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Do hydrolysed infant formulas reduce the risk of allergic disease?

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1143 (Published 08 March 2016) Cite this as: BMJ 2016;352:i1143

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Hydrolysed formula for the prevention of allergies in children: Australian peak immunology body changes guidelines in light of recent BMJ systematic review

The peak professional body of clinical Australasian immunologists and allergists, the Australasian Society of Clinical Immunology and Allergy (ASCIA) has just published updated 2016 guidelines on the prevention of allergies in infants. [1] They have acknowledged the findings of the recent systematic review and meta-analysis published by Boyle et al. [2] published in the BMJ that there is no consistent convincing evidence to support a protective role for partially hydrolysed formulas or extensively hydrolysed formulas for the prevention of eczema, food allergy, asthma or allergic rhinitis in infants or children. The guidelines now state that “If an infant is not breastfed or is partially breastfed, commercial infant formula should be used until 12 months of age”. The previous 2010 ASCIA guidelines [3] quoted by Boyle et al. recommended partially hydrolysed formulas often with the ‘HA’ or ‘hypoallergenic’ label to be used for the prevention of allergy in children with a strong family history of allergies. This is a welcome development and I would like to congratulate Boyle et al. for carrying out and publishing their review which has had an immediate impact on national guidelines here in Australia. I hope more overseas learned immunology and allergy societies will follow the Australian example soon.

The new change is important as it will potentially reduce costs for families who have been buying the generally more expensive ‘HA’ or ‘hypoallergenic’ brands and again puts breastfeeding rightly back in the limelight. It is important that paediatricians update families on this current available evidence so they can make informed choices for their infants. The big question that will linger on is whether food regulatory agencies such as the Food and Drug Administration (FDA) in the USA or the Food Standards Australia New Zealand (FSANZ) here will take this evidence on board and put new guidance on 'hypoallergenic' labelling of formula milk.

References
[1] Guidelines for allergy prevention in infants. Link: http://www.allergy.org.au/images/pcc/ASCIA_PCC_Guidelines_Allergy_Preven...
[2] Boyle RJ, Ierodiakonou D, Khan T, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ 2016;351:i974.
[3] ASCIA. Infant Feeding Advice. Secondary Infant Feeding Advice 2008.http://www.allergy.org.au/images/stories/hp/info/ASCIA_Infant_Feeding_Ad...

Competing interests: No competing interests

11 March 2016
Clever Banda
Consultant Paediatrician
Senior Lecturer, University of Queensland Hervey Bay Rural Clinical School, Hervey Bay Hospital
Urraween Street, Urraween, QLD 4655, Australia