Crying babies, babies with eczema, wheezing, and other ailments due to allergies and autoimmune diseases are understandably anathema to parents. One highly recommended means of dealing with that is to provide formulas in which the cows' milk protein is broken down into smaller units — peptides or amino acids — which supposedly won't incite an allergic reaction. And such formulas have been widely recommended for babies whose family history suggests they might have a propensity for developing allergies. For example, the American Academy of Pediatrics (AAP) has stated:
"In infants who have a high risk of developing allergies (because of family history, for example) and who have not been breastfed exclusively for four to six months, there is some evidence that skin conditions like eczema or atopic dermatitis can be prevented or delayed by feeding them either extensively or partially hydrolyzed (hypoallergenic) formulas."
Advice like this is also the norm in Europe and Australasia.
However, in response to a move by Nestle to add labels touting such advantages for hydrolyzed protein formula, the FDA said the science wasn't sufficient to allow it. Now a study recently published in the British Medical Journal also disputes this advice. Led by Dr. Robert J Boyle, senior lecturer in pediatric allergy at the Imperial College London, UK, the investigators performed a systematic review and meta-analysis of studies on feeding infants with hydrolyzed formulas.
They found 37 well-run trials that compared use of such formulas with standard formulas or breast milk. There was no consistent evidence that use of partially or completely hydrolyzed formulas decreased the risk of babies having allergic or autoimmune reactions. And the babies examined were at higher than usual risk of such outcomes.
In an accompanying editorial, Professor Shyamali Chandrika Dharmage and colleagues from the Allergy and Lung Health Unit of the University of Melbourne, Australia, stated that Boyle's review used rigorous methods, and superseded earlier reviews. In addition, the editorialists pointed out that advice to use these formulas could "undermine efforts to promote breast feeding."
They also noted that "accepting that a particular formula prevents allergy based on poor quality evidence hinders further efforts by formula producers to improve their products." And they encouraged the formula industry to pursue more effective products in this area that might indeed diminish the risk of allergy and autoimmune diseases in babies.
So once again we have a situation in which standard advice is found to be lacking. Hopefully advisory groups such as the AAP will take this study to heart and stop giving parents advice that is first of all ineffective, and second, likely to be more expensive than alternate choices.