Intervention Review

Soy formula for prevention of allergy and food intolerance in infants

  1. David A Osborn2,
  2. John KH Sinn1,*

Editorial Group: Cochrane Neonatal Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 26 JUL 2006

DOI: 10.1002/14651858.CD003741.pub4


How to Cite

Osborn DA, Sinn JKH. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003741. DOI: 10.1002/14651858.CD003741.pub4.

Author Information

  1. 1

    Royal North Shore Hospital, Neonatal Unit, St. Leonards, New South Wales, Australia

  2. 2

    Royal Prince Alfred Hospital, RPA Newborn Care, Camperdown, New South Wales, Australia

*John KH Sinn, Neonatal Unit, Royal North Shore Hospital, Level 5, Douglas Building, Pacific Hwy, St. Leonards, New South Wales, 2065, Australia. jsinn@med.usyd.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Allergies and food reactions in infants and children are common and may be associated with a variety of foods including adapted cow's milk formula. Soy based formulas have been used to treat infants with allergy or food intolerance. However, it is unclear whether they can help prevent allergy and food intolerance in infants without clinical evidence of allergy or food intolerance.

Objectives

To determine the effect of feeding adapted soy formula compared to human milk, cow's milk formula or a hydrolysed protein formula on preventing allergy or food intolerance in infants without clinical evidence of allergy or food intolerance.

Search methods

The standard search strategy of the Cochrane Neonatal Review Group was used. Updated searches were performed of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), CINAHL (1982 - March 2006) and previous reviews including cross references.

Selection criteria

Randomised and quasi-randomised trials that compare the use of an adapted soy formula to human milk, an adapted cow's milk or a hydrolysed protein formula for feeding infants without clinical allergy or food intolerance in the first six months of life. Only trials with > 80% follow up of participants and reported in group of assignment were eligible for inclusion.

Data collection and analysis

Eligibility of studies for inclusion, methodological quality and data extraction were assessed independently by each review author. Primary outcomes included clinical allergy, specific allergies and food intolerance. Where no heterogeneity of treatment effect was found, the fixed effect model was used for meta-analysis. Where significant or apparent heterogeneity was found, results were reported using the random effects model and potential causes of the heterogeneity were sought.

Main results

Three eligible studies enrolling high risk infants with a history of allergy in a first degree relative were included. No eligible study enrolled infants fed human milk. No study examined the effect of early, short term soy formula feeding. All compared prolonged soy formula to cow's milk formula feeding. One study was of adequate methodology and without unbalanced allergy preventing co-interventions in treatment groups. One study with unclear allocation concealment and 19.5% losses reported a significant reduction in infant allergy, asthma and allergic rhinitis. However, no other study reported any significant benefits from the use of a soy formula. Meta-analysis found no significant difference in childhood allergy incidence (2 studies; typical RR 0.73, 95% CI 0.37, 1.44). No significant difference was reported in one study in infant asthma (RR 1.10, 95% CI 0.86, 1.40), infant eczema (RR 1.20, 95% CI 0.95, 1.52), childhood eczema prevalence (RR 1.10, 95% CI 0.73, 1.68), infant rhinitis (RR 0.94, 95% CI 0.76, 1.16) or childhood rhinitis prevalence (RR 1.20, 95% CI 0.73, 2.00). Meta-analysis found no significant difference in childhood asthma incidence (3 studies, 728 infants; typical RR 0.71, 95% CI 0.26, 1.92), childhood eczema incidence (2 studies, 283 infants; typical RR 1.57, 95% CI 0.90, 2.75) or childhood rhinitis incidence (2 studies, 283 infants; typical RR 0.69, 95% CI 0.06, 8.00). One study reported no significant difference in infant CMPI (RR 1.09, 95% CI 0.45, 2.62), infant CMA (RR 1.09, 95% CI 0.24, 4.86), childhood soy protein allergy incidence (RR 3.26, 95% CI 0.36, 29.17) and urticaria. No study compared soy formula to hydrolysed protein formula.

Authors' conclusions

Feeding with a soy formula cannot be recommended for prevention of allergy or food intolerance in infants at high risk of allergy or food intolerance. Further research may be warranted to determine the role of soy formulas for prevention of allergy or food intolerance in infants unable to be breast fed with a strong family history of allergy or cow's milk protein intolerance.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Soy formula for prevention of allergy and food intolerance in infants

When babies are not exclusively breastfed, evidence suggests that using a soy formula instead of a cow's milk formula does not reduce allergies in infants and children. Infant formulas have been designed to try to lower the chances of developing allergy or food intolerance. These formulas include hydrolysed cow's milk and soy formulas. A review of trials found that in infants at high risk of allergy who are unable to completely breastfeed, there is no reduction in allergies in later infancy and childhood associated with feeding soy formula compared to a cow's milk formula. No eligible studies were found that compared a soy with a hydrolysed protein formula.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在嬰兒身上使用大豆配方來預防過敏及食物的不耐性

在嬰兒與小孩中過敏和對食物產生反應是常見的; 且可能與許多食物有關包括牛奶配方。以大豆為基礎的配方已經被使用在治療罹患過敏與食物不耐性的嬰兒。然而對於未有過敏或食物不耐性的嬰兒它們是否能夠預防過敏與食物不耐的發生仍未明確。

目標

比較食用大豆配方與母奶; 牛奶或水解蛋白配方用於未有過敏或食物不耐性的嬰兒; 以預防過敏與食物不耐性的發生。

搜尋策略

使用Cochrane Neonatal Review Group的標準搜尋策略。搜尋更新的Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966  March 2006), EMBASE (1980  March 2006), CINAHL (1982  March 2006) 及先前的回顧包括參考文獻

選擇標準

隨機及半隨機取樣的試驗比較食用大豆配方與母奶; 牛奶或水解蛋白配方於沒有臨床過敏與食物不耐性的最初六個月大的嬰兒身上。此研究當中只有參與者的追蹤率超過80% 及按分配組別報告的試驗被納入。

資料收集與分析

研究是否適合納入; 研究方法的品質; 實驗數據的擷取是由個別作者獨立評估。主要的結果包括臨床上有過敏; 特殊的過敏及食物不耐性。各治療效果若沒有差異性就以固定效應模式做統合分析。若結果有顯著差異則報告以隨機效應模式呈現,並探討可能的原因。

主要結論

三個符合規定的研究網羅在ㄧ等親內具有過敏的高危險性嬰兒。符合條件的研究沒有納入餵母乳的嬰兒。沒有研究檢視早期及短期大豆配方餵食的效果。所有研究皆做長期餵食大豆與牛乳配方的比較。一個研究方法學適當且在治療組中預防過敏的介入處置一樣。一個試驗對象分配不明確且19.5% 失去追蹤的研究報告嬰兒的過敏,氣喘與過敏性鼻炎有顯著的減少。然而沒有其他的研究顯示使用大豆配方具有好處。統合分析發現在兒童過敏發生率上沒有顯著的不同 (兩個研究結果; typical RR 0.73, 95% CI 0.37, 1.44). 一個研究報告顯示下列結果皆無顯著差異: 嬰兒氣喘 (RR 1.10, 95% CI 0.86, 1.40) 、嬰兒溼疹 (RR 1.20, 95% CI 0.95, 1.52) 、兒童溼疹盛行率 (RR 1.10, 95% CI 0.73, 1.68) 、嬰兒鼻炎 (RR 0.94, 95% CI 0.76, 1.16) 或兒童鼻炎盛行率 (RR 1.20, 95% CI 0.73, 2.00). 統合分析發現下列結果無顯著差異:兒童氣喘發生率 (三個研究; 728個嬰兒; typical RR 0.71, 95% CI 0.26, 1.92) ,兒童濕疹盛行率 (兩個研究; 283個嬰兒; typical RR 1.57, 95% CI 0.90, 2.75) 或兒童鼻炎發生率 (兩個研究; 283個嬰兒; typical RR 0.69, 95% CI 0.06, 8.00). 一個研究報告下列結果沒有顯著差異:嬰兒CMPI (RR 1.09, 95% CI 0.45, 2.62) 、嬰兒CMA (RR 1.09, 95% CI 0.24, 4.86) 、兒童大豆蛋白過敏發生率 (RR 3.26, 95% CI 0.36, 29.17) 及蕁麻疹。沒有比較大豆配方與水解蛋白配方的研究報告。

作者結論

無法建議以大豆配方餵食以預防高風險嬰兒罹患過敏或食物不耐性。未來的研究需要確定在無法哺乳卻又具有強烈的過敏或牛奶不耐性家族史的嬰兒身上,大豆配方預防過敏或食物不耐的角色。

翻譯人

本摘要由高雄醫學大學附設醫院鍾宇倫翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

當嬰兒無法單靠母乳哺育時,研究證據說明使用大豆配方取代牛奶產品並不能減少嬰兒及兒童罹患過敏。嬰兒配方已經試圖降低可能產生過敏及食物的不耐性。這些配方包括水解牛奶及大豆配方。試驗回顧發現在無法完全以母乳哺育的過敏高風險嬰兒使用大豆配方取代牛奶產品並不能減少嬰兒及兒童在往後的日子裡罹患過敏。