Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow's Milk Allergy in the Middle East, North Africa, and Pakistan Region

Yvan Vandenplas 1, Christophe Dupont 2 3 4, Wajeeh Al-Dekhail 5, Hani A Al Hashmi 6, Ahmed Fouad Khalil 7, Mostafa Abdel-Aziz El-Hodhod 8 9, Khaled Husain 10, Avantika Singh 11

Affiliations

28 September 2021

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doi: 10.3390/nu13103429

Abstract

Cow's milk allergy (CMA) is the most common food allergy in early childhood, and its prevalence continues to rise. Exclusive breastfeeding is recommended for infants in the first 6 months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle East, North Africa, and Pakistan (MENAP) region. If the infant is affected by CMA, current guidelines recommend extensively hydrolyzed formulas (eHFs) or amino acid-based formulas (AAFs) in the case of severe symptoms, and hydrolyzed rice formulas (HRFs) where available. In recent years, HRFs have been proposed as a plant-based alternative to cow's milk protein-based eHFs, and updates to current guidelines have been recommended. In 2014, a consensus statement and guidelines were published for the Middle East region on the prevention, diagnosis, and management of CMA. As new advances have been made in the extensively hydrolyzed hypoallergenic infant formula space, along with updated scientific evidence, a workshop of experts from the MENAP region focused on HRF was convened in 2021. This publication summarizes the insights from this meeting. During the consensus part of the meeting, a new approach was discussed and approved by all participants, and agreement was reached that HRF can be recommended as a first-line alternative to cow's milk-based eHF in the dietary management of CMA.

Keywords: Middle East; cow’s milk allergy; hydrolyzed protein; infant allergy; infant feeding; rice.

Conflict of interest statement

Yvan Vandenplas has participated as a clinical investigator and/or advisory board member and/or consultant and/or speaker for Abbott Nutrition, BioGaia, By Heart, CHR Hansen, Danone, ELSE Nutrition, Friesland Campina, Mead Johnson Nutrition, Nestle Health Science, Nestle Nutrition Institute, Nutricia, Phathom Pharmaceuticals, United Pharmaceuticals (Novalac) and Wyeth. Christophe Dupont has participated as a clinical investigator and/or advisory board member and/or consultant and/or speaker for Abbott Nutrition, Danone, Nestle Health Science, Nutricia, United Pharmaceuticals (Novalac) and Wyeth, and is shareholder—Table cofounder of DBV Technologies. Mostafa Abdel-Aziz El-Hodhod has participated as a speaker for Abbott Nutrition, Danone, Danone Nutricia, Hero, and Nestle Nutrition Institute. None of the other authors have a conflict of interest. All authors received honoraria for a MENAP experts’ meeting roundtable, held on 9 April 2021.

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