Background:
Normal newborns have a limited immunocompetence therefore they need breast milk (BM), which represent an excellent immune protection for the
neonate during the critical period of intestinal vulnerability, owing to a great variety of functionally interactive immunological, antibacterial, antiviral,
anti-inflammatory and immuno-modulating factors. Evidence suggests that the protection afforded by BM to the recipient infant is greatest when breastfeeding is exclusive and of substantial duration. BM is not always available, but it is not surprising that cow’s milk (CM) can induce a whole spectrum of allergic manifestations, even life-threatening or fatal, especially a minute CM amount, in addition to sensitize genetically atopy-prone infants.
Considerations:
For both pediatricians and allergists the management of infants with CM allergy (CMA) is a challenge. In the first years of life of many children
CM represents the primary source of nutrients with high biological value insuring almost the whole dietary supply of proteins, carbohydrates, and
fat: its high nutritional value and low cost should be noted. Children with CMA older than two years can avoid CM without nutritional loss if the
nutrients necessary to cover daily requirements are provided by other foods. In the first years of life, dietary treatment of CMA is necessary for
evident reasons. Accordingly, the choice of an adequate CM substitute among several hypoallergenic formulas is mandatory for infants with CMA.
Conclusion:
In this paper we will discuss the nutritional adequacy, the immunogenicity and the allergenicity of the available CM substitutes, including
soy-protein, home-made, meat-based, hydrolysate, goat and mare, and amino acid-derived formulas, as well as the challenges posed by both
genetically modified foods (GMFs), and bovine spongiform encephalopathy (BSE). According to recent data, the above formulas can be also
useful for feeding “high risk” babies, when BM is unavailable for the prevention of atopic diseases, and the stopping of the atopic march.
Author(s): Arnaldo Cantani