A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: A multi-centre study

A. Fiocchi, P. Restani, R. Bernardini, S. Lucarelli, G. Lombardi, G. Magazzù, G. L. Marseglia, K. Pittschieler, S. Tripodi, R. Troncone, C. Ranzini

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Background: Children allergic to cow's milk are fed a soy- or a hydrolysed cow's milk-based substitute. Neither can rule out a sensitization risk. Previous studies have shown that hydrolysed rice is tolerated by animals and children with multiple food hypersensitivities. Objective: A prospective clinical assessment of tolerance to a rice-based hydrolysed formula was carried out in children allergic to cow's milk. Patients and methods: One hundred children (42 girls and 58 boys, mean age 3.17±2.93 years, median 2.20, range 0.18-14.6 years) with a history of immediate reactions to cow's milk and confirmed at double-blind, placebo-controlled food challenge (DBPCFC) when not contraindicated were assessed for clinical tolerance to cow's milk proteins. Their allergy work-up included skin prick tests with whole milk, α-lactalbumin (ALA), β-lactoglobulin (BLG) and total caseins, and specific IgE determinations using CAP technology were performed against whole milk, ALA, BLG and casein. Sensitization to rice and rice-based hydrolysed formula was similarly investigated. Patients' sera were evaluated at immunoblotting for specific IgE to cow's milk proteins, rice and rice-based hydrolysed formula. DBPCFC was carried out with increasing doses of a rice-based hydrolysed formula. Results: All patients were sensitized to cow's milk and/or at least one cow's milk protein fraction. Eighty-seven out of 99 were positive to cow's milk and/or a cow's milk protein fraction at skin prick test. Positive (>0.35 kUA/L) specific IgE determinations were found for cow's milk and/or milk fractions (92/95), rice (21/91) and hydrolysed rice infant formula (4/91). At immunoblotting, sera from 96 children were positive to α-casein (n=54), β-casein (n=38), ALA (n=57), BLG (n=37) and bovine serum albumin (n=61). Similarly, although patients' sera often contained specific IgE against rice proteins at CAP (21/91) and immunoblotting (70/96), only six very weakly positive responses were observed against rice-based hydrolysed formula. All DBPCFC with rice-based hydrolysed formula were negative. Conclusions: Rice-based hydrolysed formula is a possible alternative not only for children with multiple allergies, but also for children with cow's milk allergy.

Original languageEnglish
Pages (from-to)311-316
Number of pages6
JournalClinical and Experimental Allergy
Issue number3
Publication statusPublished - Mar 2006


  • Food allergy
  • Hydrolysed formula
  • Infant formula
  • Milk hypersensitivity
  • Rice hydrolysate
  • Tolerance

ASJC Scopus subject areas

  • Immunology


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