Allergist nutritional advice for infants with cow's milk protein allergy. Rating of the best hypoallergenic formulas for baby food

Food allergies are a fairly common occurrence in young children, both breastfed and bottle-fed. In the latter case, the most important component in its treatment and prevention is diet therapy with hypoallergenic mixtures, which allows you to reduce the drug load on the body and achieve a faster disappearance of the symptoms of the disease.

Important! An allergy in a breastfed baby does not require transferring the baby to a hypoallergenic formula. In this case, a correction of the diet of the nursing mother is recommended. If the child receives complementary foods, then the timing of its introduction is reviewed, taking into account the composition.

Types of hypoallergenic mixtures

The main purpose of hypoallergenic mixtures is treatment and prevention. In this regard, their protein component differs from conventional mixtures and can be represented by:

partially hydrolyzed milk protein;
highly hydrolyzed milk protein;
protein components - a mixture of amino acids.

The main task of such a transformation is to ensure that the body cannot recognize the allergen in the altered cow protein. The smaller parts of the protein are formed in the process of hydrolysis, the less likely that the body "recognizes" them and responds with an allergic reaction. After hydrolysis, the resulting mixture of peptides and amino acids is freed from non-cleaved molecules and their large fragments by ultrafiltration and processed on sorbents.

Depending on the purpose, all hypoallergenic mixtures are divided into preventive and therapeutic. Sometimes, in the group of prophylactic mixtures, a subgroup of therapeutic and prophylactic mixtures is distinguished, which are no longer used for prevention, but for the treatment of mild manifestations of allergies. Classification of the mixture as prophylactic or treatment-and-prophylactic depends on the degree of protein cleavage and recommendations for its use by the manufacturer.

Preventive hypoallergenic mixtures

Depending on the degree of adaptation, prophylactic mixtures can be adapted from birth to six months (mixture formula 1), adapted to the age of children from birth to one year old, and also partially adapted from six months (mixture formula 2). You can distinguish hypoallergenic mixtures by the marking on the can "GA" or by the word: "Low-allergenic".

The protein in such mixtures is subject to partial hydrolysis, as a result of which separate fragments are split off from it - peptides, the allergenicity of which is reduced by 300-1000 times compared to cow's milk protein. In the HIPP Combiotic GA 1 mixture, the protein has a higher degree of hydrolysis compared to other preventive mixtures, but, nevertheless, this mixture is not curative. Almost all mixtures with partially hydrolyzed milk protein contain lactose, so these mixtures are not recommended for lactose intolerance. The exception is the Bellakt GA 1 and 2 mixture, which belongs to lactose-free hypoallergenic mixtures and can be used for lactase deficiency.

Preventive mixtures contain quite a lot of large protein fragments with a high molecular weight, capable of causing an allergic reaction under certain conditions, therefore they are used:

for feeding healthy children who have a predisposition to food allergies to cow's milk proteins (the father or mother has an allergy);
with the gradual transfer of the child from therapeutic mixtures to conventional mixtures;
when an allergy to cow's milk proteins is not confirmed and its external manifestations are moderate.

Important! Formulas based on partially hydrolysed protein are not recommended for confirmed allergy to cow's milk proteins, even if it is mild.

If the child has reached the age of 5-6 months, he is not allergic to soy proteins, and the diagnosis of intolerance to cow's milk proteins is laboratory confirmed, then mixtures based on partially hydrolyzed milk protein can be used instead. They are therapeutic dairy-free, lactose-free mixtures and can only be prescribed by a doctor. A child receiving such mixtures should be under constant supervision, as there is a risk of intolerance to soy protein.

Another alternative to mixtures based on partially hydrolyzed milk protein can be the usual adapted ones ("Cabrita" and), but they must be used with extreme caution, since there are cases when, after the onset of an allergy to cow's milk proteins, an allergy to goat's milk proteins develops.

Important! Mixtures based on goat's milk and soy protein isolate are not hypoallergenic. Their use instead of prophylactic hypoallergenic mixtures should be agreed with the doctor.

And probiotic mixtures are also non-hypoallergenic and, in case of intolerance to cow's milk proteins, are used only at the recovery stage when expanding a dairy-free diet. The use of products with probiotics is especially important for frequent infections or infectious complications of an allergic disease.

List of hypoallergenic prophylactic formulas

Name		price, rub.
"NAN GA 1", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Bifidobacteria and lactobacilli. Nucleotides.	595
"NAN GA 2", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose and maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic. Bifidobacteria and lactobacilli. Nucleotides.	565
Nutrilon GA 1, 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Prebiotics, nucleotides.	600
Nutrilon GA 2, 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose and starch. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Prebiotics, nucleotides.	600
Frisolak GA 1, 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose and maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. prebiotics, nucleotides	725
Frisolak GA 2, 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose, glucose syrup, maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Prebiotics, nucleotides.	725
"Similak GA 1", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose, maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. There is no palm oil. Nucleotides, prebiotics, lutein.	597
"Similak GA 2", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. There is no palm oil. Nucleotides, prebiotics, lutein.	597
"Celia GA" from 0 to 12 months, 400 g	Blend of partially hydrolyzed casein and whey proteins. The carbohydrate component is represented by lactose and maltodextrin. Contains polyunsaturated fatty acids: linoleic, linolenic. Probiotics.	850
"Bellakt GA 1", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by maltodextrin. Contains polyunsaturated fatty acids: linoleic, linolenic, docosahexaenoic, arachidonic. Prebiotics, nucleotides. Can be used for lactose intolerance.	460
"Bellakt GA 2", 400 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by maltodextrin. Contains polyunsaturated fatty acids: linoleic, linolenic, docosahexaenoic. Prebiotics, nucleotides. Can be used for lactose intolerance.	460

List of hypoallergenic formulas

Name	Brief description of the composition	Price, rub
"HiPP Combiotic GA 1", 500 g	Highly hydrolyzed whey proteins. The carbohydrate component is represented by lactose and starch. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Prebiotics, probiotics.	892
"HiPP Combiotic GA 2", 500 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose, maltodextrin and starch. Contains polyunsaturated fatty acids: linoleic, linolenic. Prebiotics, probiotics.	892
"Humana GA 1", 300 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic.	850
"Humana GA 2", 300 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose, starch, maltodextrin, glucose syrup. Contains polyunsaturated fatty acids: linoleic, linolenic. Prebiotics.	750
"Nutrilak GA 1", 350 g "Nutrilak GA 1", 350 g	Partially hydrolyzed whey proteins. The carbohydrate component is represented by lactose and maltodextrin. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Prebiotics, nucleotides, lutein.	528

Therapeutic hypoallergenic mixtures

Most therapeutic mixtures, unlike prophylactic ones, are not divided into adapted mixtures (with formula 1) and partially adapted mixtures (with formula 2), but are adapted mixtures intended for feeding from birth to one year. The exception is the Nutramigen Lipil mixture, which has degrees of adaptation with formulas 1 and 2.

Indications for the appointment of these mixtures are:

acute allergic reactions;
syndrome of impaired absorption and digestion (non-infectious diarrhea, acute intestinal infections, galactosemia, celiac disease, etc.);
hypotrophy;
after operations on the stomach or intestines;
feeding premature newborns.

Treatment mixtures include mixtures based on highly hydrolyzed protein (whey or casein) and synthetic amino acids.

Highly Hydrolyzed Protein Blends

The allergenicity of mixtures based on highly hydrolyzed cow's milk protein is reduced by 10,000-100,000 times compared to unchanged cow's protein. They contain quite a lot of peptides with a molecular weight of 1.5 kilo Daltons, which have minimal allergenicity, but at the same time, there are protein antigens with a molecular weight of 3.5-5 kilo Daltons, which in some cases can cause food allergies. Therefore, the criterion of their effectiveness is not the depth of hydrolysis, but the results of clinical studies, as a result of which 90% of children have no allergic reaction to cow's milk proteins.

The basis of the protein component of mixtures based on highly hydrolyzed protein can be whey protein hydrolyzate and casein hydrolyzate.

Mixtures based on whey protein hydrolyzate. They are considered more allergenic than mixtures based on casein hydrolysates, as they have quite a lot of peptides with a molecular weight of about 5 kilo Daltons. Most of these mixtures can be used for lactase and lipase deficiency, as they are lactose-free and contain easily digestible medium chain triglycerides (up to 50% of all lipids). The exceptions are mixtures based on highly hydrolyzed whey protein "Nutrilon Pepti Allergy" and "Alfare Allergy", which contain lactose and lack medium chain triglycerides. Used for moderate allergies. Whey protein hydrolysates have a greater nutritional value than casein hydrolysates, and therefore, when using these mixtures, a large increase in body weight is observed, which is important for malnutrition and for premature babies. They have a bitter taste due to the significant amount of free amino acids.
Mixtures based on casein hydrolyzate. The average molecular weight of the peptides of these mixtures is 3.5 kilodaltons, therefore mixtures based on casein hydrolysates rarely cause allergic reactions and are recommended for severe forms of food allergy or hypersensitivity to whey proteins. Due to the high amount of free amino acids, they taste even more bitter than whey protein formulas.

List of Whey Protein Hydrolyzate Treatment Blends

Name	Brief description of the composition	Price
"Alfare", 400 g	Protein component (80% oligopeptides and 20% free amino acids). The carbohydrate component is represented by maltodextrin and starch. Contains polyunsaturated fatty acids: linoleic, linolenic and medium chain triglycerides. Nucleotides.	1146
"Alfare Allergy", 450 g	The carbohydrate component is represented by maltodextrin and lactose. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic.	1159
"Pepticate", 450 g	Protein component (90% oligopeptides and 10% free amino acids). The carbohydrate component is represented by glucose syrup. Contains medium chain triglycerides. Nucleotides.	1180
"Nutrilak Peptidi SCT", 350 g	The carbohydrate component is represented by maltodextrin, glucose syrup. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic and medium chain triglycerides.	860
"Nutrilon Pepti Allergia" 400 g	The carbohydrate component is represented by maltodextrin, lactose. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic. Nucleotides, prebiotics.	1183
"Nutrilon Pepti Gastro" 450 g	The carbohydrate component is represented by glucose syrup. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic and medium chain triglycerides. Nucleotides.	1220
"Frisopep" 400 g	The carbohydrate component is represented by maltodextrin, glucose syrup. Contains polyunsaturated fatty acids: linolenic and linolenic and medium chain triglycerides.	864

List of medical mixtures based on casein hydrolyzate

Name	Brief description of the composition	price, rub.
"Nutramigen Lipil 1", 400 g	The carbohydrate component is represented by glucose syrup modified with corn starch. Contains polyunsaturated fatty acids: linolenic, linolenic, arachidonic, docosahexaenoic.	1000
"Nutramigen Lipil 2", 400 g	The carbohydrate component is represented by glucose syrup, fructose, modified corn starch. Contains polyunsaturated fatty acids: linolenic, linolenic, arachidonic, docosahexaenoic.	1000
"Pregestimil Lipil", 400 g	The carbohydrate component is represented by glucose syrup and modified corn starch. Contains polyunsaturated fatty acids: linolenic, linolenic, arachidonic, docosahexaenoic.	1300
"Frisopep AS" 400 g	The carbohydrate component is represented by glucose syrup. Contains polyunsaturated fatty acids: linolenic and linolenic. Nucleotides.	1200

Therapeutic mixtures based on synthetic amino acids

These mixtures do not contain protein at all, so the occurrence of allergic reactions to protein is impossible. The disadvantages of these mixtures include high osmolality and low taste.

The appointment of mixtures based on amino acids is carried out if:

treatment with mixtures based on highly hydrolyzed milk proteins for two weeks does not give a result;
allergy to cow's milk proteins is accompanied by malabsorption in the small intestine and delayed physical development;
allergic reaction to mixtures with highly hydrolyzed protein.

List of medicinal mixtures based on synthetic amino acids

Name	Brief description of the composition	price, rub.
"Neocate LCP" 400 g	The carbohydrate component is represented by glucose syrup. Contains polyunsaturated fatty acids: docosahexaenoic, linolenic, arachidonic. Nucleotides.	2300
Nutrilon Amino Acids, 400 g	The carbohydrate component is represented by glucose syrup. Contains polyunsaturated fatty acids: linolenic and linolenic.	2650
"Alfare Amino", 400 g	The carbohydrate component is represented by corn syrup and potato starch. Contains polyunsaturated fatty acids: docosahexaenoic, linoleic, linolenic, arachidonic and medium chain triglycerides.	2600

Algorithm for choosing a therapeutic mixture for children of the first year of life with an allergy to cow's milk proteins

How to switch to a hypoallergenic mixture

When prescribing any of the above mixtures, it is necessary to take into account the content of lactose in them, since an allergy to cow's milk proteins is often accompanied by lactose intolerance. In such cases, the appointment of lactose-free hypoallergenic mixtures is recommended.

A confirmed allergy to cow's milk proteins requires a complete conversion to therapeutic mixtures. However, amino acid mixtures can be used for a relatively short time to diagnose milk protein allergy. Preventive and treatment-and-prophylactic mixtures can be given to a child as supplementary food or as the main type of food.

When transferring a child to a hypoallergenic mixture, the following rules must be followed:

introduce the product gradually, by reducing the amount of the previously obtained mixture;
before each feeding, first give a formula based on protein hydrolyzate, and then the usual one.

Important! A change in the color of the stool to greenish or its consistency is not a reason to cancel the hypoallergenic mixture and is considered to be a variant of the norm.

The duration of taking hypoallergenic mixtures is individual and takes an average of 3-6 months, but in some cases treatment may be required for a year or more.

In contact with

Breastfeeding is the best food for a newborn. Only mother's milk fully satisfies the needs of the child, saturates the body with all the necessary vitamins and elements.

However, not always the mother can feed the baby. Then milk formulas come to the rescue. Before switching to artificial or mixed feeding, think carefully and consult with your pediatrician. Read more about the benefits of breast milk and breastfeeding.

When you need a hypoallergenic mixture

Young children, especially in the first 3-4 months, are prone to allergies and eating disorders. At this time, the baby's digestion is only getting used to new conditions, so they often react negatively to food. If the child is on mixed or artificial feeding, it is likely that the allergy manifests itself precisely to the mixture. Then hypoallergenic infant formula is needed.

Food allergy symptoms include:

Rash and redness on the body;
Itching and peeling;
Diaper rash and swelling;
Profuse regurgitation and vomiting;
Change in the consistency and color of the stool;
Severe colic, flatulence and abdominal pain;
Nasal congestion, runny nose and sneezing;
Cough and sore throat;
Throat difficulty and asthma;
Tearing and eye irritation.

Hypoallergenic mixtures for newborns can be used not only for allergy sufferers. They are suitable for children with increased gas formation and problems in the intestines, with severe colic. In addition, such food is better to choose for babies prone to allergic reactions. Remember that allergies are often hereditary. If mom or dad has allergies, it's better to play it safe. And the mixture will be a good prevention of the disease.

How to choose the right hypoallergenic mixture

Seek medical attention at the first sign of an allergy. He will be able to determine which substances the child has a negative reaction to and, depending on this, select the appropriate mixture;
Choose a mixture that is suitable for age. You will find the label on the packaging. For premature and underweight babies, take "0" or "Pre" ("Pre"), for newborns and toddlers up to six months, "1" is suitable, for ages 6-12 months - "2", for a one-year-old baby and older - "3". Some brands produce special baby milk to replace cow milk for children from 1.5 years old under the number “4”;
Hypoallergenic mixtures contain the label “HA” or “HA” on the pack;
It is desirable that the composition includes prebiotics and probiotics, dietary fiber, iodine, iron and folic acid in sufficient quantities;

Choose foods free of palm, canola, and coconut oil that are labeled accordingly;
Do not forget to check the date of manufacture and expiration date;
When introducing the mixture, give the newborn a small portion and observe the reaction. If there are negative consequences, the mixture must be changed. The mixture needs to be changed if the child is not gaining weight well and sleeps restlessly, often crying during, before or after feeding;
Once you've found the right mix, don't change your diet again. Frequent change leads to a deterioration in the well-being of the child.

Preventive and therapeutic mixtures

To choose the right mixture and understand which one is better, you need to consider the types. First of all, they are divided into preventive and therapeutic. Prophylactic mixtures are nutrition in which the protein is partially broken down into small molecules (peptides). It is easier to digest and suitable for babies at risk of allergies. For moderate and severe allergies, you should choose therapeutic mixtures that contain highly hydrolyzed protein.

Prophylactic formulas are suitable for continuous feeding of children who have developed an allergy to cow's milk for the first time or are at increased risk of such a disease. Most companies that produce such nutrition include probiotics and prebiotics. These substances facilitate the condition of the child and improve digestion. Some also include nucleotides to boost immunity and lutein to help develop newborn vision.

Medicated formulas do not contain whole cow's milk proteins, so they are suitable for babies with moderate to severe allergies. The composition of such nutrition is more physiological and better absorbed. It promotes rapid weight gain and has no age division. But pediatricians recommend switching to prophylactic mixtures after 5-6 months of remission after the disease.

Soy, whey and goat milk formulas

Soy formula is suitable for children with allergies to cow protein and cow's milk. Be careful, as 30% of babies are allergic to soy protein. This food is not suitable for newborns, it is recommended for use after 5-6 months. At the same time, in addition to the soy mixture, the child’s menu must necessarily include fermented milk products (cheese, cottage cheese, butter).

Whey or lactase-free formulas are highly digestible and suitable for children with bowel and digestive problems. Such nutrition is prescribed for newborns with lactose and sugar intolerance, with acute intestinal infections. But it is not suitable for lactase deficiency.

Goat milk formulas are suitable for newborns with intolerance to cow and soy protein. Such food has a high nutritional value, contains the right amount of animal proteins for the full development of the baby. It is well absorbed, normalizes the work of digestion and the child's stool.

Rating of the best HA mixtures

Mixture	Advantages	Flaws
NAN GA (Netherlands)	The content of lactose, as in breast milk, fatty acids provide the development of vision and nerve cells, strengthen the immune system, improve the intestinal microflora	High price; not suitable for children with lactase deficiency, sometimes causes constipation; contains palm oil
Nutrilak GA (Russia)	Suitable for complete lactose and sugar intolerance, contains prebiotics, nucleotides and luteins, gently affects bowel function, regulates stool	Sometimes causes allergies and increases regurgitation
Nutrilon GA (Netherlands)	Contains prebiotics and nucleotides, beneficial fatty acids, strengthens the immune system and stabilizes bowel function, reduces colic	Poorly mixed and diluted, contains palm oil
Frisolak GA (Netherlands)	Good quality and tolerability, contains prebiotics, beneficial fatty acids and nucleotides, pleasant taste, ideal for premature babies and small children	Insufficient content of iron, calcium and potassium, contains palm oil, high cost
Hipp GA (Austria/Germany)	Contains lactose and prebiotics, starch and fatty acids, sufficient iron and folic acid, speeds up digestion, suitable for children with anemia	Not suitable for babies under 3-4 months old as starch is difficult to digest and causes severe colic, expensive, difficult to find in regular stores
Humana GA (Germany)	Contains lactose, prebiotics and nucleotides, improves digestion and helps with colic, easy to digest	High price
Similak GA (Denmark/ Ireland)	Contains nucleotides and prebiotics, lutein and fatty acids, no palm oil! Well bred and easily digestible	High cost, sometimes causes diarrhea
Celia GA (France)	Contains lactose, probiotics, fatty acids, good value for money	Less adapted in composition, not divided by age and suitable only for children under one year old
Bellakt GA (Belarus)	Lactose-free formula suitable for babies with lactose intolerance, with severe and moderate allergies, contains prebiotics and nucleotides, fatty acids, enriched composition at an affordable price, well tolerated	hard to find in regular stores
MD mil Goat (Spain)	Goat milk mixture is suitable for children with atopic dermatitis and cow protein allergy, facilitates digestion and absorption, strengthens the immune system	High price
GA theme (Germany/Russia)	Affordable price and sweet taste, promotes rapid digestion, contains lactose	Contains glucose syrup, which is not recommended in the diet of children under 6 months, the composition includes starch, which is difficult to digest
Agusha Gold (Russia, France, Denmark)	The rich composition contains lactose and fatty acids, nucleotides and lutein, prebiotics and probiotics, affordable price, improves immunity	Foams and does not stir well, sometimes increases colic

How to prepare a mixture

It is impossible to say unequivocally which mixture is better. Each baby is characterized by individual development and perception. Some babies eat the mixture without problems, while others have allergies or colic to the same composition. When choosing, take into account the reviews of other parents, but, first of all, be guided by the recommendations of the pediatrician, taking into account the characteristics of the development and health of the child.

For cooking use pure filtered water. The optimal temperature of the mixture for feeding a newborn is 36-38 degrees above zero. Do not heat milk formula in the microwave! In extreme cases, you can heat the food in a water bath or simply in hot water. And it is better to fill the powder with boiling water and wait until the mixture cools down, or take water immediately at the desired temperature.

How to dilute the mixture and what portion to give to the baby is indicated on the package. The consumption rate depends on the age of the child. To calculate the dosage for newborns up to 10 days and weighing up to 3.2 kg, the number of days of life is multiplied by 70, weighing over 3.2 kg is multiplied by 80. For children from 10 days to two months, the portion is 1/5 of the weight, in 2 -4 months - 1/6 of the weight, from four months to six months - 1/7 of the weight, from six months to a year - 1/9 of the weight.

With moderate and severe course in a child who is on artificial or mixed feeding, therapeutic hypoallergenic mixtures are used. These are mixtures based on cow's milk with a high degree (cleavage) of the protein substrate, which results in the formation of peptides with a low molecular weight (up to 5,000 Daltons).

Protein particles of such a mass rarely cause allergic reactions. All mixtures based on deep hydrolysates are enriched with complexes of vitamins, minerals and trace elements; their composition meets the requirements of WHO in all criteria (ingredient composition, biological and nutritional value, impact on the physical and psychomotor development of children in the first year of life).

Indications for appointment

Hypoallergenic therapeutic mixtures are prescribed:

with mild, moderate and severe food allergies;
with a high degree of malnutrition;
children with severe forms of the syndrome of impaired absorption in the intestine (malabsorption);
in violation of digestion and absorption against the background of certain conditions (resection of the intestine and other operations on the intestines, pancreatic insufficiency, cystic fibrosis, chronic diarrhea, etc.).

In moderate and severe form of food allergy, feeding with therapeutic mixtures is carried out in acute periods and before the transition to the stage of stable remission. Subsequently, when clinical improvement is achieved in children older than six months and with mild food allergies, it is preferable to use them as more physiological and tastier for the child, and less expensive for parents.

Before starting feeding with a therapeutic hypoallergenic mixture, it is desirable to confirm the occurrence of hypersensitivity reactions specifically to cow's milk protein - by examining blood for food allergens. In any case, transfer to a medicinal mixture should only be done on the advice of a doctor(pediatrician, allergist) and under his control.

Classification of therapeutic hypoallergenic mixtures

Therapeutic hypoallergenic mixtures are divided according to the type of hydrolyzate (whey and casein) and the presence of lactose (lactose-free and lactose-containing). In a special place are amino acid mixtures that are completely devoid of protein and contain only free amino acids.

Whey hydrolysates

Whey hydrolysate formulas are made by enzymatic hydrolysis of whey and are devoid of casein. These include:

"Alfare"
Alfare Allergy,
"Nutrilak peptidi SCT",
"Frisopep with nucleotides",
"Nutrilon pepti allergy";
"Nutrilon pepti gastro";
"Damil pepti";
"Pepticate".

Advantages

Cow whey milk proteins are similar to human milk proteins, so whey hydrolysates are more physiological for children, are better absorbed and have a greater nutritional and biological value compared to casein hydrolysates.

Flaws

Among the peptides of whey hydrolysates, there are more large molecules (with a mass of more than 5,000 D) than in casein ones, which means that whey ones are more allergenic. Therefore, formulas based on whey hydrolyzate are not recommended for children with severe allergies.

Casein hydrolysates

Mixtures from this group are made by hydrolysis of casein. These include:

"Nutramigen lipil",
"Pregestimil lipil",
"Frisopep AS".

Advantages

In casein hydrolysates, the content of peptides with a mass above 5,000 D is minimal, therefore, they are practically not capable of causing food allergies and can be used when feeding children with severe allergies.

Flaws

Casein is a non-physiological protein for an infant (its share in human breast milk is small, while casein prevails in cow's milk).
Casein hydrolysates have less biological and nutritional value than whey hydrolysates.
They have an even more bitter and unpleasant taste compared to whey.

Note: laboratory (blood test) in a child, a predominant sensitization (hypersensitivity) to casein or whey proteins can be established, and then the type of hydrolyzate is selected based on these data, and not on the clinical course (the principle "with moderate severity - whey hydrolysates, with severe allergies - casein" does not work).

Amino acid blends

Lactose-free and lactose-containing mixtures

Lactose is an important nutritional component that stimulates growth and inhibits the reproduction of pathogenic microflora. Lactose promotes the absorption of manganese and magnesium, preventing the development of rickets and anemia. On the other hand, moderate to severe allergies are often accompanied by the development of lactase deficiency, as a result of which lactose is not broken down and absorbed. Clinically, lactase deficiency is manifested by bloating in an infant, rumbling in the abdomen, or, conversely, a tendency to. If there are symptoms of lactase deficiency, the child should be fed lactose-free mixtures.

Well, since food allergies, especially in moderate and severe forms, are extremely often accompanied by lactase deficiency, then therapeutic hypoallergenic mixtures usually do not contain lactose. they are represented by glucose syrup, maltodextrin and starch. The exception is Frisopep, Alfare Allergy, Nutrilon Pepti Allergy, Neocate, which contain lactose.

Additional components

Mixtures can be enriched with the following important components:

Nucleotides are necessary for the formation of immunity.
Prebiotics - promote the growth of normal intestinal microflora, strengthen the immune system. Mixtures with prebiotics are especially indicated for concomitant dysbacteriosis.
Polyunsaturated fatty acids (PUFAs) - arachidonic and docosahexaenoic - play an important role in the development of the infant's brain, the development of psychomotor skills.
Medium chain triglycerides are fats that are absorbed in the gastrointestinal tract, bypassing the lymphatic system, and directly into the bloodstream. Their presence makes it possible to use the mixture against the background of impaired digestion and absorption of long-chain fats due to allergies, which is clinically manifested by steatorrhea (fats in stool analyses).

General features of therapeutic hypoallergenic mixtures:

Due to the content of free amino acids, they have a distinctly bitter taste and a bitter unpleasant odor. It is problematic at first to transfer a child who was previously fed with a regular mixture to a hypoallergenic one. However, in severe forms of allergies, there is simply no other way out, and parents will have to make efforts to overcome the baby's refusal from tasteless mixtures. In the early days, in the absence, you can dilute the mixture with a little more water than recommended by the instructions, thereby achieving a lower concentration and less bitterness. After 1-3 days, you should switch to standard dilution.
When feeding with protein hydrolysates, the stool in an infant often acquires. This is fine.
Hypoallergenic mixtures from the medical line have a high cost. They don’t have very cheap analogues, but saving on the baby’s health is unacceptable: remember that an attempt to save and feed a child with an inappropriate mixture or substitute (goat milk) is fraught with severe exacerbations and even greater financial costs for drugs.
Hypoallergenic therapeutic mixtures (except for amino acids) do not give a 100% guarantee that a child will not be allergic to them. Even after deep protein hydrolysis, molecules weighing less than 1,000 D retain residual antigenic activity, i.e., they can provoke an allergic reaction. In such cases, it is necessary to transfer the child to soy or amino acid mixtures.

When and how to stop feeding with therapeutic hypoallergenic mixtures

Parents often wonder, when will a child be able to switch to “normal”, tasty and less expensive formula or another type of food? In each case, the issue is resolved individually with the obligatory participation of a doctor. With a moderate course of allergies, against the background of feeding with therapeutic mixtures, it is possible to achieve improvement after a few weeks, however, feeding with a selected brand is kept for at least 2-3 months. In the absence of relapses and after the child reaches six months of age, when moving to the second stage of diet therapy (), you can try to change the therapeutic mixture to a prophylactic one. But there will be some risk of the allergy returning. The usual, non-hypoallergenic, mixture is not prescribed for up to a year.

Severe allergies, especially in the case of a long-term selection of a “suitable” mixture, exclude the transfer of a child to another type of milk nutrition until he reaches the age of 1 year (and even older). This means that the baby must constantly receive a therapeutic mixture of the same brand (if there are subsequent formulas, then with the transition to them), but complementary foods are introduced with caution from six months, and the amount of the mixture is gradually reduced.

Brands of therapeutic hypoallergenic mixtures

Let us dwell in more detail on individual brands of mixtures.

"Alfare"

It is a whey hydrolyzate. Lactose-free. Producer - "Nestlé", the Netherlands.

Advantages

Enriched with nucleotides. The fat component includes a mixture of medium chain triglycerides (40% of fat), PUFA (docosahexaenoic acid). Among fats, the manufacturer emphasizes the presence of lipids with anti-inflammatory activity. It has a low osmolarity (217 mOsm / kg), which means that it does not create an excessive burden on the baby's kidneys.

Flaws

Does not contain prebiotics. The carbohydrate component is represented, among other things, by starch, which is undesirable for babies under six months of age.

"Alfare Allergy"

Whey hydrolyzate. Contains lactose. Producer - "Nestlé", the Netherlands.

Advantages

As close as possible in composition to human milk and conventional (non-hypoallergenic) mixtures. The presence of lactose causes a pleasant taste, so children easily switch to this food product. Enriched with PUFA. Does not contain starch. Due to its good taste and composition, identical to the composition of conventional mixtures, it can be used for a long time (from birth to a year) and does not require transfers to other substitutes.

Flaws

Contains no prebiotics or nucleotides. The fatty component is represented only by long chain acids.

"Nutrilak peptidi SCT"

Lactose-free whey hydrolyzate. Producer: "Nutritek", Russia.

Advantages

Contains medium chain triglycerides and PUFAs. It has the lowest osmolarity of whey hydrolysates (190 mOsm/kg). Contains no starch. It is relatively inexpensive (about 30% cheaper than Alfare).

Flaws

Does not contain prebiotics and nucleotides.

"Frisopep with nucleotides"

Whey hydrolyzate. Contains lactose. Producer: Friesland Foods, the Netherlands.

Advantages

Good taste, children easily switch to it. Contains prebiotics, nucleotides.

Flaws

Fats are represented only by long chain acids. Contains glucose syrup.

"Nutrilon pepti allergy"

Whey hydrolyzate, contains lactose. Producer: Nutricia, the Netherlands.

Advantages

Enriched with nucleotides, prebiotics, PUFAs, fats contain medium chain triglycerides. Does not contain starch, glucose.

Flaws

Fairly high osmolarity (280 mOsm/l).

"Nutrilon pepti gastro"

It differs from Nutrilon Pepti Allergy mainly in the absence of lactose (replaced by glucose syrup). It is recommended for children with moderate allergies, including those with gastrointestinal manifestations and lactase deficiency.

"Damil pepti"

Whey lactose-free hydrolyzate. Producer: ANEGO Aps, Denmark.

Disadvantages: does not contain nucleotides, PUFAs, medium chain triglycerides, prebiotics. Contains starch.

"Pepticate"

Whey lactose-free hydrolyzate. Producer: Nutricia, the Netherlands.

Advantages

Contains nucleotides, medium chain triglycerides, PUFAs.

"Nutramigen lipil", "Pregestimil lipil"

Casein hydrolysates manufactured by Mead Johnson, the Netherlands. Currently, they are almost not represented on the Russian market.

"Frisopep AS"

Lactose-free casein hydrolyzate. Producer: Friesland Foods, the Netherlands.

Advantages

Contains nucleotides, no starch.

Flaws

Does not contain PUFAs, medium chain glycerides, prebiotics.

Amino acid blends:

"Neocate LCP" - produced by "Nutricia", UK. It has the following formula - "Neocate Advance" - for the nutrition of children older than a year.
"Nutrilon amino acids" - produced by "Nutricia", the Netherlands.
"Alfare amino" - produced by "Nestlé", the Netherlands.

All amino acid blends are lactose free. Contains PUFAs, medium chain triglycerides. Nucleotides are present only in the Neocate mixture. The energy value of amino acid mixtures is increased (compared to the standard one) in order to compensate for the increased nutritional needs of children with severe allergies. The taste, despite the high content of amino acids, is quite pleasant.

They have high osmolarity. Expensive.

Recommended for severe food allergies, including the gastrointestinal form, the presence of complications. They can be used in the diet of children with other forms of allergies (bronchial asthma, rhinitis, hay fever, etc.). Indicated in case of persistence of allergy symptoms on the background of feeding with whey or casein complete hydrolysates, with unsuccessful attempts to transfer to soy mixtures. Suitable for long-term, constant feeding and as the only source of nutrition for children up to a year.

Conclusion

Currently, pediatricians and allergists, as well as parents of allergic people, have the opportunity to choose from a wide range of specialized therapeutic foods for children with sensitization to cow's milk protein. The generally accepted recommendations for the diet of a formula-fed child usually end only with the choice of a certain group of women's milk substitutes (whey, casein hydrolysates, amino acid mixtures, partial hydrolysates). In practice, mixtures within the same group are tolerated by children in different ways. Therefore, the peculiarities of the clinical course of allergy in each particular child require a strictly individual approach when choosing a brand of therapeutic mixture, with the obligatory participation of the attending physician and his subsequent monitoring of the baby's condition.

The program "School of Dr. Komarovsky" tells about feeding children with artificial milk mixtures, including hypoallergenic ones:

Everyone knows that breastfeeding is the best food for babies. It is ideal, it is necessary to breastfeed the baby for as long as possible. Then the possibility of an allergic reaction in the baby is minimal. But sometimes you have to introduce artificial bait into the diet. How to do it right and not cause negative consequences.

How is fermented milk mixture selected for an allergic reaction to cow protein? Many mixtures are based on cow's milk, there are substitutes.

Let's figure it out.

What is cow protein allergy?

An allergy to cow's milk protein is a specific reaction of the immune system to a foreign protein. It is found in 5-8% of infants. The life of the baby is not threatened, the pathology is not severe. As a rule, passes by 4-5 years. It may even take a year.

In addition to allergies, there is intolerance to cow's milk - when the digestive system cannot produce enzymes that break down cow's milk proteins.

Very rarely, such ailments last a lifetime. In 90% of cases, they disappear completely. In this case, it is necessary to carefully diagnose the accompanying problems that affect the allergy in the child, aggravating his condition.

External signs of cow protein allergy - symptoms

An allergic reaction can be fleeting, within 2 hours, or slow - a few days. Allergy symptoms:

Redness and rashes of small spots (urticaria) on the cheeks, forearms, breasts, buttocks, knees.
Rapid breathing, nasal congestion, runny nose, coughing and sneezing.
Belching, vomiting, colic, flatulence, loose stools.

In newborns, the manifestations are much more severe. Foam may appear in the stool. The baby is very naughty, irritable, sleeps and eats poorly.

After about three days, the symptoms may disappear if the baby is no longer given cow's milk or lactic acid formula. When milk protein continues to be present in feeding, the symptoms worsen dramatically. Dermatoses itch, swell, infection of the skin occurs when combing.

The most severe reaction is anaphylactic shock - swelling of the throat, spasms of the larynx, the child begins to choke, convulsions may appear . Urgently address to the doctor!

Causes of allergies and intolerance to cow protein.

Among the reasons are the following:

Lack of digestive and protein digesting enzymes
Inadequate and unbalanced nutrition of the mother
Too fast transition to complementary foods
Heredity
Unsuitable milk formulas for complementary foods or artificial feeding

Cow's milk contains a whole system of proteins, among them two main groups: casein (78-85%) and whey - globulins and albumins (15-22%).

Whey protein intolerance is rare. In addition, there may be a reaction to lactose - milk sugar.

Allergy mainly occurs on the presence of casein proteins in food. The child still lacks the necessary enzymes to digest their rather large molecules. Therefore, for artificial feeding and complementary foods, hypoallergenic fermented milk mixtures with hydrolyzed cow protein are produced. In them, protein molecules are partially or completely broken into smaller parts and it is easier for the baby to absorb them.

Types of hypoallergenic mixtures

Preventive
Therapeutic

They differ in the degree of protein breakdown.

Preventive hypoallergenic mixtures

NAN hypoallergenic, Humana GA, Nutrilon GA, Similak GA, Frisolak GA, Nutrilak GA, Hipp HA Combiotic 2.

They are heavily advertised, but they are not suitable for a child with an allergy to cow protein, the splitting is partial. Can be used with caution when switching from breastfeeding to artificial feeding. But at the first signs of a painful reaction, it is better to transfer the baby to the following milk substitutes.

Therapeutic hypoallergenic mixtures

The protein is completely broken down. They cannot cause an allergy, they are prescribed for complete intolerance to cow protein. They are divided into whey hydrolysates, casein hydrolysates and elemental mixture. Due to the breakdown of proteins, nutritional value and palatability deteriorate depending on the degree of processing.

Whey hydrolysates

Frisopep with nucleotides, Nutrilon Pepti Allergia, Alfare, Nutrilak Pepti MSC, Hipp NA Combiotic 1.

Obtained by complete breakdown of whey proteins. But the size of the protein particles is quite large. The molecular weight of the peptides is 6000 daltons. They can be fed to babies with intolerance to cow's and goat's milk. Allergic reaction does not cause. Bitter off free amino acids.

Casein hydrolysates

Frisopep AS, Nutramigen, Pregestimil.

In these hydrolysates, the size of the protein particles is much smaller. The molecular weight of the peptides is 3500 daltons. The nutritional value is less than that of whey, and the taste is worse. Used in more severe cases of allergy to cow's and goat's milk.

elemental mixture

Nutrilon Amino acids.

Milk replacer consisting of a set of amino acids. Allergy - does not cause. This is the ultimate choice. If the previous ones didn't fit.

The transition to the mixture should occur gradually - 1-2 weeks, at least 3-5 days. The body of the baby and his digestive system need to slowly adapt to the new diet and not cause disorders.

An unnatural reaction due to food occurs in half of children with allergies. It is especially common in children under one year of age. Where does the disease originate, what does it look like and what methods to deal with it?

From this article you will learn:

Predisposition plays a key role. It is inherited by children with both parents with allergies (up to 80%), one parent with allergies (up to 40%), healthy parents (up to 20%). Very often, the immune system develops as a child grows. Adaptation to allergens occurs, antibodies are formed and symptoms weaken or disappear.

The second factor is the immature digestive system. In a newborn, its formation occurs gradually. In babies, the mucous membrane of the digestive organs is extremely permeable. And the production of enzymes capable of splitting the antigen is still poorly debugged. Consumption of unnatural foods leads to an outbreak of allergy to infant formula.

4/5 of dry baby food is made from milk or whey of cows. Their milk proteins are perceived by the child's body as foreign. Antibodies are produced, but they do not yet have the intelligence to deal with the enemy. Instead, they enter into association with foreign proteins. The resulting immunocomplexes destroy cell membranes. Little pleasant for the children's liver. Its barrier functions are still immature, and the blow has to be kept.

The main reason for an allergy to a formula in a baby is not in the mixture itself, but in the amount of its consumption. Babies of the first year of life eat as much as they like, exceeding the necessary and sufficient nutritional standards. If artificial feeding is guided by the completion of the meal at the initiative of the child, then he can overeat by about a quarter.

How does it manifest

An allergy to the mixture in infants can appear almost immediately after consumption (from half an hour to two hours) or 24-48 hours before.

Manifestations:

Skin rashes - urticaria, dermatitis, rash around the mouth, on the scalp, cheekbones, neck, forearms, in skin folds, behind the ears. They may later spread to other parts of the body. Shine, redness and crusts are expressed. The spots may be plaque-like.
Itchy inflammation or weeping eczema . They look like papules on the cheeks, back, vulva, buttocks, legs. Children try to comb them, become irritable and whiny.
Difficulty breathing - cough, runny nose with clear discharge, rhinitis, shortness of breath. Very dangerous in young children. After all, they still have poor control over their breathing. When eating, babies cannot breathe through their mouths with a clogged nose.
Disorders of the digestive system. For example, bloating, regurgitation, vomiting, diarrhea, constipation. Symptoms of this group are found in many viral diseases. But, if there is only an allergy to the mixture, then there is no fever.

TOP 6 ways to deal with an allergy to formula in a baby

You need to take only two steps: identify the allergen and refuse contact with it. But there are many conditions to be checked.

Relief of manifestations

In case of skin manifestations, combing should be excluded so as not to infect the infection (wear anti-scratches, swaddle with handles). Baby moisturizers are used to reduce dryness and flaking. To facilitate breathing, you need to remove mucus from the nasal passages with an aspirator, cotton flagella or a syringe without a needle.

With urticaria due to the milk mixture, accompanied by shortness of breath, intestinal upset - call the district pediatrician or an ambulance. The doctor will examine the baby, prescribe treatment. Severe cases require hospitalization.

Finding a Problematic Source

It is important to make sure that the mixture is the culprit. A doctor will help you figure it out. Here is the verification algorithm:

Examination of a pediatrician, establishment of a rash of allergic origin;
Exclusion of contact dermatitis on baby cosmetics, diapers, washing powder;
Exclusion of reactions to medicines and food (teas with herbs, complementary foods, errors in the mother's diet with mixed feeding).

The composition of mixtures for children from six months includes cereals. Or maybe rashes from dry food in a newborn are just because of them. Very often expressed reaction to gluten. It is not found in buckwheat, rice, corn. It happens that the children's body is “stormed” by several other allergens at once.

Thanks to molecular diagnostics, it is possible to detect allergies to the components of the nutritional composition. Allergy tests are carried out in laboratories. If, nevertheless, the reaction to the mixture, then you need to choose the tactics described below.

Down with provocateurs

You need to monitor how intensely the baby sweats. With increased sweating, the development of allergic dermatitis is provoked. Therefore, you need to dress for a walk according to the weather and not wrap up at home. External contacts should also be reduced. Bathing in chlorinated water has a negative effect.

Less is better

If the baby is overweight, you can add a smaller amount of dry matter at each feeding. So the percentage of the allergen will decrease, the fermentation of excess food in the intestine will stop.

Changing the mixture

The transition to a new product is carried out at least three days in advance, preferably two weeks, so that addiction develops. It is obvious that the allergy to the mixture of the previous sample remains. Otherwise, the baby may simply refuse to drink the saving option. With a sharp transition, aggravation of disorders of the digestive system is possible.

fermented milk;
with prebiotics;
with probiotics.

The intake of such compounds improves the conditions for the reproduction of lactic acid bacteria in the intestine. Sour-milk representatives consist of partially split lactose with protein. They are easier to digest and less likely to cause negative reactions.

Compositions on goat milk or soy

They account for only 1/5 of the total number of mixtures. The protein in goat's milk is less than cow's. It is easier to break down and digest. The nutritional value of soy protein is significantly lower than that found in milk. After all, it belongs to the plant type. It is worse digested and absorbed.

Usually soy mixtures are used for several months until the allergy disappears completely. This food is not as tasty as dairy. Up to 17% of children react negatively to soy protein.

Rice mix

It does not contain animal fats. Therefore, special additives are introduced into the diet of crumbs that compensate for the missing substances.

Hypoallergenic formulations

In them, the protein is split partially, completely or replaced. In the first and second cases, they receive prophylactic, and in the third - therapeutic mixtures. In the last example, allergy with hypoallergenic mixtures is almost excluded. For prevention, nutrition is prescribed for children at risk.

With a mild degree of rashes, you can also use preventive products. Representatives: NAS hypoallergenic, Frisolak GA, Hipp NA.

The treatment group is divided into three types:

Serum - do not cause relapses, but sometimes maintain existing symptoms (Alfare, Nutrilak Pepti STC, Pepticate).
Casein - more complete protein breakdown. Those who did not fit the serum types (Nutromigen, Frisopep AS, Pregestimil).
Elemental mixtures - proteins are replaced by amino acids. Indicated in severe disease. Minus: do not contribute to the development of their own protective bodies to allergens.

Switching to breastfeeding

With mixed feeding, you can leave only breastfeeding. This eliminates diathesis from dry milk substitute. The process should be adjusted so that the baby has enough milk. The return to the breast should be gradual so that lactation has time to approach the usual portion of food. Artificial children cannot be deprived of a substitute without providing an alternative.

In parallel with the main methods of treatment, the allergist may prescribe the Enterol biological product in capsules. The pediatrician can prescribe Enterosgel preparations or Zirtek drops in complex therapy. Until the effect of the treatment becomes noticeable, it will take from a week to a month. Delaying treatment is fraught with the development of atopic dermatitis, chronic rhinitis, bronchial asthma.

Knowing about the baby's predisposition to allergies and the developmental features of the child's body, you can prevent or reduce its symptoms. Seeing the manifestations, use the TOP 6 ways to deal with it. In order to exclude serious consequences, immediately enlist the support of a doctor.