The patient report by Tarim et al above describing fatal anaphylaxis in a 7-week-old infant with the introduction of a partially hydrolyzed cow's milk formula (Good Start) deserves the attention of pediatrie practitioners and educators. The authors draw our attention to the fact that we cannot be complacent about hydrolyzed formulas in the management of allergic or high-risk infants. As Businco et al1 documented several years ago in their report of five severe allergic reactions in infants aged 3 to 8 months when fed with a small amount of cow's milk whey protein hydrolysate (AlfaRe), one cannot assume that these formulas are not antigenic. To my knowledge, there is one prospective randomized trial of high-risk infants reported in the literature2 and it has described a protective effect up to 4 years of age of hydrolysate formula compared with cow's milk formula in the first 4 months of life
Harrison GG. Fatal Anaphylaxis in a Very Young Infant Possibly Due to a Partially Hydrolyzed Whey Formula. Arch Pediatr Adolesc Med. 1994;148(11):1228–1229. doi:10.1001/archpedi.1994.02170110110027
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