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Review

Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis

1
Medical Affairs, Nutricia Ltd., White Horse Business Park, Trowbridge BA14 0XQ, UK
2
Institute of Human Nutrition, Faculty of Medicine, Mailpoint 113, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
3
Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading RG6 6AP, UK
4
Department of Nutrition and Dietetics, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
*
Author to whom correspondence should be addressed.
Academic Editors: Diego Peroni, Gian Vincenzo Zuccotti and Elvira Verduci
Received: 19 February 2021 / Revised: 8 March 2021 / Accepted: 10 March 2021 / Published: 14 March 2021
(This article belongs to the Special Issue New Insights into Cow's Milk and Allergy)
Cow’s milk protein allergy (CMPA) is associated with dysbiosis of the infant gut microbiome, with allergic and immune development implications. Studies show benefits of combining synbiotics with hypoallergenic formulae, although evidence has never been systematically examined. This review identified seven publications of four randomised controlled trials comparing an amino acid formula (AAF) with an AAF containing synbiotics (AAF-Syn) in infants with CMPA (mean age 8.6 months; 68% male, mean intervention 27.3 weeks, n = 410). AAF and AAF-Syn were equally effective in managing allergic symptoms and promoting normal growth. Compared to AAF, significantly fewer infants fed AAF-Syn had infections (OR 0.35 (95% CI 0.19–0.67), p = 0.001). Overall medication use, including antibacterials and antifectives, was lower among infants fed AAF-Syn. Significantly fewer infants had hospital admissions with AAF-Syn compared to AAF (8.8% vs. 20.2%, p = 0.036; 56% reduction), leading to potential cost savings per infant of £164.05–£338.77. AAF-Syn was associated with increased bifidobacteria (difference in means 31.75, 95% CI 26.04–37.45, p < 0.0001); reduced Eubacterium rectale and Clostridium coccoides (difference in means −19.06, 95% CI −23.15 to −14.97, p < 0.0001); and reduced microbial diversity (p < 0.05), similar to that described in healthy breastfed infants, and may be associated with the improved clinical outcomes described. This review provides evidence that suggests combining synbiotics with AAF produces clinical benefits with potential economic implications. View Full-Text
Keywords: paediatrics; allergy; cow’s milk protein allergy; synbiotics; gut microbiome; amino acid formula; clinical outcomes paediatrics; allergy; cow’s milk protein allergy; synbiotics; gut microbiome; amino acid formula; clinical outcomes
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MDPI and ACS Style

Sorensen, K.; Cawood, A.L.; Gibson, G.R.; Cooke, L.H.; Stratton, R.J. Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis. Nutrients 2021, 13, 935. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030935

AMA Style

Sorensen K, Cawood AL, Gibson GR, Cooke LH, Stratton RJ. Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis. Nutrients. 2021; 13(3):935. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030935

Chicago/Turabian Style

Sorensen, Katy, Abbie L. Cawood, Glenn R. Gibson, Lisa H. Cooke, and Rebecca J. Stratton 2021. "Amino Acid Formula Containing Synbiotics in Infants with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis" Nutrients 13, no. 3: 935. https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030935

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