Cow’s milk allergy (CMA) is a common allergy in early childhood that is frequently misdiagnosed and inadequately treated. In this symposium, held during the 57th Annual Congress of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), a panel of experts described the latest European guidelines for the diagnosis and treatment of CMA (ESPGHAN 2024), including the recommendation to use extensively hydrolysed formula (EHF) at first line in infants with mild-to-moderate CMA who are not breastfed. Factors for clinicians to consider when prescribing a tailored diet for patients in this population were discussed, such as type of protein, degree of hydrolysis, and immune factors. Although hydrolysis breaks down proteins into short peptides that have reduced allergenicity, the residual levels of longer peptides vary considerably between EHFs available for the management of CMA. Initial data were presented from a blinded study that aims to characterise EHFs, including longer peptides and aggregates that may have the potential to cause an IgE-mediated reaction. The results to date indicate considerable compositional variability between products. Further research is needed to support the introduction of standardised methodology for characterising EHF, together with clinically relevant read-outs. Such research will help set standards for EHF manufacturing and provide information that will help clinicians in selecting the most appropriate EHF for infants and young children with CMA.
Nicola Humphry (Wed,) studied this question.