Carver JD. Dietary nucleotides: effects on the immune and gastrointestinal systems. Acta Pediatr Suppl 1999;88(430):83-88.

Bode L. Human milk oligosaccharides: Every baby needs a sugar mama. Glycobiology 2012;22(9):1147-1162. IgE mediated –rapid onset allergic reactions and can occur within 15 minutes after consuming cows’ milk or dairy products. Azad MB et al. Human Milk Oligosaccharide Concentrations Are Associated with Multiple Fixed and Modifiable Maternal Characteristics, Environmental Factors, and Feeding Practices J Nutr 2018;148(11):1733-1742. Rapp M, et al. Characterization of an extensively hydrolyzed whey infant formula with a low bitterness. Clin Transl Allergy. 2013; 3(Suppl 3): P132.Petrus, N.C.M., Schoemaker, A.A., van Hoek, M.W. et al. Remaining symptoms in half the children treated for milk allergy. Eur J Pediatr 2015;174(6):759-765. Nowak-Wegrzyn A, et al. Hypoallergenicity of a whey-based, extensively hydrolysed infant formula prepared with nonporcine enzymes. Allergy 2019;74(8):1582-1584. Koletzko S, et al. Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines. JPediatrGastroenterolNutr2012;55(2):221-229.

Extensively hydrolyzed formulas,* or “eHFs,” in which CMPs have been extensively hydrolyzed into peptides. As a result, they are less allergenic than whole milk formulas and are very well tolerated by most children with cow’s milk or soy protein allergies. Nowak-Wegrzyn A, et al. Evaluation of hypoallergenicity of a new, amino acid-based formula. Clin Pediatr (Phila). 2015;54(3) 264–72. Nowak-Wegrzyn A, et al. ConfirmedHypoallergenicityof a Novel Whey-Based ExtensivelyHydrolyzedInfant Formula Containing Two Human Milk Oligosaccharides. Nutrients 2019;11(7):E1447. Host A and Halken S. Cow's milk allergy: where have we come from and where are we going? EndocrMetabImmuneDisordDrug Targets 2014;14(1):2-8. In both cases, the cow’s milk protein triggers the body’s immune system to have an allergic reaction. This can cause symptoms that affect the skin, breathing and/or digestive system of your baby. There are two types of allergic reactions:

Bode L, Human milk oligosaccharides: Every baby needs a sugar mama. Glycobiology, 2012. 22(9): p. 1147-1162. Nutritional information from product datacards: Puramino®, Neocate LCP® and Neocate Syneo®. June 2018.

Schappi M, et al. Omega 3 PUFA enriched semi-elemental diet for protracted diarrhoea. Abstract PG3-14 presented at ESPGHAN, 2006. Puccio G, et al. Effects of Infant FormulaWithHuman Milk Oligosaccharides on Growth and Morbidity: A Randomized Multicenter Trial. JPediatrGastroenterolNutr2017;64(4):624-631. Ayechu-Muruzabal V, et al. Diversity of Human Milk Oligosaccharides and Effects on Early Life Immune Development. Front Pediatr 2018;6:239.

Breast milk is best for baby and provides ideal nutrition. Good maternal nutrition is important for preparation and maintenance of breastfeeding. Introducing partial bottle feeding could negatively affect breastfeeding and reversing a decision not to breastfeed is difficult. Professional advice should be followed on infant feeding. Infant formula should be prepared and used exactly as directed or it could pose a health hazard. The preparation requirements and cost of providing infant formula until 12 months of age should be considered before making a decision to formula feed. ALFARÉ ® and ALFAMINO ® are Infant Formula Products for Special Dietary Use. Products are not suitable for general use. ALFAMINO ® Junior is a food for special medical purposes specifically formulated for children with severe allergy and/or food intolerances. Products must be used under medical supervision. Chauveau, A., et al. Immediate hypersensitivity to extensively hydrolysed formulas: An important reminder. Pediatric Allergy and Immunology, 2016. 27(5): p. 541-543. West CE, et al. The gut microbiota and its role in the development of allergic disease: a wider perspective Clin Exp Allergy 2015;45(1):43–53. Thompson-ChagoyanOC, et al.Faecal Microbiota and Short-Chain Fatty Acid Levels in Faeces from Infants withCow‘s Milk Protein Allergy Int Arch Allergy Immunol 2011;156(3):325–332.

Nutten S, et al. Peptide size profile and residual immunogenic milk protein or peptide content in extensively hydrolysed infant formulas. Allergy, 2019. Mazzocchi A, et al. The Role of Lipids in Human Milk and Infant Formulae. Nutrients 2018;10(5):E567.

Mothers should be encouraged to continue breastfeeding, but in case this is not an option, specialty formulas are available for infants and young children with CMPA to reduce or completely remove the allergenic potential. These formulas contain the adequate nutrients to support healthy infant growth and development. There are two different types of formulas for the management of CMPA: ALFAMINO® is an infant formula product for special dietary use and must be used under medical supervision. It is not suitable for general use. Chin AM, et al. Morphogenesis and maturation of the embryonic and postnatal intestine. Semin Cell Dev Biol 2017;66:81-93. Chin AM, et al. Morphogenesis and maturation of the embryonic and postnatal intestine. Semin Cell Dev Biol2017;66:81-93. Non-IgE mediated - delayed reactions to cows’ milk may take up to several hours to days to appear after consumption of the allergen.