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Help Build Oral Tolerance to Cow’s Milk Protein Several steps, including food challenges, are often required to identify CMA. The ultimate goal of the dietary management of CMA is not only to modify the course of the allergy, but to build oral tolerance, meaning that the infant does not react negatively to cow’s milk proteins†. Recent studies have demonstrated that an infant with CMA can build tolerance to cow’s milk when fed an extensively hydrolyzed formula with the added probiotic LGG®1-3,‡. In one study with otherwise healthy infants referred to a tertiary care allergy center for suspected CMA, more infants built a tolerance to cow’s milk protein after 6 months (P=0.004) and 12 months (P=0.027) of feeding Nutramigen® with LGG vs Nutramigen without LGG1,2. LGG is the most extensively studied probiotic for allergy management. Nutramigen Nutramigen LGG 90 80 P=0.0274 81% Infants who built tolerance (%) 70 60 P=0.0044 50 59% 54% 40 30 20 21% 10 0 At 6 months Cumulative at 12 months R esults persisted 6 months after last food challenge †Tolerance is the presence of a negative, double-blind, placebo-controlled food challenge in the study. ‡ LGG is a registered trademark of Valio Ltd. Extensively hydrolyzed proteins + LGG helps build oral tolerance sooner The results show the selection of a particular type of formula influences tolerance building in infants with CMA1. These two studies suggest that infants affected with CMA who received extensively hydrolyzed casein formula (EHCF) containing LGG built tolerance more frequently than those receiving other formulas or formula without LGG in the study1-3,†. Cumulative after 12 months 80 79% 80% more infants built oral tolerance than closest study group 70 Infants who built tolerance (%) In a second study, Nutramigen® LGG® was demonstrated to help more infants build tolerance to cow’s milk than other formulas used in the study for CMA management after 12 months of feeding (P<0.05)3. 60 50 44% 40 33% 30 24% 20 10 0 Nutramigen LGG Extensively hydrolyzed casein formula (EHCF) Rice hydrolysate formula (RHF) Soy formula (SF) 18% Amino acid formula (AAF) Studies did not include Nutramigen® LGG® Toddler. †EHCF: Nutramigen®, Nutribén hydrolyzed®, RHF: Risolac®, SF: Isomil®, Sinelac®, Nutrilon Soya, AAF: Neocate®, Nutramigen AA® or Sineall® Nutramigen LGG—first line for infants with CMA Nutramigen LGG has proven results and it works fast, when colic is due to CMA4. About 90% of infants with colic due to CMA experienced relief within 48 hours4. For those infants with suspected CMA, adding the probiotic LGG to an eHF (extensively hydrolyzed formula) results in 0% of infants with blood in stools vs 64% in Nutramigen without LGG at 4 weeks5. Nutramigen LGG is WIC®‡ eligible in all 50 states, regardless of who has the state Women, Infants and Children Program contract. References: 1. Berni Canani R, et al. J Allergy Clin Immunol. 2012;129:580-582. 2. Berni Canani R. email. April 23, 2012. 3. Berni Canani R et al. J Pediatr. 2013;163:771-777. 4. Lothe L, et al. Pediatrics. 1989;83:262-266. 5. Baldassarre ME et al. J Pediatr. 2010;156:397-401. ‡ WIC is a registered trademark of the United States Department of Agriculture (USDA) for Women, Infants and Children Program. Nutribén hydrolyzed, Risolac, Isomil, Sinelac, Nutrilon Soya, Neocate and Sineall are registered trademarks of entities unrelated to Mead Johnson & Company, LLC.