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Article

Clinical Phenotypes of Severe Cow’s Milk Protein Allergy with Various Responses to Amino Acid-Based Formula

by
Łukasz Błażowski
1,2,
Daniela Podlecka
3,4,*,
Agnieszka Brzozowska
3,4,
Joanna Jerzyńska
3,4,
Michał Seweryn
5,
Marcin Błażowski
6 and
Paweł Majak
4,7
1
Department of Allergology and Pulmonology, National Research Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, Poland
2
Department of Pathophysiology, Institute of Medical Sciences of Rzeszow University, Rzeszow, Poland
3
Department of Pediatrics and Allergy, Medical University of Lodz, 90-419 Lodz, Poland
4
Korczak Pediatric Center, 92-328 Lodz, Poland
5
Biobank Laboratory, Department of Molecular Biophysics, University of Lodz, 90-136 Lodz, Poland
6
Specialist Hospital, 38-200 Jaslo, Poland
7
Department of Pediatric Pulmonology, Medical University of Lodz, 90-419 Lodz, Poland
*
Author to whom correspondence should be addressed.
Nutrients 2025, 17(11), 1809; https://doi.org/10.3390/nu17111809
Submission received: 17 April 2025 / Revised: 14 May 2025 / Accepted: 23 May 2025 / Published: 26 May 2025
(This article belongs to the Section Proteins and Amino Acids)

Abstract

Background: The symptoms of cow’s milk allergy (CMA) can vary widely in severity and course, so diagnosis and treatment are still challenging. Objective: This study aims to establish the phenotype of severe CMA in children with the greatest improvement following the application of amino acid-based formula (AAF). Methods: This is a post hoc analysis of data from the multicenter, real-life study assessing the clinical effectiveness of a 5-week AAF intervention in 232 infants with severe CMA. A cluster analysis based on symptom severity at the 1st visit was performed. The differences in the severity scale of each symptom before and after the intervention were assessed and compared within and between clusters. The clustering results were validated in a separate cohort of infants with CMA (n = 157). Results: Three clusters were identified: cluster A (38.8% of patients) with moderate-to-severe gastrointestinal symptoms, cluster B (34.1%) with severe skin symptoms, and cluster C (25.9%) with combined moderate-to-severe gastrointestinal and severe skin symptoms. In the validation cohort, three clusters with the same pattern of symptoms were observed among children with moderate-to-severe CMA. The multivariate model of linear regression showed that severity score reductions after AAF treatment were significantly higher in cluster C than in clusters A and B, in children with a positive family history of allergy, and in children with growth retardation at baseline. Conclusion: Symptoms of severe CMA in children are grouped into three distinct phenotypes—gastrointestinal, skin, and combined gastrointestinal and skin. The most significant improvement after AAF implementation was obtained in patients with a combined phenotype.
Keywords: cow’s milk allergy; infants; children; cluster analysis; phenotypes; treatment; amino acid-based formula cow’s milk allergy; infants; children; cluster analysis; phenotypes; treatment; amino acid-based formula

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MDPI and ACS Style

Błażowski, Ł.; Podlecka, D.; Brzozowska, A.; Jerzyńska, J.; Seweryn, M.; Błażowski, M.; Majak, P. Clinical Phenotypes of Severe Cow’s Milk Protein Allergy with Various Responses to Amino Acid-Based Formula. Nutrients 2025, 17, 1809. https://doi.org/10.3390/nu17111809

AMA Style

Błażowski Ł, Podlecka D, Brzozowska A, Jerzyńska J, Seweryn M, Błażowski M, Majak P. Clinical Phenotypes of Severe Cow’s Milk Protein Allergy with Various Responses to Amino Acid-Based Formula. Nutrients. 2025; 17(11):1809. https://doi.org/10.3390/nu17111809

Chicago/Turabian Style

Błażowski, Łukasz, Daniela Podlecka, Agnieszka Brzozowska, Joanna Jerzyńska, Michał Seweryn, Marcin Błażowski, and Paweł Majak. 2025. "Clinical Phenotypes of Severe Cow’s Milk Protein Allergy with Various Responses to Amino Acid-Based Formula" Nutrients 17, no. 11: 1809. https://doi.org/10.3390/nu17111809

APA Style

Błażowski, Ł., Podlecka, D., Brzozowska, A., Jerzyńska, J., Seweryn, M., Błażowski, M., & Majak, P. (2025). Clinical Phenotypes of Severe Cow’s Milk Protein Allergy with Various Responses to Amino Acid-Based Formula. Nutrients, 17(11), 1809. https://doi.org/10.3390/nu17111809

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