Breastfeeding improves growth in babies with cow's milk protein allergy: Study

A new study published in the Journal of Evidence-Based Medicine showed that studies with low confidence indicated that pectin-based thickened amino acid-based formula (TAAF) could lower the Scoring Atopic Dermatitis (SCORAD) index.

Over the past 40 years, cow's milk protein allergy (CMPA) has become more common in industrialized nations. Concurrently, atopic dermatitis (AD) manifests early in childhood, with an incidence of 9.6% and a prevalence of almost 20% among newborns and children in Westernized nations. Atopy and AD in the family have long been known to be risk factors for CMPA, and a significant percentage of newborns with CMPA also have early and severe AD.

In order to lower the Scoring Atopic Dermatitis score and encourage growth in newborns with cow milk protein allergy, Tengfei Li and colleagues undertook this study to assess the efficacy of different formulas and the capacity of nursing without cow milk protein.

The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, Embase, ClinicalTrials.gov, WanFang Data, China National Knowledge Infrastructure, Weipu, and the China Biomedical Literature Database were all thoroughly searched by investigators. The time frame for the search was from each database's launch to December 2023 (with an update until January 15, 2025). For babies with cow's milk protein allergies, they considered randomized controlled trials (RCTs) that compared formulas and nursing.

Using the updated Cochrane risk-of-bias 2.0 tool, two independent reviewers evaluated the risk of bias and retrieved data using defined procedures. Using a Bayesian fixed-effects model in RStudio, this research conducted a network meta-analysis (NMA) and used the Confidence in Network Meta-Analysis (CINeMA) web program to evaluate the evidence's level of certainty.

This analysis evaluated 12 therapies and comprised 23 RCTs with 1997 children. The pectin-thickened amino acid formula (TAAF) may lower the SCORAD index when compared to the standard formula.

Breastfeeding may improve the length-for-age Z score (LAZ) at ≤6 months of follow-up when compared to rice-hydrolyzed formula (RHF), and breastfeeding and extensively hydrolyzed formula (EHF) with probiotics may improve the weight-for-age Z score (WAZ) and weight-for-length Z score (WLZ), respectively.

When compared to RHF, EHF may enhance the LAZ and WLZ at the 12-month follow-up, while the amino acid formula (AAF) may improve the WAZ. Overall, breastfeeding may improve the LAZ and WAZ at ≤6 months of follow-up, whereas EHF with probiotics may improve the WLZ, according to moderate- to medium-confidence evidence. 

Reference:

Li, T., Zheng, Q., Xu, J., Li, Y., Zhang, M., Zhang, B., Zhou, L., & Tian, J. (2025). Comparison of 11 formulas and breastfeeding for atopic dermatitis and growth in pediatric cow’s milk protein allergy: A systematic review and Network Meta-analysis of 23 randomized Controlled Trials. Journal of Evidence-Based Medicine, 18(2), e70026. https://doi.org/10.1111/jebm.70026