Table 1.
Systematic reviews of Infant formulas and the risk of food allergy or food sensitization.
| First author (year) AMSTAR quality Meta-analysis (MA)+ or − |
Designs of the studies included in each review and search dates | Intervention/s/comparisons | Population/s studied | Outcome/s measured | Main Results | Authors’ Conclusion/s |
|---|---|---|---|---|---|---|
|
Szajewska (2010) [74] Quality: High (9) MA− |
1 RCT 1985–2010 |
Partially hydrolysed 100% whey formula (pHF) vs. Standard infant formula (StF) |
High Allergy risk Infants with at least 2 first degree relatives with allergy whose mothers decided not to breastfeed |
Food Allergy (FA) at 6 months. Food Allergy—not defined in SR. Source papers—symptoms suggestive of cow’s milk allergy such as diarrhoea and colic. |
RR 0.36, 95% CI (0.15, 0.89) (1 study (n = 67) | Results indicate that pHF is effective in prevention of symptoms of possible CMA compared to StF ☺ |
|
Osborn (2006) [70] update (2009) * Quality: High (11) MA− |
1 RCT Search 1980–2006 Included only trials with greater than 80% follow up |
Soy Formula vs. Cow’s milk formula |
High Allergy risk Children with biparental history of allergic disease |
Food Allergy Not defined in SR. Source papers—Not clear—GI symptoms and IgE characterized as Obvious, Probable or possible atopic disease Cow’s Milk protein intolerance (CMPI) Soy protein allergy (SPA) Cow’s milk allergy (CMA) |
CMPI RR = 1.09 (0.45, 2.62) SPA RR = 3.26 (0.36, 29.17) CMA RR 1.09 (0.45, 4.86) All results from 1 study (n = 50) |
Feeding with soy formula cannot be recommended for primary prevention for infants at high risk of allergy or food intolerance 😐 |
|
Osborn (2006) * [71] Quality: High (11) MA− |
5 RCTs Updated search March 2009 Included only trials with greater than 80% follow up |
Hydrolysed infant formula vs. human milk or cow’s milk formula AND Partially hydrolysed vs. extensively hydrolysed cow’s milk |
High Allergy Risk (3 studies) 2 studies biparental atopy or uniparental atopy with raised cord IgE 1 study at least 1 first degree relative Population based (2 studies) Updated search March 2009 |
Food Allergy/CMA1 study unknown 2 studies unblinded food elimination/challenge 2 studies used symptoms with specific IgE |
1. Short term studies (2): 1.1 Hydrolysed vs. human milk CMA RR 7.11, 0.35, 143.84 (n = 90) RR 0.87, 0.52, 1.46 (n = 3,559) Food Allergy RR 1.43, 0.38, 5.37 (n = 90) 1.2 Hydrolysed vs. cow’s milk CMA RR 5.13, 0.25, 103.43 (n = 90) RR 0.62, 0.38, 1.00 (n = 3,559) Food Allergy RR 1.37, 0.33, 5.71 (n = 90) 2. Long-term studies (3) 2.1 Hydrolysed vs. cows CMA RR 0.36, 0.15, 0.89 (n = 67) Food Allergy RR 1.82, 0.64, 5.16(n = 141) 2.2 Extensive vs. partial hydrolysed CMA RR 0.13, 0.01, 1.16 (n = 246) Food Allergy RR 0.43, 0.19, 0.99 (n = 341) |
No evidence to support feeding with hydrolysed formula for prevention of allergy compared to breastfeeding. 😐 In high-risk infants unable to be breast fed limited evidence of allergy and CMA reduction. ☺ Need further trials |
|
Hays (2005) [72] Quality: Low (2) MA− |
RCTs 22 studies |
Comparison of hydrolysed formulas with: breastfeeding, cow’s milk formula, soy formula or combinations |
High Allergy Risk (22) Population based (1) |
Atopy Not defined in SR. Source papers—seems largely based on objective measure in the presence of GI symptoms—open food challenge, DBPCFC, SPT IgE |
High-risk infants demonstrate significant reductions in the cumulative incidence of atopic disease through the first 1 to 5 years of life compared with feeding CMF. (no pooled results) |
Formulas seem effective but better measures food allergy needed to confirm ☺ |
|
Schoetzau (2001) [73] Quality: Medium (5) MA− |
RCTs Prospective Cohorts 3 studies up to 2001 ‡ |
Comparison of hydrolysed formulas vs. cow’s milk formula |
High Allergy Risk |
Food allergy: based on strict, well-defined food elimination and challenge procedures including double-blind placebo controlled food challenge. |
Food allergy 0.50 (0.04; 5.72) (1 study, n = 91) Sensitization to cow’s milk: (1 study, n = 91) 9 months 0.19 (0.02; 1.66) 18 Months 0.26 (0.05; 1.32) (1 study, n = 67) 6 months 0.07 (0.00; 1.29) 12 months 0.05 (0.00;1.01) |
The lack of statistical power of these studies means that more studies will have to be conducted to determine the effect of hydrolysed formulas and allergy 😐 |
* Cochrane review; ‡ Includes 2, now discredited, studies by Chandra, but results from these studies not used for form these results; ☺ = Intervention associated with prevention of food allergy or food sensitization; 😐 = Intervention not associated with either increased or decreased risk of food allergy or food sensitization.