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Allergy

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Specialized Relief for Baby’s Allergy


Cow’s milk protein (CMP) is the most cause of food allergy

Allergy: A Global Health Problem

1

3

Prevalence of allergy is increasing 1

2 -7 %

Allergy problem during infancy and childhood persists in adulthood 1

%

of infants affected by CMPA

3

CMPA is complex as most infants have 2 or more common symptoms 4

– Prevalence %

of childhood asthma persists

of childhood hay fever persists

Of childhood eczema persists

50% 60%

20% 30%

#1 Factor for

Having

Risk of Allergy

1-2 parents atopic

Family History

the risk of allergy in infant by

40

50% 60%

CMA Symptoms

0

20

60

80

100

Common symptoms of CMPA 4 Dermatological eczema, rashes

Gastrointestinal diarrhea, constipation, vomition

Respiratary wheezing, coughing, respiratory diseases

2

4-12 folds

Delayed diagnosis prolongs distress for infants and their parents, with potential impact on infant growth

2


Primary prevention in the early years may provide long term protection 5

of allergy

Double protection for babies at risk

Recommendations for Allergy Prevention ESPGHAN/ESPACI, 1999 & SP-EAACI, 2008: 6,7

• E xclusive breastfeeding during the first 4-6 months of life. • In bottle fed infants at risk of atopy, formula with reduced allerginicity is recommended 9-13

9

12,13

10

AAP, 2009:

9-13

8

• In bottle fed infants at risk of atopy, the use of extensively or partially hydrolyzed formula is recommended

Allergy protection

Allergenicity of a hydrolysed protein decreases with decreasing chain length and molecular mass of the peptides

Strengthened immune system

Additionally: LCP: for brain and visual development as well as immune system development 14 5 Nucleotides: for growth and maturation of GI tract 15


clinically Proven to be effective

clinically Proven to be effective achieves an anti-allergic immunoglobulin profile 13

Preventive Effect of Prebiotics in

on atopic dermatitis 16

Total plasma lgE

CMP-specific lgG1

p<0.01

p<0.05 1000

1000 [kU/I]

[kU/I]

Standard HA formula

100

100

10

10

p<0.05

Cumulative incidence of atopic dermatits at 1 year [%]

10

0

0 (n=35)

(n=33)

(n=33)

(n=35)

Double-blind, randomized, placebo-controlled study; N=84 infants,(vaccination taken at 3 months)

5

GOS/FOS supplementation the incidence of allergy by immune response without loss of response to vaccination

the allergen specific

reduces the risk of atopic dermatitis in the first 6 months of age9 0 (n=414)

Control group (n=416)

Human milk reference (n=300)

Randomized controlled, double-blind European multi center Trial; N=1187 healthy full term infants

Cumulative incidence at 6 months (%)

30

23%

* p=0.014

20

9.8%

10

0

Control group (n=104)

*

group (n=102)

Prospective, randomized, double-blind, placebo-controlled trial; N=259 infants at risk of atopy (206 completers); intervention period: from 2 weeks till 6 months of age


Recommendations for dietary management of CMPA ESPGHAN, 2012: • B reast-fed infants: A strict CMP-free diet is recommended for mothers • B ottle-fed infants with confirmed CMPA: Extensively hydrolyzed

A Uniquely Designed Formula

17

For infants suffering from mild to moderate CMPA

protein-based formula with proven efficacy is recommended

Extensively hydrolysed formula milk (eHF) – Whey protein

AAP, 2000: • F ormula-fed infants with confirmed CMPA may benefit from the use of 18

• 85%small peptides • 15% free amino acids • Very low allerginicity

extensively hydrolyzed formulae

ESPGHAN/ESPACI, 1999: • P roducts with highly reduced allergenicity based on extensively 19

hydrolysed protein are recommended

• Infants with CMPA and with malasorptive entheropahy should have formula with highly reduced allerginicity without lactose and with MCT 20

meets all Recommendations 17-20

• C linically Proven to relieve mild to moderate CMPA symptoms • A complete formula for infants with mild to moderate CMPA, intolerance and severe malabsoption 11,12

11

Superior palatability to a casein based hydrolysate

Suitable for entheropathy and malabsorption secondary to food allergy:20 • MCT to facilitate absorption (41% of total fat) •Virtually lactose free


Clinical benefits of , Extensively hydrolysed whey formula

Clinical benefits of , Extensively hydrolysed whey formula

is clinically proven to relieve symptoms of CMPA

is clinically proven to be tolerated by 97% of children with CMPA

22

After Feeding

n=46

80

prevalence (%)

60 *p<0.05 40 * 20

*

* *

0

Atopic dermatitis

Inconsollable crying

Vomiting

100

n=46

Colic

Multicenter, randomized, double-blind trial, N=46 infants (< 4 months old), 10-12-wk intervention period

% of children tolerating the formula

Before Feeding

23

90

97%

80

Required infant formula tolerance

94%

70 60

64%

50 0 n=31

Standard extensively hydrolysed n=26

Standard partially hydrolysed n=25

Double blind, Placebo, controlled study, N= 32 infants, average age=37 months ( 11-129 months)


provides the complete solution for Allergy, from Prevention to Treatment

partial Hydrolysate Formula (pHF)

extensive Hydrolysate Formula (eHF)

for Prevention with double protection for babies at risk of allergy:

for mild to moderate allergy and severe malabsorption

• 100% partially hydrolyzed whey protein for allergy prevention • Patented prebiotic mixture scGOS/lcFOS (9:1) for strengthened immune system

• 100% extensively hydrolyzed whey protein • MCT for easier fat absorption • Virtually lactose free

Breast Feeding is best for babies. Aptamil Infant milks are intended to replace breast milk when mothers cannot or choose not to breastfeed. It is recommended that infant milks are used only on advice of the doctor. Follow-on milks should be used as part of the mixed diet and not as a breastmilk substitute before 6 months.

1. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006 Oct 18;CD003664. 2. Bousquet J, Menardo JL, Robinet Levy M, Michel FB, Maglichkeiten der Vorhersage allergischer Erkrankungen im Sauglingsalter,In: Aktuelle Probleme der pad, Allergologie, Wahn U,Gustav Fischer 1983 Stuttgart, 43-54. 3. Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr 1986;109; 270-6. 4. Høst A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma immunol 2002;89 (Suppl 1):33-37. 5. Worth, A, and A, Sheikh, Food allergy and atopic eczema. Curr Opin Allergy Clin Immunol. 2010. 10(3): p226-30. 6. Recommendations for Allergy Prevention ESPGHAN/ESPACI 1999. 7. SP-EAACI 2008. 8. Ananth Thygarajan’, M.D. and A. Wesley Burks, M.D.American Academy of Pediatrics recommendations on the Effects of Early Nutritional Interventions on the Development of Atopic Disease.Ananth Thygarajan’, M.D. and A. Wesley Burks, M.D. Curr Opin Pediatr. Author manuscript; available in PMC 2009. 9. Moro G, Arslanoglu S, Stahl B, Jelinek J, Wahn U, Boehm G. A mixture if prebiotic oligosaccharides reduces the incidence of atopic dermatitis during first six months of age. Arch Dis Child 2006;91:814-9. 10. Haarman M, Knol J. Quantitative real-time PCR assays to identify and quantify fecal Bifidobacterium species in infants receiving a prebiotic infant formula. Appl Environ Microbiol 2005;71:2318-24. 11. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr 2008;138:1091-5. 12. Vos AP, Haarman M, Buco A, Govers M, Knol J, Garssen J, Stahl B, Boehm G, M’Rabet L. A specific prebiotic oligosaccharide mixture stimulates delayed-type hypersensitivity in a murine influenza vaccination model Int immunophamacol 2006;6:1277-86. 13. Van Hoffen E,Ruiter B,Faber J,M’Rabet L,Knol EF,Stahl B,Arslanoglu S,Moro G,Boehm G,Garssen J.A specific mixture of short-chain galacto-oligosaccharides and long-chain fructo oligosaccharides includes a beneficial immunoglobulin profile in infants at high risk for allergy. Allergy 2009;64:484-7. 14. Carver JD.Advances in nutritional modifications of infant formulas. Am J Clin Nutr. 2003 ;77(6):1550S-1554. 15. Carver JD. Dietary nucleotides: effects on the immune and gastrointestinal systems. Acta Paediatr 1999;430:83-8. 16. Grüber C, van Stuijvenberg M, Mosca F, Moro G, Chirico G, Braegger CP, Reidler J, Boehm G, Wahn U, MIPS 1 working Group. Reduced occurrence of early atopic dermatitis because of immunoactive. 17. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y.Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012 ;55(2):221-9. 18. AAP 2000. 19. European Society for Paediatric Gastroenterology Hepatology and Nutrition Source Host A, et al. Arch Dis child. 1999; 81: 80-84. 20. Host A, Koletzko B, Dreborg S, Muraro A, Wahu U, Aggett P, Bresson JL, Hernell O, Lafeber H, Michaelsen KF, Micheli JL, Rigo J, Heymans H, Strobel S, Vandenplas Y. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of ESPACI and, ESPACI and, ESPGHAN. Arch Dis Child 1999;81:80-4. 21. Knol J, van der Linde EGM, Wells JCK, Böckler HM. An infant formula containing prebiotics changes the intestinal microbiota of term infants. J Pediatr Gastroenterol Nutr 2003;36:566. 22. Verwimp JJ, Bindels JG, Barents M, Heymans HS. Symptomatology and growth in infants with cow’s milk protein intolerance using two different whey-protein hydrolysate based formulas in a Primary Health Care setting. EUR J Clin Nutr 1995;49:539-48. 23. Giampietro PG, Kjellman NI, Oldaeus G, Wouters-Wesseling W, Businco L. Pediatr Allergy Immunol 2001; 12 (2): 83–6

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