SKIN
Swelling
Rashes/itching
Atopic eczema
ENTER A NEW ERA IN THE MANAGEMENT OF COW’S MILK PROTEIN ALLERGY
IMPORTANT NOTICE: Breastfeeding is best for infants and is recommended for as long as possible during infancy. Arize is a food for special medical uses for infants and should be used under medical supervision.
CMPA is an immune-mediated allergic response to one or more proteins in cow’s milk. CMPA can manifest in 3 forms:1
Immunoglobulin (Ig)E-mediated:
Produces immediate symptoms,
typically within 2 hours of ingestion
Non-IgE-mediated:
Usually manifests between 2
and 72 hours after ingestion
Mixed IgE and non-IgE:
Reactions involve both IgE and non-
IgE mediated responses
CMPA is a common food allergy in the UK, affecting approximately 1.6-3.5% of babies and young children.2 It typically develops in infancy, usually when cow’s milk products are first introduced into the baby’s diet.3 The UK has the highest incidence of non-IgE-mediated CMPA in Europe.4
Common symptoms and signs of a CMPA reaction include:1
SKIN
Swelling
Rashes/itching
Atopic eczema
GASTROINTESTINAL (GI)
Abdominal pain/discomfort
Diarrhoea
Vomiting
RESPIRATORY
Coughing/wheezing
Chest tightness
Shortness of breath
CHALLENGES IN CMPA MANAGEMENTWhile the first aim of CMPA management is to prevent allergic reactions, ensuring optimal growth and avoiding nutritional deficiencies in infants on a cow’s milk protein-free diet is crucial.5 While breastmilk remains the ideal source of nutrition, where breastmilk is not available, a hypoallergenic formula may need to be considered.6
However, hypoallergenic formulas, such as extensively hydrolysed formulas (eHFs), provide varying levels of efficacy,7-9 and may still cause allergic reactions due to residual cow’s milk protein:10-14
of children with IgE-mediated CMPA react to eHFs10-12
of children with non-IgE-mediated CMPA react to eHFs12-14
Ongoing allergic reactions to residual cow’s milk protein can negatively impact the wellbeing of the both the child and their family/carers:1,15-16
Uncomfortable symptoms for the child
Reduced quality of life for parents/carers
Parental anxiety and stress
eHFs may also contain animal-based ingredients, which might make them unsuitable for patients and families who require vegetarian, halal or kosher diets.7-8,17
HRFs are a well-tolerated, plant-based alternative to cow’s milk protein-based eHFs.18-20 Available in Europe for over 20 years, HRFs are recommended by DRACMA and ESPGHAN guidelines as the first-line option for CMPA dietary management.9,21,22
HRFs are shown by a wealth of clinical evidence to be nutritionally adequate and well-tolerated, with a range of benefits for infants with CMPA:23-26
Proven hypoallergenicity and efficacy
Shown to support growth
Palatable and cost-effective
Suitable for plant-based, vegetarian, kosher and halal diets
HRFs are amongst some of the formulas that are least likely to trigger allergic reactions24
ARIZE, BY SIMILACDESIGNED TO WORK FIRST LINE, 100% OF THE TIME†8,27-29
Arize is a hypoallergenic, hydrolysed rice protein infant formula, formulated for the dietary management of infants with CMPA and other conditions where an extensively hydrolysed formula is indicated. It is suitable from birth.
Arize stands out from the crowd with its unique formulation and benefits, helping you make an informed prescription choice that meets the highest standards for your patient's health and growth.
PER 100ML SERVING | ARIZE | ALTHERA39 | APTAMIL PEPTI 140 | APTAMIL PEPTI 241 | APTAMIL PEPTI SYNEO42 | NUTRAMIGEN 1 WITH LGG43 | NUTRAMIGEN 2 WITH LGG44 |
|---|---|---|---|---|---|---|---|
ENERGY | 68 kcal | 67 kcal | 66 kcal | 68 kcal | 66 kcal | 68 kcal | 68 kcal |
PROTEIN | 2 g | 1.6 g | 1.6 g | 1.6 g | 1.6 g | 1.88 g | 1.68 g |
FATS AS MCTs | 30.6% | N/A | N/A | N/A | N/A | N/A | N/A |
OSMOLARITY | 204(mOsm/l) | 260(mOsm/l) | 250(mOsm/l) | 260(mOsm/l) | 250(mOsm/l) | 270(mOsm/l) | 351(mOsm/l) |
OSMOLALITY | 227(mOsm/Kg) | 290(mOsm/Kg) | 280(mOsm/Kg) | 300(mOsm/Kg) | 280(mOsm/Kg) | N/A | N/A |
SUITABLE FOR VEGETARIAN | √ | √ | X | X | X | X | X |
SUITABLE FOR HALAL | √ | √ | X | X | X | X | X |
SUITABLE FOR KOSHER | √ | √ | √ | √ | √ | X | X |
Parents of Babies with Cow’s Milk Allergy Face Long and Emotional Journey
Cow’s milk allergy (CMA) usually develops in the first year of life and is one of the most common food allergies among children. MomenTums.co.uk, powered by Abbott, is a comprehensive resource for parents of children with special nutritional needs, including CMA. A series of practical guides for parents are also available to download from the site. These include: Allergy Versus Intolerance infographic; Preparing to Visit Your Child’s Healthcare Professional; Practical Strategies for Parents; Cookbook of Cow’s Milk Free Recipes for Children.
What is All the Fuss About the Gut Microbiome and 2'-FL?
This article from Dr Akshay Batra, MBBS, MD, MRCPCH, highlights the impact of human milk oligosaccharides (HMOs) on the microbiome and their synergistic relationship; explains the diversity of probiotics in the infant microbiome; and discusses the current research regarding reduction in infant mortality and morbidities.
Hot topics in the dietary management of IBD
In this 18-minute podcast, Lauren Arpe, RD, discusses the latest evidence-based practice in the dietary management of inflammatory bowel disease (IBD); reviews the role of the gut microbiome in relation to IBD; and explores factors that can impact the gut microbiome of patients with IBD.
Footnotes:
DRACMA – Diagnosis and Rationale for Action against Cow’s Milk Allergy. ESPGHAN – European Society for Paediatric Gastroenterology, Hepatology and Nutrition. *In children with multiple food allergies. †Maximum lactose content <68mg/L as fed, <10mg/100kcal. ‡Resulted in zero reactions in two hypoallergenicity studies conducted in Risolac® now called Arize. Rice hydrolysate identical in both formulations. §2’-FL - 2’-fucosyllactose. Structurally identical to that found in breast milk (not sourced from human milk).31 ¶Arize is supplemented with 26 mg/L nucleotides.
References:
1. NICE, 2024. Cow’s milk allergy in children. Available online: https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/ (Last accessed January 2025)
2. Venkataraman D, et al. Clin Exp Allergy. 2018 Apr;48(4):394-402
3. West Suffolk NHS Foundation Trust, 2022. Cow’s milk protein allergy (immediate and delayed symptoms). Available online: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/PaediatricDepartment/6434-1-Cows-milk-protein-allergy-immediate-and-delayed-symptoms.pdf (Last accessed January 2025)
4. Schoemaker AA, et al. Allergy. 2015;70:963–972.
5. Coppola S, et al. Nutrients. 2023 Jul 26;15(15):3328.
6. Vandenplas Y, et al. J Asthma Allergy. 2021 Oct 21;14:1243-1256.
7. Fiocchi A, et al. Pediatr Allergy Immunol. 2010;21(Suppl. 21):1–125.
8. Fiocchi A, et al. World Allergy Organ J. 2016;9(1):35.
9. Koletzko S, et al. J Pediatr Gastroenterol Nutr. 2012;55(2):221–229
10. De Boissieu D, et al. J Pediatr. 1997;131(5):744–747.
11. Caffarelli C, et al. Clin Exp Allergy. 2002;32(1):74–79.
12. Meyer R. J Allergy Clin Immunol Pract. 2018;6(2):383–399.
13. McLeish CM, et al. Arch Dis Child. 1995;73(3):211– 215.
14. Latcham F, et al. J Pediatr. 2003;143(1):39–47.
15. Meyer R, et al. World Allergy Organ J. 2017;10(1):1–8.
16. Birdi G, et al. J Allergy (Cairo). 2016;2016:1497375
17. Lien EL, et al. Prostaglandins Leukot Essent Fatty Acids. 2018;128:26–40.
18. Reche M, et al. Pediatr Allergy Immunol. 2010;21(4 Pt 1):577–585.
19. Vandenplas Y, et al. Eur J Pediatr. 2014;173(9):1209–1216.
20. Bocquet A, et al. Arch Pediatr. 2019;26(4):238–246.
21. Dupont C, et al. Nutrients. 2020;12(9):E2654.
22. Fiocchi A, et al. World Allergy Organ J. 2010;3(4):57–161.
23. Fiocchi A, et al. World Allergy Organ J. 2022;15(12):100717.
24. Vandenplas Y, et al. Nutrients. 2021;13(10):3429.
25. Bejarano R, et al. JSM Nutr Disord. 2022;4(1):1011.
26. Anania C, et al. J Clin Med. 2022;11(16):4823.
27. Fiocchi A, et al. Clin Exp Allergy. 2003;33(11):1576–1580.
28. Fiocchi, A et al. Clin Exp Allergy. 2006;36(3):311–316.
29. Similac® Arize™ datasheet. May 2024.
30. Agostoni C, et al. Pediatr Allergy Immunol. 2007;18(7):599–606.
31. Reverri EJ, et al. Nutrients. 2018;10(10):1346.
32. Marriage BJ, et al. J Pediatr Gastroenterol Nutr. 2015;61(6):649–658.
33. Yau KI, et al. J Pediatr Gastroenterol Nutr. 2003;36(1):37–43.
34. Buck R, et al. Pediatr Res. 2004;56(6):891–900.
35. Goehring KC, et al. J Nutr. 2016;146(12):2559–2566.
36. Abbott. Data on File. Similac Arize. 2021.
37. Bognanni A, et al. World Allergy Organization Journal. 2024; 17:100888.
38. Vandenplas Y, et al. J Pediatr Gastroenterol Nutr. 2024.
39. Althera (Nestle) Data Sheet. October 2024.
40. Aptamil Pepti 1 (Nutricia) Data Card. October 2024.
41. Aptamil Pepti 2 (Nutricia) Data Card. October 2024.
42. Aptamil Pepti Syneo (Nutricia) Data Card. October 2024.
43. Nutramigen 1 with LGG (Mead Johnson) Data Card. October 2024.
44. Nutramigen 2 with LGG (Mead Johnson) Data Card. October 2024.
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1 x 220 ml
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1,5 kcal / ml
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