1. Venter C et al. Better recognition, diagnosis and management of non-IgE-mediated cows’ milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. 2017;7:26.

2. Verwimp JJ et al. Symptomatology and growth in infants with cow’s milk protein intolerance using two different whey-protein hydrolysate based formulas in a Primary Health Care setting. Eur J Clin Nutr. 1995;49(Suppl 1):S39-48.

3. Campden BRI conducted a blind taste test using a home usage design with 100 Dieticians and General Practitioners. The results from ranking ordering showed that Danone Aptamil Pepti was liked significantly more than all the other three samples tested.

4. Pampura AN et al. A highly hydrolyzed formula based on whey protein with the effectively abolishes the symptoms of atopic dermatitis: Results of a multicenter open-label trial in Russia. Ros Vestn Perinatol Paediat 2014;4:96-104.

5. Arslanoglu S et al. Early neutral prebiotic oligosaccharide supplementation reduces the incidence of some allergic manifestations in the first 5 years of life, J Biol Regul Homeost Agents. 2012;26:49-59.

6. Arslanoglu S et al. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutri. 2008;138:1091-5.

7. Venter C. Cows milk protein allergy and other food hypersensitivities in infants. (Online) 2010. Available at https://www.jfhc.co.uk/cows-milk-protein-allergy-and-other-food-hypersensitivities-in-infants. (Accessed March 2017).

8. Miraglia Del Giudice M et al. Flavour, relative palatability and components of cows’ milk hydrolysed formulas and amino acid based formulas, Ital J Pediatr. 2015;41:42.

9. Francavilla R et al. Effect of lactose on gut microbiota and metabolome of infants with cows’ milk allergy. Pediatr Allergy Immunol 2012:23(5);420-427.

10. Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118(3):1279–1286.

11. Host A et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrtion. Arch Dis Child. 1999;81(1):80-4.

12. Meyer et al. The prevalence of lactose intolerance in children with non-IgE-mediated gastrointestinal cow’s milk allergy. British Journal of General Practice Website. Available from: http://bjgp.org/content/prevalence-lactose-intolerance-children-non-ige-mediated-gastrointestinal-cow%E2%80%99s-milk-protein. Published: 20 October 2016. Accessed: July 2017.

13. Giampietro PG et al. Hypoallergenicity of an extensively hydrolyzed whey formula. Pediatr Allergy Immunol. 2001;12:83-86.

14. Moro G et al. Dosage-related bifodogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr. 2002;34(3):291–295.

15. Knol J et al. An infant formula containing prebiotics changes the intestinal microflora of term infants. J Pediatr Gastroenterol Nutr. 2003;3:566.

* A home usage test assessment was carried out between 16/11/16 and 9/12/16 on the 4 products indicated for cows’ milk allergy from birth and included 100 UK healthcare professionals.

** BSACI Milk Allergy guidelines and the Milk Allergy in Primary Care guidelines.