Nutricia welcomes publication of the PRESTO study on outgrowth of cow’s milk allergy in the Journal of Allergy and Clinical Immunology

Nutricia is pleased to announce publication in the Journal of Allergy and Clinical Immunology (JACI) of the results of the ‘PRESTO’ study, which examined how quickly infants outgrew cow’s milk allergy when having either an amino acid-based formula or an amino acid-based formula fortified with synbiotics. The study found that infants who received either of these formulas outgrew their cow’s milk allergy in line with clinical expectations.

The article on the PRESTO study in JACI, entitled “Tolerance development in cow’s-milk-allergic infants receiving amino-acid-based formula- a randomized controlled trial”, shows that approximately one-half (49%) of infants with – what is referred to as ‘immunoglobulin E-mediated’ (lgE) – cow’s milk allergy became tolerant to cow’s milk within 12 months. Close to two-thirds (62%) of infants in the study outgrew their allergy within 24 months. 

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Typically, lgE-mediated cow’s milk allergy occurs as gastrointestinal, respiratory and/or skin symptoms, and these symptoms occur immediately after consuming cow’s milk. The PRESTO study shows that the rate at which babies outgrow lgE-mediated cow’s milk allergy is comparable if fed an amino acid-based formula versus reported rates for other hypoallergenic formulas.

Nutricia is supporting research in this field as the global prevalence of allergy steadily rises. Today, up to 40% of the world’s population is estimated to have one or more allergies. Cow’s milk allergy is one of the most common food allergies in formula fed infants. While breastmilk is the best source of nutrition for infants, cow’s milk allergy can at times even affect breastfed babies, since an allergic baby can also detect the cow’s milk protein in their mother’s diet through her breastmilk.

In IgE-mediated cow’s milk allergy, an infant’s immune system reacts to the cow’s milk protein by producing IgE antibodies. In very severe cases, an IgE-mediated allergic reaction could lead to anaphylaxis — a potentially life-threatening allergic reaction that comes on quickly, affects the whole body, and requires medical help straight away. An amino acid-based formula is indicated in more severe cases of cow’s milk allergy, for example when an infant has anaphylaxis, multiple food allergies, faltering growth or when an extensively hydrolysed formula (eHF) is not tolerated.

The PRESTO study was led by a group of international allergy experts at 20 sites in Germany, Italy, Singapore, Thailand, United Kingdom, and the United States. Infants with confirmed IgE-mediated cow’s milk allergy, including those with a history of anaphylaxis and suspected multiple food sensitizations, were randomized to receive either Neocate LCP or Neocate Syneo (an amino acid-based formula supplemented with synbiotics) for 12 months, with follow-up for an additional 2 years.

We’re very happy to see the fast tolerance development, which was similar to observations in other studies, particularly because it has been questioned whether tolerance development in cow’s milk allergy occurs in children on an amino acid-based formula in a similar proportion to children on extensively hydrolyzed formula.

Dr. Kirsten Beyer, Department of Pediatric Respiratory Medicine, Immunology & Critical Care Medicine, Charité University Hospital Berlin, Germany

Since allergies in infants have been linked to lower levels of specific gut microbiota – such as bifidobacteria – hypoallergenic formulas can be supplemented with pre-, pro- and synbiotics (a combination of prebiotics and probiotics) to help balance an infant’s gut microbiota and support the development of the immune system. Results of the PRESTO study also suggest that after 12 months fewer infants, who received the amino acid- based formula supplemented with synbiotics, were hospitalized due to serious infections.

Interestingly, we also saw that children in the PRESTO study, who received an amino acid-based formula with synbiotics required fewer hospitalizations as a result of infection compared with those allocated to an AAF without synbiotics. This preliminary finding is clinically relevant in this group of infants, who may be more susceptible to infections.

Dr. Jane Langford, Global Medical Director – Allergy & GI, Nutricia and co-author of the study

More information on the PRESTO study can be found by visiting Danone Nutricia Research:

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Cow’s Milk Allergy

The global prevalence of allergy is steadily rising, with around 30-40% of the world’s population now affected by one or more allergic conditions.

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