P35: ACID‐BASED FORMULA WITH SYNBIOTICS MODIFIES GUT MICROBIOTA IN NON‐IGE MEDIATED COW’S MILK ALLERGIC INFANTS

Abstract

Cow's milk allergy (CMA) is associated with an aberrant gut microbiota in early life. Non-IgE mediated CMA is less well understood and symptoms are complex. Previously, it was shown that gut microbiota of non-IgE mediated CMA infants became closer to that of healthy breastfed infants after an intervention with a synbiotics-containing amino acid-based formula (AAF). In a prospective, randomised, double-blind controlled study, effects of an AAF with synbiotics (oligofructose, inulin, B. breve M-16V) were studied on gut microbiota, symptoms, safety and medication use in infants with suspected non-IgE mediated CMA. The infants received either an AAF or an AAF with synbiotics for 8 weeks and use of study products was continued if advised by clinicians. At baseline, 8, 12 and 26 weeks, faecal samples were collected, symptoms recorded and medication use reported. The percentages of faecal bifidobacteria and Eubacterium rectale/Clostridium coccoides (ER/CC) were determined. Microbial composition of faeces was further analysed by16S ribosomal sequencing. At inclusion, mean age (±SD) of infants (n = 71) was 6.00±2.98 months. Subjects had predominantly GI (90%) and dermatological symptoms (10%). Percentage of bifidobacteria at weeks 8, 12 and 26 were higher in those using AAF with synbiotics (36, 42, 41%) vs AAF only (15, 16, 15%) (all P < 0.001). ER/CC was lower in infants on AAF with synbiotics (12, 9, 18%) vs AAF (27, 28, 31%) (all P ≤ 0.001). Diversity increased over time characterised by a gradual increment in the AAF with synbiotics vs those on AAF (Shannon index, difference = -0.026, P = 0.005). Symptoms decreased in both groups. During the study, infants on AAF with synbiotics had less ear infections (0% vs 20%; P = 0.011) and used less dermatologicals (17% vs 45.7%; P = 0.019). Higher bifidobacteria and lower ER/CC were observed in infants receiving AAF with specific synbiotics vs AAF only. Interesting effects were observed at infection rate and medication use.