D3.234 - Personalized Selection of Milk Formulas for Children with Cow’s Milk Allergy and Histamine Intolerance: Intersection of Innovative Allergy Management and Sustainability

The prevalence of combined cow’s milk allergy (CMA) and histamine intolerance (HIT) in children presents a dual challenge: addressing allergic inflammation and reducing histamine exposure. Extensively hydrolyzed formulas (eHF) and amino acid-based formulas (AAF) are essential in managing CMA, but their suitability for HIT has not been systematically studied. Furthermore, sustainable approaches to formula selection are critical to minimize food waste and promote resource efficiency. Objective: To identify HIT prevalence in children with CMA, evaluate histamine content in commercially available formulas, and propose a personalized selection algorithm aligned with clinical efficacy and sustainability.

Twenty-six children with confirmed CMA were recruited from four centers in Uzbekistan. Histamine and diamine oxidase (DAO) in blood serum were assessed using validated ELISA assays (DRG Instruments GmbH, Germany) following written informed parental consent. Five eHFs from different manufacturers were analyzed for histamine concentration, using HistamineFood ELISA, with whole milk-based formulas as controls. Specific IgE to eHF were determined by dot blot. Data were statistically evaluated to develop a clinical compass-algorithm for formula selection.

Fifty-six percent of CMA children exhibited a borderline HIT index (0.1–0.3), while 15.4% had significant HIT (max 1.5). Histamine concentrations in eHFs ranged from 2.3–3.4 ng/mL, while whole milk-based formulas showed higher levels (13.9–15.9 ng/mL), but all formulas met European standards. The lowest histamine content (1.7 ng/mL) was found in a lactose-free eHF. A personalized formula selection compass-algorithm was developed based on confirmed CMA, sIgE to eHFs, histamine/DAO ratios, clinical tolerance, and sustainability considerations.

This study pioneers a personalized approach to formula selection for children with CMA and HIT, demonstrating the potential for improved health outcomes while addressing global sustainability goals.The proposed algorithm is a practical tool for clinicians, promoting evidence-based dietary recommendations for paediatric allergy management.