Formula choices in infants with cow’s milk allergy

Abstract

Question I frequently encounter infants with symptoms suggestive of allergy after being introduced to standard cow’s milk formula. Parents are concerned and ask for recommendations regarding formula alternatives. Which formulas are best for children with cow’s milk allergy? Answer Cow’s milk allergy is common, and the criterion standard for diagnosis is elimination, provocation (with a double-blind, placebo-controlled food challenge protocol), and re-elimination. The allergy is treated by eliminating cow’s milk protein from the diet. Formula alternatives include hydrolyzed cow’s milk formula, rice-based formula, soy-based formula, and amino acid–based formula, which are all nutritionally adequate alternatives to cow’s milk formula. Symptom severity, patient preference, cost, and efficacy are factors to be considered when choosing an alternative.