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This study is designed as multicentric, interventional, with two successive randomised, double-blind, crossovers. The aim of the study is to demonstrate the tolerance of an extensively hydrolysed anti-regurgitation casein-based formula in infants with cow's milk protein allergy. After a confirmation of the diagnostic, this demonstration will be performed with oral food challenge. Secondarily, a long term tolerance phase will be performed to get growth outcomes with a consumption of the formula compared with a non-enriched formula.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| First cross-over : EHF-STD / AAF | Other | At V2 visit, an OFC is performed with EHF-STD (extensively hydrolysed anti-regurgitation casein-based formula). At V3 visit, an OFC is performed with AAF (amino acid formula). |
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| First cross-over : AAF / EHF-AR | Other | At V2 visit, an OFC is performed with AAF (amino acid formula). At V3 visit, an OFC is performed with EHF-STD (extensively hydrolysed anti-regurgitation casein-based formula). |
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| Second cross-over : EHF-AR / EHF-STD | Other | From V4 to V5 visit, the subject consumes EHF-AR (extensively hydrolysed anti-regurgitation casein-based formula). From V5 to V6 visit, the subject consumes EHF-STD (extensively hydrolysed casein-based formula). |
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| Second cross-over : EHF-STD / EHF-AR | Other | From V4 to V5 visit, the subject consumes EHF-STD (extensively hydrolysed casein-based formula). From V5 to V6 visit, the subject consumes EHF-AR (extensively hydrolysed anti-regurgitation casein-based formula). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Oral Food Challenge V2 | Other | At V2, a randomization is performed and a product is allocated to be administrated in an OFC. According to the randomization the product is EHF-AR or AAF. The progressive doses of 2, 5, 10, 25, 50, and 100 mL are administered to the patient at 15-minute intervals as long as no symptoms appear. If no symptoms appear within 3 hours after administration of the last dose, the product is considered to be tolerated. |
| Measure | Description | Time Frame |
|---|---|---|
| The proportion of infants with CMPA who do not experience any allergic symptoms. | The proportion of infants with CMPA who do not experience any allergic symptoms that lead to study discontinuation, as per the investigator, during the first week following the OFC with the EHF-AR formula, including the OFC period itself (between V2 and V3, or V3 and V4). | 5 months |
| Measure | Description | Time Frame |
|---|---|---|
| Variation of the CoMISS subscores | Variation of the CoMISS subscores (crying, regurgitation, stools, respiratory symptoms, and skin signs) (expressed in arbitrary unit (a.u.), range 0-33) between:
| 9 months |
| Variation of the IGSQ score |
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Inclusion Criteria:
I1. Age ≥ 1 month and < 9 months, I2. Exclusively formula fed and planning to be formula-fed for the duration of the study (food diversification allowed),
I3. With:
a suspicion of CMPA based on suggestive allergic symptoms
a confirmed diagnosis of CMPA within the two months before inclusion:
Exclusion Criteria:
E1. Birthweight < 2500 g, E2. Gestational age < 37 weeks, E3. Breastfeeding at the time of inclusion and throughout the study period, E4. Already fed with an AAF, or with the investigational formula EHF-AR, E5. History of anaphylactic reaction grade 4 or 5 according to classification oFASS-5 (Fernández-Rivas et al. 2022), or of severe FPIES (previous reaction with any change in behaviour from baseline, any pallor and dehydration requiring intravenous fluids), after mammalian milk exposure, E6. Diagnosed or reported fever and/or infectious diseases, or current systemic infections, or history of congenital infections,
E7. History / diagnosis of:
After V1, the participant will be excluded from participation in this trial if he/she fulfils the following criteria:
E12. No allergic symptoms following the OFC with a standard CMPF.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Grégory ALLAIN | Contact | +33 6 65 74 91 49 | gregory.allain@biofortis.fr | |
| Basile FRILLEY | Contact | +33 6 64 08 92 96 | basile.frilley@biofortis.fr |
| Name | Affiliation | Role |
|---|---|---|
| GUERVILLE Mathilde | Lactalis | Study Director |
| Charlotte MAGNANT | Lactalis | Study Director |
| Anaïs LEMOINE |
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Two successive randomised, double-blind, crossovers
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| Product administration between V4 and V5 | Other | At V4, a randomization is performed and a product is allocated for the consumption between V4 and V5. According to the randomization, the product is EHF-AR or EHF-STD. The patient will be fed this product for 2 months. |
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| Oral Food Challenge V3 | Other | At V3, the second product is administrated (EHF-AR or AAF)(cross-over). The progressive doses of 2, 5, 10, 25, 50, and 100 mL are administered to the patient at 15-minute intervals as long as no symptoms appear. If no symptoms appear within 3 hours after administration of the last dose, the product is considered to be tolerated. |
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| Product administration between V5 and V6 | Other | At V5, a second allocation is performed and the second product is consumed between V5 and V6 (EHF-AR or EHF-STD)(crossover). The patient will be fed this product for 2 months. |
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Variation of the IGSQ score (expressed in a.u., range 13-65) from V4 to V5, and from V5 to V6. |
| 9 months |
| Number of TEAEs |
| 9 months |
| Z-scores for age of anthropometric parameters | Z-scores for age of anthropometric parameters (length (cm), weight (g) and head circumference (cm)) at V4, V5 and V6 | 9 months |
| Parents' satisfaction | Rate of parents' answer to the following questions:
| 9 months |
| Hôpital Armand Trousseau - APHP |
| Principal Investigator |