Plant-based baby formulas meet guidelines but raise new allergy questions

By Pooja Toshniwal PahariaOct 26 2023Reviewed by Susha Cheriyedath, M.Sc.

In a recent review published in the journal Nutrients, researchers reviewed existing data on improved plant-based formulas that comply with European Food Safety Authority (EFSA) and United States Food and Drug Administration (US FDA) guidelines to support infant growth. They also evaluated the impact of plant-based formulas on food allergy risk.

Study: Early Introduction of Novel and Less-Studied Food Allergens in the Plant-Based Era: Considerations for US and EU Infant Formula Regulations. Image Credit:  Created with the assistance of DALL·E 3

The Importance of Early Nutrition

Early childhood eating patterns may affect an individual's health, particularly concerning the incidence of metabolic disorders and allergies. In particular, studies indicate that introducing solid foods after breastfeeding and formula feeding may elevate disease risk in the short- and long-term. Global food allergy-related protocols state that nursing mothers are not required to preclude food allergens and that no baby formula is recommended for allergy avoidance.

Recommendations for introducing solid foods to prevent food allergies include starting with peanuts and well-cooked eggs for infants aged between four and six months and introducing additional food allergens without any further delay.

In recent times, there has been an increasing tendency to feed newborns plant-based formulas and diets due to cultural preferences, health perceptions, and environmental awareness.

Methodology

In the present review, researchers investigated associations between plant-based formulas, infant development, and food allergies. The EMBASE, MEDLINE, Web of Science, CINAHL, Scopus, and Cochrane Library databases were searched for records published in English without geographical limitations but only EFSA and US FDA guidelines.

A Closer Look: Cow's Milk vs. Plant-Based Formulas

Inadequate food intake can hurt a child's development, and cow's milk is crucial to pediatric nutrition. Formulas containing soy and hydrolyzed rice include intact proteins that can aid in child development. Rice is high in critical amino acids, while human milk lacks a few. Hydrolyzed rice formulas, like other hypoallergenic formulas, are fortified with tryptophan, threonine, and lysine to guarantee nutritional sufficiency and development among infants with cow's milk allergy (CMA) and fulfill the micronutrient criteria for baby formulae.

The arsenic concentration in rice formulas is below acceptable limits. In previous studies, hydrolyzed rice formulas, within the initial month of administration, supported normalization of body weight for infant age and length and the z-scores for body mass index (BMI) within six months. Soy-based formulations are enriched with amino acids such as carnitine, taurine, and methionine. The American Academy of Pediatrics (AAP) recommends using soy-based baby formulas to help term non-breastfed newborns fed cow's milk formula grow and develop normally.

A few studies showed that the hydrolyzed rice-based formula ingestion did not cause allergic responses, which are usually related to CMA. A three-study review showed that 10% to 14% of newborns with cow's milk allergy may be allergic to soy formulations. Recent studies have provided significantly lower soy allergy estimates, and current guidelines permit soy-based formulations for CMA children.

Food Allergies and Plant-Based Formulas

Almond and buckwheat are two allergens found in formulas based on almond milk in the United States and the European Union. 2S albumin, the major allergen of almonds, may cause cross-sensitization to walnuts, sunflower seeds, and peanuts. Clinically severe cross-reactions related to main food allergies, on the other hand, are uncommon. Almond allergies were not diagnosed in any six-to-nine-year-old children in Turkey or the United Kingdom, and just 0.2% of UK-based children were diagnosed at three years.

Buckwheat allergy is an uncommon food allergy, including common allergens such as Fag e1, Fag e2, and Flag e3, and Tartary allergens such as Flag t1, Fag t2, and Fag t3. Clinical cross-reactivity with peanuts, latex, coconut, quinoa, and poppy seeds has been described. There are no OFC studies to assess the prevalence rates of buckwheat allergy, and data are scarce on self-reported prevalence, particularly among children and newborns from non-Asian countries. Robust research is needed to determine the true frequency of buckwheat and almond allergies in babies.

According to research, introducing food allergens such as peanuts and eggs to newborns at a young age is critical for avoiding food allergies. However, no study has been conducted to investigate the impact of the age at which buckwheat and almonds are introduced to infants on food allergy incidence. However, research concentrating on particular food items such as egg, milk, or peanuts, or those utilizing food allergen mixtures, indicates that introducing these allergens early and consistently decreases individual food allergies. The most effective dosage of dietary allergens for inducing tolerance is unknown. Severe allergic response risk among early newborns is modest, with a 0.1% chance of occurrence. Thus, food allergens can safely be introduced into infant diets.

Takeaways and Recommendations

Based on the review findings, plant-based dietary formulas are increasingly used to support infant growth, complying with FDA and EFSA guidelines. Examples include those based on buckwheat and almond proteins enriched with amino acids to ensure vitamins, essential amino acids, minerals, omega 3 fatty acids (such as docosahexaenoic acid), and omega 6 fatty acids (such as arachidonic acid) levels.

The prevalence rates of buckwheat and almond allergies remain unclear, and early introduction may increase or decrease the risk. Existing plant-based formulas can be used for managing CMA. Introducing food allergens at an early stage among young infants is safe and is likely to prevent food allergies.