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Impact of Infant Formula on Resolution of Cow's Milk Allergy

Primary Purpose

Milk Allergy

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Lactobacillus GG
Extensively Hydrolyzed Casein Formula
Amino Acid Formula
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Milk Allergy focused on measuring milk, allergy, tolerance

Eligibility Criteria

undefined - 120 Days (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria (to consent):

  • Infants 0-120 days of age with suspected CMA, as determined by the pediatrician or specialist, will be referred to the study. A Standard Operating Procedures (SOP) document will be provided for the clinicians to help guide their referral to the study. Physician diagnosis of CMA will be based on the following:
  • Physician documented, gross or persistent microscopic blood in stool (3 positive guaiac cards on three separate stools) in the absence of other explanation (e.g., fissure, moderate-to-severe constipation) AND / OR

Infant with at least one gastrointestinal, dermatological, or respiratory allergic manifestation suggestive of CMA:

  • Gastrointestinal: Chronic Diarrhea, Constipation or Vomiting/Gastro-esophageal reflux
  • Dermatologic: Atopic Dermatitis or Urticaria
  • Respiratory: Cough, Allergic rhinitis or Recurrent Wheezing
  • General:Colic / Irritability
  • No change in treatment with medications during the 7 days preceding the elimination diet and no expected change in medications during the DBPCFCs (unless otherwise medically necessary)
  • Signed informed consent obtained for infants participation in the study
  • Signed authorization obtained to use and/or disclose Protected Health Information for infant from birth through the length of the study period
  • Willingness to comply with following inclusion criteria if found to have a positive DBPCFC screen:

    1. Caregiver(s) agree to comply with the infant elimination diet given to them by the investigator for the duration of the study
    2. Mother agrees to follow an elimination diet throughout duration of breast feeding
    3. Parent(s) or legally authorized representative agrees not to enroll infant in another interventional clinical study while participating in this study

Inclusion Criteria (to randomization):

  • Positive Double Blind Placebo Controlled Food Challenge (DBPCFC).

Exclusion Criteria (to consent):

  • History of anaphylaxis to milk
  • Use of probiotics
  • Use in the previous 4 weeks of systemic steroids
  • Use of systemic immunomodulatory treatment, including biologics with an immune target such as Xolair
  • Known eosinophilic GI disorders
  • Episode(s) of severe repetitive vomiting and lethargy prompting an emergency room visit and occurring within 4 hours of ingesting a milk protein (i.e. consistent with FPIES)
  • Co-existing autoimmune or other chronic disease or serious health problem, including celiac disease, inflammatory bowel disease, malignancy, congenital, metabolic or genetic disorders or malformations
  • Intention to exclusively breast feed
  • Infants born at less than 36 weeks gestation (35 weeks + 6 days is considered 35 weeks gestation)

Exclusion Criteria (to randomization):

  • Severe reaction to Milk Protein during the DBPCFC

Sites / Locations

  • Massachusetts General Hospital
  • Woburn Pediatric Associates

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Placebo Comparator

Active Comparator

Active Comparator

Arm Label

Amino Acid Formula

EHCF

EHCF + LGG

Arm Description

Extensively Hydrolyzed Casein Formula

Extensively Hydrolyzed Casein Formula + Lactobacillus GG

Outcomes

Primary Outcome Measures

The percentage of subjects who develop tolerance to cow's milk protein by 12 months post randomization to study formula.

Secondary Outcome Measures

Safety as assessed by adverse events graded using the NCI-CTCAE scale by treatment group.
The rate of reported adverse events by treatment group.
Tolerance as assessed by the transcriptional profile of milk-specific T cells by clinical outcome.
Tolerance as assessed by weight for age Z-scores.
Tolerance as assessed by length for age Z-scores.
Tolerance as assessed by weight for length Z-scores.
Tolerance as assessed by stool consistency using the Bristol Stool Chart.
Tolerance as assessed by stool frequency.
Tolerance as assessed by changes in the stool microbiome.
Tolerance as assessed by the estimated frequency of milk-specific T cells by clinical outcome.
Tolerance as assessed by the TCR diversity of milk-specific T cells by clinical outcome.
Tolerance as assessed by the milk allergen component-specific IgE, IgG4 and IgA by clinical outcome.

Full Information

First Posted
October 30, 2015
Last Updated
July 11, 2018
Sponsor
Massachusetts General Hospital
Collaborators
Mead Johnson Nutrition
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1. Study Identification

Unique Protocol Identification Number
NCT02719405
Brief Title
Impact of Infant Formula on Resolution of Cow's Milk Allergy
Official Title
A Prospective Randomized Controlled Trial to Evaluate the Effect of Infant Formula on the Resolution of Cow's Milk Allergy of Infancy
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Terminated
Why Stopped
Insufficient enrollment
Study Start Date
February 2016 (Actual)
Primary Completion Date
February 2018 (Actual)
Study Completion Date
February 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
Mead Johnson Nutrition

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Primary Endpoint -The percentage of subjects who develop tolerance to cow's milk protein by 12 months post randomization to study formula. Secondary Endpoints Tolerance The transcriptional profile of milk-specific T cells by clinical outcome. Growth and Weight Velocity Stool Consistency and Frequency The estimated frequency of milk-specific T cells by clinical outcome. The TCR diversity of milk-specific T cells by clinical outcome. The milk allergen component-specific IgE, IgG4 and IgA by clinical outcome. Safety The rate of reported adverse events by treatment group.
Detailed Description
Cow's Milk Allergy (CMA) is prevalent and most often presents during infancy. Disease manifestations vary through a range of immediate and delayed inflammatory responses to milk protein from anaphylaxis to enterocolitis. The natural history is also highly variable; most children will achieve clinical tolerance early in life, while a minority will have disease persisting to adulthood for reasons that are not known. Most presentations are mild and are managed by restriction or reduction of immunologically intact milk protein with reintroduction sometime after a year of age; however, there are data to suggest that some level of antigenic stimulation may be beneficial. Furthermore, recent data suggest that oral probiotic exposure may also promote tolerance, though the kinetics of tolerance acquisition, the interaction between these two factors (probiotics and milk antigen exposure) and their relationship to regulatory T cell responses are all poorly defined. Therefore, there is an unmet need to identify dietary interventions, along with corresponding immune responses, that favor the promotion of tolerance. A major objective will be to measure the effect probiotics have on the development of tolerance to milk antigen over time. By following these infants during the first year of life, and repeatedly collecting blood and stool samples from them, we will be poised to analyze their stool microbiome signatures, and we will estimate the frequency, phenotype and TCR diversity of milk-specific T cells over time. By repeatedly challenging them with more immunologically intact milk protein, we will better define the kinetics of CMA resolution and its association to these variables. This information is likely to further elucidate CMA disease mechanisms and identify possible biomarkers of disease resolution versus persistence. It will be directly useful for evaluating the efficacy of probiotics and hydrolyzed formula for promoting milk tolerance.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Milk Allergy
Keywords
milk, allergy, tolerance

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Amino Acid Formula
Arm Type
Placebo Comparator
Arm Title
EHCF
Arm Type
Active Comparator
Arm Description
Extensively Hydrolyzed Casein Formula
Arm Title
EHCF + LGG
Arm Type
Active Comparator
Arm Description
Extensively Hydrolyzed Casein Formula + Lactobacillus GG
Intervention Type
Dietary Supplement
Intervention Name(s)
Lactobacillus GG
Intervention Description
Lactobacillus GG
Intervention Type
Dietary Supplement
Intervention Name(s)
Extensively Hydrolyzed Casein Formula
Intervention Description
Extensively Hydrolyzed Casein Formula
Intervention Type
Dietary Supplement
Intervention Name(s)
Amino Acid Formula
Intervention Description
Amino Acid Formula
Primary Outcome Measure Information:
Title
The percentage of subjects who develop tolerance to cow's milk protein by 12 months post randomization to study formula.
Time Frame
12 months post randomization
Secondary Outcome Measure Information:
Title
Safety as assessed by adverse events graded using the NCI-CTCAE scale by treatment group.
Description
The rate of reported adverse events by treatment group.
Time Frame
36 months
Title
Tolerance as assessed by the transcriptional profile of milk-specific T cells by clinical outcome.
Time Frame
36 months
Title
Tolerance as assessed by weight for age Z-scores.
Time Frame
36 months
Title
Tolerance as assessed by length for age Z-scores.
Time Frame
36 months
Title
Tolerance as assessed by weight for length Z-scores.
Time Frame
36 months
Title
Tolerance as assessed by stool consistency using the Bristol Stool Chart.
Time Frame
36 months
Title
Tolerance as assessed by stool frequency.
Time Frame
36 months
Title
Tolerance as assessed by changes in the stool microbiome.
Time Frame
36 months
Title
Tolerance as assessed by the estimated frequency of milk-specific T cells by clinical outcome.
Time Frame
36 months
Title
Tolerance as assessed by the TCR diversity of milk-specific T cells by clinical outcome.
Time Frame
36 months
Title
Tolerance as assessed by the milk allergen component-specific IgE, IgG4 and IgA by clinical outcome.
Time Frame
36 months

10. Eligibility

Sex
All
Maximum Age & Unit of Time
120 Days
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (to consent): Infants 0-120 days of age with suspected CMA, as determined by the pediatrician or specialist, will be referred to the study. A Standard Operating Procedures (SOP) document will be provided for the clinicians to help guide their referral to the study. Physician diagnosis of CMA will be based on the following: Physician documented, gross or persistent microscopic blood in stool (3 positive guaiac cards on three separate stools) in the absence of other explanation (e.g., fissure, moderate-to-severe constipation) AND / OR Infant with at least one gastrointestinal, dermatological, or respiratory allergic manifestation suggestive of CMA: Gastrointestinal: Chronic Diarrhea, Constipation or Vomiting/Gastro-esophageal reflux Dermatologic: Atopic Dermatitis or Urticaria Respiratory: Cough, Allergic rhinitis or Recurrent Wheezing General:Colic / Irritability No change in treatment with medications during the 7 days preceding the elimination diet and no expected change in medications during the DBPCFCs (unless otherwise medically necessary) Signed informed consent obtained for infants participation in the study Signed authorization obtained to use and/or disclose Protected Health Information for infant from birth through the length of the study period Willingness to comply with following inclusion criteria if found to have a positive DBPCFC screen: Caregiver(s) agree to comply with the infant elimination diet given to them by the investigator for the duration of the study Mother agrees to follow an elimination diet throughout duration of breast feeding Parent(s) or legally authorized representative agrees not to enroll infant in another interventional clinical study while participating in this study Inclusion Criteria (to randomization): Positive Double Blind Placebo Controlled Food Challenge (DBPCFC). Exclusion Criteria (to consent): History of anaphylaxis to milk Use of probiotics Use in the previous 4 weeks of systemic steroids Use of systemic immunomodulatory treatment, including biologics with an immune target such as Xolair Known eosinophilic GI disorders Episode(s) of severe repetitive vomiting and lethargy prompting an emergency room visit and occurring within 4 hours of ingesting a milk protein (i.e. consistent with FPIES) Co-existing autoimmune or other chronic disease or serious health problem, including celiac disease, inflammatory bowel disease, malignancy, congenital, metabolic or genetic disorders or malformations Intention to exclusively breast feed Infants born at less than 36 weeks gestation (35 weeks + 6 days is considered 35 weeks gestation) Exclusion Criteria (to randomization): Severe reaction to Milk Protein during the DBPCFC
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wayne G Shreffler, MD, PhD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Woburn Pediatric Associates
City
Woburn
State/Province
Massachusetts
ZIP/Postal Code
01801
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
33006765
Citation
Amari S, Shahrook S, Namba F, Ota E, Mori R. Branched-chain amino acid supplementation for improving growth and development in term and preterm neonates. Cochrane Database Syst Rev. 2020 Oct 2;10(10):CD012273. doi: 10.1002/14651858.CD012273.pub2.
Results Reference
derived

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Impact of Infant Formula on Resolution of Cow's Milk Allergy

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