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Proposed Changes to NHMRCs 2012 Infant Feeding Guidelines submission

ID: 
22
This submission reflects the views of
Organisation Name: 
Infant Nutrition Council
Personal Details
Question 1
Do you agree with the proposed change? If no, please provide rationale and relevant citations: 
Yes, in part – INC recommends against inclusion of the first sentence of the proposed new text and suggests alternative text as set out in 1) and 2) below. INC suggests additions to the second proposed sentence as described in the below in 3) to 6). 1) INC recommends against inclusion of the proposed new text: “There is no evidence that the use of soy or goat’s milk-based formulas will prevent the development of allergies to cow’s milk-based formulas.” The rationale given by the NHMRC for making changes to this section is to provide better clarity and alignment regarding advice on use of soy-based formula. This new statement proposed is providing information with regard to allergy prevention and it is negative statement which is not overly helpful to parents and caregivers. INC recommends a statement about, “reducing the risk of developing allergy,” in preference to, “allergy prevention,” as no formula option, nor breast-feeding, can guarantee prevention of allergic diseases. The further addition of the following statement from the ASCIA, Infant Feeding Advice, 2010, would also be helpful: “Infants are unlikely to develop a new allergy to any milk* that is already tolerated, if it is given regularly.” *suggest replacing ‘milk’ with ‘formula.’ 2) INC agrees that goat’s milk-based formulas are not suitable alternatives for infants with established allergies to cow’s milk-based formulas. 3) However, current Australian paediatric allergy consensus advice (Kemp et al, 2008) is for extensively hydrolysed formulas to be used for these infants, particularly for those infants under 6 months. This accords with the DRACMA Guidelines, that extensively hydrolyzed formulas have proved a useful and widely used protein source for infants suffering from cows’ milk allergy. (Fiocchi et al, 2010 p70). 4) As well, while current Australian paediatric allergy consensus advice (Kemp et al,2008) is that soy milk-based formulas not be recommended for infants under 6 months, soy milk-based formulas can be utilised for infants over 6 months. This is reinforced in the DRACMA Guidelines produced by the World Allergy Organisation (Fiocchi et al, 2010). This is consistent with the following point under the heading of ‘Foods that should be avoided’ in the Summary section of the NHMRC Guidelines (page 6): “Soy (except soy follow-on formula) and other nutritionally incomplete plantbased milks (e.g. rice, oat, coconut or almond milk) are inappropriate alternatives to breast-milk or formula in the first 12 months.” 5) Amino acid formula is recommended as first choice in anaphylaxis and eosinophilic oesophagitis (Kemp et al, 2008). 6) In summary of the above, INC suggests alternative replacement text to that proposed by NHMRC which is: “Goat’s milk-based formulas are not suitable alternatives for infants with allergies to cow’s milk-based formulas.” “Infants under 6 months of age with allergies to cow milk should use an extensively hydrolysed formula under medical supervision or, in certain circumstances, an amino-acid based infant formula. Infants over the age of 6 months with allergies to cow milk may be recommended a soy based formula.” NHMRC may also consider that adding the following statement from the ASCIA, Infant Feeding Advice, 2010, would be helpful: “Infants are unlikely to develop a new allergy to any milk* that is already tolerated, if it is given regularly.” *suggest replacing ‘milk’ with ‘formula.’ References ASCIA, Infant Feeding Advice, 2010 http://www.allergy.org.au/healthprofessionals/papers/ascia-infant-feeding-advice AAAAI. Primary prevention of allergic disease through nutritional interventions: Guidelines for healthcare professionals, Physician Reference Card. American Academy of Allergy, Asthma, and Immunology, 2013 Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, du Toit G, Eigenmann P, Rivas MF, Halken S, Hickstein L, Host A, Knol E, Lack G, Marchisotto MJ, Niggemann B, Nwaru BI, Papdopoulos NG, Poulsen LK, Santos AF, Skypala I, Schoepfer A, van Ree R, Venter C, Worm M, Vlieg-Boerstra B, Panesar S, de Silva D, Soares-Weiser K, Sheikh A, Ballmer-Weber BJ, Nilsson C, de Jong NW, Akdis A. On behalf of EAACI. “Food allergy and anaphylaxis guidelines: primary prevention of food allergy”. Allergy: European Journal of Allergy and Clinical Immunology 2014; 69-8: 590-601. Kemp AS, Hill DJ, Allen KJ, Anderson K, Davidson GP, Day AS, Heine RG, Peake JE, Prescott SL, Shugg AW, Sinn JK. “Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion”. Medical Journal of Australia 2008; 188: 109-112. Fiocchi A, Brozek J, Schunemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S. World Allergy Organisation (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatric Allergy & Immunology 2010; 3(4): 57-161.
Question 2
Do you agree with the proposed change? If no, please provide rationale and relevant citations: 
Yes – INC agrees with the proposed changes as described above.

Page reviewed: 16 September, 2015