About Campaign

The prevalence of allergic diseases worldwide is rising dramatically.(1,2) These allergic diseases include atopic dermatitis/eczema, food allergy(3), asthma and rhinitis. CMPA is one of the most common food allergies among infants, which can affect up to ~5% of the worldwide population(2). It is acknowledged that both eczema and food allergy may progress into allergic asthma and rhinitis later in life, a phenomenon generally described as the atopic march. Overall, the epidemic of allergic disease points to specific vulnerabilities of the developing immune system to modern environmental changes and challenges. As a consequence, preventing the first onset of allergic manifestations might have a long lasting beneficial impact on the further development to severe, chronic manifestations such as asthma and allergic rhinitis(4) and potentially Non Communicable Diseases.

1+1>2 campaign aims to increase awareness about CMPA preventing strategies in high risk non breast fed infants through nutrition, based on the recommendation of international guidelines.

Please watch the video to know more about the campaign

ALLERGIES ARE ON THE RISE:

30-40% OF THE WORLD POPULATION IS NOW ALLERGIC

The prevalence of allergic diseases is rising dramatically worldwide in both developed and developing countries, affecting 30 to 40% of the world population today(1,2). Food allergies affect up to 8% of infants and young children globally(5) and cow’s milk protein allergy (CMPA) is one of the key food allergies in infants and children.(6,8) The burden of allergic diseases are also rapidly increasing in developing countries, It is predicted that allergies will affect up to 4 billion people globally.(9,10)

ENVIRONMENTAL FACTORS MAY HAVE A ROLE IN INCREASING THE RISK OF DEVELOPING ALLERGIES

GUT MICROBIOTA DYSBIOSIS CHALLENGES THE DEVELOPMENT OF A HEALTHY IMMUNE RESPONSE

GUT MICROBIOTA DYSBIOSIS

Lower levels of beneficial bacteria (i.e. Bifidobacterium breve) may impair development of appropriate immune response, which can affect the ability to recognise substances as harmful or harmless.(26,27)

GUT MICROBIOTA ALTERATIINS ASSOCIATED WITH FOOD AlLLERGIES

Infants with food allergies such as CMA have been shown to have low levels of bifidobacteria and lactobacilli in their gut mcrobiota compared with healthy, breast-fed infants.

Strong rationale for the need of gut microbiota modification in the dietary prevention and management of allergy

BEYOND DIGESTIVE FUNCTION THE GUT IS OUR LARGEST IMMUNE ORGAN

Early life is a critical period, as the infant’s immune system is still maturing and is influenced by the gut microbiota.(33)
There is high potetial for crosstalk between the gut microbiota and the immune system as 70-80% of immune cells reside in the gut microbiota.(34) It consists of several types of lymphoid tissue, e.g. Peyer’s patches, known as the gut-associated lymphoid tissue (GALT).(35,36)
The GALT is important both for defense and tolerance as it plays a critical role in developing and sustaining immune balance.(34,37)

Microbial interactions are important drivers in the maturation of the immune system. So maintaining(37) a healthy gut with balanced microbiota could be a first step in food allergy prevention.

EXPERT RECOMMANDATION FOR PRIMARY ALLERGY PREVENTION IN INFANCY

The primary recommendation by experts and authorities to reduce the risk of developing allergic disease is via the route of exclusive breastfeeding for 4-6 months and the introduction of complementary foods by the age of 4-6 months with concurrent breastfeeding (39).

If breastfeeding is not possible, many scientific authorities recommend infant formula with a partially hydrolyzed protein for infants at increased risk of allergy development based on family history of allergy. These authorities include the European and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESGPHAN / NASGPHAN) (40,41), the European Academy of Allergy and Clinical Immunology (EAACI) (39), the American Academy of Pediatrics (AAP) (42) and the National Institute of Allergy and Infectious Diseases (NIAID). (43)

BREAST MILK IS ONE OF THE KEY INFLUENCERS OF GUT MICROBIOTA TO SUPPORT DEVELOPMENT OF HEALTHY IMMUNE RESPONSE

In addition to controlled exposure to antigen via hydrolyzed proteins, there is increasing evidence that additional/complementary nutritional supplementation by using prebiotic and probiotic supplementation to infant formula could have a positive influence on imbalances in the immune system leading to allergy, by influencing immunological and microbiological mechanisms. The combination of specific prebiotics and probiotics has been demonstrated to support the development of a healthy gut microbiota.

BREASTMILK NATURALLY TRAINS THE IMMUNE SYSTEM VIA (44,45)

EVOLUTION OF CARE

FROM AVOIDANCE TO ACTIVE TOLERANCE DEVELOPMENT

ORAL TOLERANCE DEVELOPMENT IS THE ULTIMATE ALLERGY PREVENTION

Therefore, probiotics and prebiotics are now also part of propositions in allergy prevention: In the most recent World Allergy Organization (WAO)-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P), the use of prebiotic and probiotic supplementation is conditionally recommended, based on the GRADE approach (www.gradepro.org)

NUTRICIA PROPOSITION FOR DIETRY MANAGEMENT OF ALLERGY PREVENTION

Nutricia allergy prevention strategy is based on reducing sensitization and promoting tolerance to reduce the risk of allergic disease, via combination of hydrolysed protein and microbiota modulating factors (prebiotics and probiotics).

SYNBIOTIC : PREBIOTICS + PROBIOTICS

HUMAN MILK OLIGOSACCHARIDES ARE THE REFFERENCE

The prebiotic mixture (scGOS/lcFOS 9:1) developed by Nutricia Research has been designed to mimic the molecular structures, profile (9:1) , amount (0.8 g/100ml) and beneficial effects of the complex human milk oligosaccharides combination also found in human(HMOs) (71).

BIFIDOBACTERIA AND LACTOBACILLI ARE COMMONLY ISOLATED BACTERIAL SPECIES IN HUMAN MILK (74)

Human milk has been shown to be a continuous source of commensal, mutualistic and/or probiotic bacteria for the infant gut.(74) They are present in relatively low levels 10³-10⁵ Colony Forming Units/ml bacteria.(75) There is high variability (among different human milk samples) in term of different species that can be isolated. (75) The most commonly isolated bifidobacterial species from human milk, is Bifidobacterium breve (B. breve). It is a natural species in the infant gut and is one of the predominant bifidobacterial species in breastfed infants. By including this probiotic strain to infant formula would bring it even closer to human milk. The specific strain B. breve M-16V was selected, because this strain has a well-established safety and has allergy reducing potential. (76)

SYNEO: THE UNIQUE COMBINATION OF PREBIOTIC AND PROBIOTIC

SYNEO is supported by more than 40 years of Human Milk research

SYNEO HAS GREATER EFFECTS THAN EITHER PREBIOTIC AND PROBIOTC ALONE

THE HEALTH BENEFITS OF OUR SPECIFIC GOS/FOS PREBIOTIC MIXTURE

The health benefits of scGOS/lcFOS (9:1) are validated in over 30 clinical studies, described in more than 55 scientific publication and include:

STRONG SCIENTIFIC SUBSTANTIATION (30 STUDIES) FOR OUR SPECIFIC GOS/FOS PREBIOTIC FIBRE (98-101)

BIFIDOBACTERIUM BREVE M-16V IS A POWERFUL PROBIOTIC COMPONENT IN SYNEO

A POWERFUL PROBIOTIC COMPONENT IN SYNEO BIFIDOBUCTERIUM BREVE IS INSPIIRED BY NATURE

A POWERFUL PROBIOTIC COMPONENT IN SYNEO BIFIDOBACTERIUM BREVE IS SAFE

PRECLINICAL EVIDENCE SHOWS BIFIDUBACTERIUM BREVE M-16V IS EFFECTIVE (109)

BIFIDOBUCTERIUM M-16V IS IMMUNOPOTENT IN ALLERGIC MODELS

EFFICACY OF BIFIDOBACTERIUM BREVE M-16V IS SCIENTIFICALLY SUPPORTED BY CLINICAL EVIDENCE (110)

TOLEROGENIC CAPACITY

Hydrolysis of the protein and reduced allergenicity alone are not the only elements needed for allergy prevention. A balance is required between reduced allergenicity and the ability to still influence the immune response positively (tolerogenic capacity). Currently, hydrolysed infant formulas are characterized mainly by methods that provide information on the degree of hydrolysis and the molecular weight or peptide size distribution. Although important and informative, these do not provide any compositional information about the peptides present in the formula. Especially with the current understanding of peptide specificity in relation to immune modulation, structural information is crucial to understand the overall biological activity a hydrolysed infant formula might possess.

An intact protein can contain fragments that are seen as harmful epitopes and would elicit an allergic response by activating T-helper 2 cells. Or it can contain tolerogenic epitopes that are recognised as harmless and would induce tolerance by activating T regs.

Epitopes should contain at least 9 amino acids, as this is the minimal size for binding to antigen presenting structures and subsequent T cell recognition. The presence of tolerogenic epitopes in a partially hydrolysed infant formula is thus essential for the induction of cow’s milk-specific T-regs and subsequent oral tolerance development.

NUTRICIA HYDROLYSED FORMULA HAS THE POTENTIAL TO SUPPORT ORAL TOLERANCE VIA IT’S FUNCTIONAL PEPTIDES WITH TOLEROGENIC CAPACITY

NUTRICIA INNOVATIVE PARTIALLY HYDROLYZED PROTEIN CONTAINING FORMULAS COULD BE AN IMPOROVED SOLUTION FOCUSING ON ORAL TOLERANCE AND MICROBIOME DEVELOPMENT (111)

PATCH STUDY (111)

The PATCH study was a multi center, multi-country double-blind randomised controlled clinical trial, set up to prove the efficacy of the pHP formula with specific prebiotic mixture including scGOS/lcFOS versus intact cow’s milk formula, in reducing the risk of eczema (primary objective) and allergic manifestations in high risk infants up to 3-5 years of age following an observational follow-up study (primary objective PATCH Follow up). More than 1000 infants at risk were included from 3 geographical locations (UK-IR, SGP, AU).

PATCH STUDY SHOWS THAT CONTROLLED PROTEIN EXPOSURE + GUT MICROBIOTA MODULATION CAN BE AN EFFECTIVE APPROACH (112-118)

JULIUS STUDY

Effcet of synbiotic on the gut microbiota of cesarean deliverd infants: A Randomized, Double-blind, Multicenter Study

SYNEO TM HAS BEEN SHOWN TO MODULATE THE BALANCE OF GUT MICROBIOTA AND POTENTIAL TO REDUCE THE DEVELOPMENT OF ATOPIC DERMATITIS/ECZEMA (61,89)

A COMPREHENSIVE CLINICAL TRIAL PROGRAMME IS UNDERWAY

A WORLDWIDE NETWORK FOR THE CLINICAL TRIAL PROGRAME

WHO IS ELIGIBLE FOR NUTRICIA HA PROSYNEO

NUTRICIA

PIONEERING SOLUTIONS IN ALLERGY

NUTRICIA 40 YEARS OF INNOVATION IN ALLERGY

* Amino Acid Formula ** Extensively Hydrolysed Formula

References