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Expert Review of Clinical Immunology Volume 9, 2013 - Issue 1
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Perspective

The role of partially hydrolyzed whey formula for the prevention of allergic disease: evidence and gaps

Adrian J Lowe Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia; Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia. [email protected]
,
Shyamali C Dharmage Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia; Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia
,
Katrina J Allen Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia; Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia
,
Mimi LK Tang Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia; Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Australia
&
David J Hill Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
Pages 31-41 | Published online: 10 Jan 2014
 
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Abstract

Hydrolyzed formulae are created by using enzymatic processes to break native proteins into smaller fragments. They may prevent development of allergic diseases by reducing exposure to intact allergens. Partially hydrolyzed whey formula (pHWF) is particularly promising for allergy prevention, as it is cheap to manufacture and palatable. Scientific organizations have recommended the use of hydrolyzed formula in the first 4–6 months of life for the prevention of allergic disease based on a limited number of trials. Three recent developments challenge these recommendations: our growing understanding of the importance of allergen exposure for induction of immune tolerance, recently published evidence that failed to identify a protective effect of pHWF, which the authors and other experts believe will necessitate updating of systematic reviews, and methodological limitations of available trials and systematic reviews on which these recommendations are based. Until more definitive evidence is obtained, the authors recommend continuing to advocate that ‘breast is best’, and caution against overstating the potential for pHWF to prevent allergic disease.

Financial & competing interests disclosure

AJ Lowe was previously supported by Dairy Australia, CRC for Asthma & Airways and VicHealth. Currently, AJ Lowe and SC Dharmage are supported by the Australian National Health & Medical Research Council. KJ Allen is funded by a Vietel Senior Medical Research Fellowship, and has received speaker fees from Abbott, Nutricia and Pfizer. DJ Hill has received support from Nutricia, SHS International and Nestlé for research and has presented lectures at sponsored meetings. MLK Tang is a member of Medical Advisory Boards for Nestlé Nutrition Institute and Nutricia, has sat on advisory committees for Pfizer, and has received payment for speaking engagements with Danone. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

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