{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:55:58Z","timestamp":1785412558139,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011947","name":"Abbott Nutrition","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011947","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00p99t114","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Cow\u2019s milk allergy (CMA) remains one of the most common food allergies in infancy, requiring the avoidance of cow\u2019s milk and its derivatives. Breast milk is the best source of nutrition for infants. For those infants with CMA whose mothers are unable to breastfeed or choose not to, extensively hydrolysed formulas (eHFs) are widely recommended as first-line milk substitutes, whereas hydrolysed rice formulas (HRFs) are increasingly recognised as a viable alternative. This concept paper provides a healthcare professional (HCP) perspective on HRF, drawing on expert consensus from two meetings convened in 2025. Discussions noted the long history of safe and effective HRF use in Europe, its nutritional adequacy, and the evolving international guidelines supporting HRF as an alternative first-line option. A key meeting outcome was the development of a practical decision tree to help UK clinicians decide when HRF should be the preferred choice. Key considerations for its use in non-breastfed infants include the following: parental\/caregiver stress related to persistent symptoms; ongoing symptoms despite multiple interventions; cultural and lifestyle choices; religious dietary requirements; and specialists\u2019 recommendations. Secondary considerations highlighted by HCPs include the following: proven reactions whilst infants are breast-milk-fed together with parental request for formula; faltering growth; multiple symptoms; taste acceptance (older infants); and parental preference based on experience. The role of functional components, such as prebiotics and human milk oligosaccharides (HMOs), was noted in regard to the emerging evidence of benefits to the microbiome and immune development. The experts emphasised the importance of engaging HCPs across all levels of CMA care and addressing challenges in translating current guidance into treatment practice. It was concluded that, overall, HRF represents a nutritionally complete, plant-based alternative that has been shown to be well tolerated (taste, symptoms) in clinical studies. It can be used to broaden therapeutic options for infants with CMA in the UK who are not exclusively fed breast milk.<\/jats:p>","DOI":"10.3390\/nu18081225","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T08:14:17Z","timestamp":1776154457000},"page":"1225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Hydrolysed Rice Formula in the Dietary Management of Infants with Cow\u2019s Milk Allergy: A UK Healthcare Perspective"],"prefix":"10.3390","volume":"18","author":[{"given":"Nick","family":"Makwana","sequence":"first","affiliation":[{"name":"Sandwell and West Birmingham Hospitals, Birmingham B71 4HJ, UK"},{"name":"Birmingham Medical School, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8907-2558","authenticated-orcid":false,"given":"Lauren","family":"Arpe","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Great Ormond Street Hospital, London WC1N 3JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneta","family":"Ivanova","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham Hospitals, Birmingham B71 4HJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Evans-Howells","sequence":"additional","affiliation":[{"name":"Dr Helen Allergy, Ringwood BH24 1HP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2631-5200","authenticated-orcid":false,"given":"Claire","family":"Trigg","sequence":"additional","affiliation":[{"name":"Royal Glamorgan Hospital, Ynysmaerdy, Pontyclun CF72 8XR, UK"},{"name":"Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2188-9235","authenticated-orcid":false,"given":"Bahee","family":"Van de Bor","sequence":"additional","affiliation":[{"name":"UK Kids Nutrition, London W1G 9PF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Walsh","sequence":"additional","affiliation":[{"name":"Castle Partnership, Norwich NR3 1SE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Weaver","sequence":"additional","affiliation":[{"name":"Allergy UK, Crayford DA1 4SL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Wood","sequence":"additional","affiliation":[{"name":"Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7473-5355","authenticated-orcid":false,"given":"Carina","family":"Venter","sequence":"additional","affiliation":[{"name":"Section of Allergy and Clinical Immunology, Children\u2019s Hospital Colorado, University of Colorado, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1862-8651","authenticated-orcid":false,"given":"Yvan","family":"Vandenplas","sequence":"additional","affiliation":[{"name":"KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosan","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department Medicine, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, September 12). Infant and Young Child feeding. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/infant-and-young-child-feeding."},{"key":"ref_2","unstructured":"Australian Society of Clinical Immunology and Allergy (2025, September 12). Cow\u2019s Milk (Dairy) Allergy. Available online: https:\/\/www.allergy.org.au\/patients\/food-allergy\/cows-milk-dairy-allergy."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/j.1365-2222.2009.03427.x","article-title":"Impact of dietary regimen on the duration of cow\u2019s milk allergy: A random allocation study","volume":"40","author":"Terracciano","year":"2010","journal-title":"Clin. Exp. Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Dupont, C., Bocquet, A., Tome, D., Bernard, M., Campeotto, F., Dumond, P., Essex, A., Frelut, M.L., Guenard-Bilbault, L., and Lack, G. (2020). Hydrolyzed rice protein-based formulas, a vegetal alternative in cow\u2019s milk allergy. Nutrients, 12.","DOI":"10.3390\/nu12092654"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jaip.2017.09.003","article-title":"When should infants with cow\u2019s milk protein allergy use an amino acid formula? A practical guide","volume":"6","author":"Meyer","year":"2018","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13601-017-0162-y","article-title":"Better recognition, diagnosis and management of non-IgE-mediated cow\u2019s milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline","volume":"7","author":"Venter","year":"2017","journal-title":"Clin. Transl. Allergy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e664","DOI":"10.1016\/S2468-2667(24)00163-4","article-title":"Time trends in the epidemiology of food allergy in England: An observational analysis of Clinical Practice Research Datalink data","volume":"9","author":"Turner","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bajerova, K., Salvatore, S., Dupont, C., Eigenmann, P., Kuitunen, M., Meyer, R., Ribes-Koninckx, C., Shamir, R., Szajewska, H., and Vandenplas, Y. (2022). The cow\u2019s milk-related symptom score (comiss(TM)): A useful awareness tool. Nutrients, 14.","DOI":"10.3390\/nu14102059"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13975","DOI":"10.1111\/pai.13975","article-title":"The role of online symptom questionnaires to support the diagnosis of cow\u2019s milk allergy in children for healthcare professionals\u2014A Delphi consensus study","volume":"34","author":"Meyer","year":"2023","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00431-014-2308-4","article-title":"Safety and tolerance of a new extensively hydrolyzed rice protein-based formula in the management of infants with cow\u2019s milk protein allergy","volume":"173","author":"Vandenplas","year":"2014","journal-title":"Eur. J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.iac.2021.01.009","article-title":"Dietary management of food allergy","volume":"41","author":"Durban","year":"2021","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_12","unstructured":"World Health Organization (2025, September 12). Breastfeeding. Available online: https:\/\/www.who.int\/health-topics\/breastfeeding#tab=tab_1."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100888","DOI":"10.1016\/j.waojou.2024.100888","article-title":"World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow\u2019s Milk Allergy (DRACMA) guideline update\u2014XII\u2014Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA","volume":"17","author":"Bognanni","year":"2024","journal-title":"World Allergy Organ. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/MPG.0000000000003897","article-title":"An ESPGHAN position paper on the diagnosis, management, and prevention of cow\u2019s milk allergy","volume":"78","author":"Vandenplas","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Vandenplas, Y., Meyer, R., Nowak-Wegrzyn, A., Salvatore, S., Venter, C., and Vieira, M.C. (2023). The remaining challenge to diagnose and manage cow\u2019s milk allergy: An opinion paper to daily clinical practice. Nutrients, 15.","DOI":"10.3390\/nu15224762"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ribes-Koninckx, C., Amil-Dias, J., Espin, B., Molina, M., Segarra, O., and Diaz-Martin, J.J. (2023). The use of amino acid formulas in pediatric patients with allergy to cow\u2019s milk proteins: Recommendations from a group of experts. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1110380"},{"key":"ref_17","unstructured":"Australian Society of Clinical Immunology and Allergy (2025, September 12). Guide for Milk Substitutes in Cow\u2019s Milk Allergy. Available online: https:\/\/www.allergy.org.au\/images\/stories\/pospapers\/ASCIA_HP_Guide_CMA_Milk_Substitutes_2024.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/cea.12302","article-title":"BSACI guideline for the diagnosis and management of cow\u2019s milk allergy","volume":"44","author":"Luyt","year":"2014","journal-title":"Clin. Exp. Allergy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"100830","DOI":"10.1016\/j.waojou.2023.100830","article-title":"World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow\u2019s Milk Allergy (DRACMA) guidelines update\u2014X\u2014Breastfeeding a baby with cow\u2019s milk allergy","volume":"16","author":"McWilliam","year":"2023","journal-title":"World Allergy Organ. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/all.13947","article-title":"Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper","volume":"75","author":"Meyer","year":"2020","journal-title":"Allergy"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Vandenplas, Y., Dupont, C., Al-Dekhail, W., Hashmi, H.A.A., Khalil, A.F., El-Hodhod, M.A., Husain, K., and Singh, A. (2021). Exploring the advantages of a hydrolyzed rice formula in the dietary management of infants with cow\u2019s milk allergy in the middle east, north africa, and pakistan region. Nutrients, 13.","DOI":"10.3390\/nu13103429"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100931","DOI":"10.1016\/j.waojou.2024.100931","article-title":"World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow\u2019s Milk Allergy (DRACMA) guidelines update\u2014XVI\u2014Nutritional management of cow\u2019s milk allergy","volume":"17","author":"Venter","year":"2024","journal-title":"World Allergy Organ. J."},{"key":"ref_23","first-page":"235","article-title":"Consensus on the diagnosis and treatment of cow\u2019s milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition","volume":"87","author":"Toca","year":"2022","journal-title":"Rev. Gastroenterol. Mex. (Engl. Ed.)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.2147\/JAA.S276992","article-title":"Current guidelines and future strategies for the management of cow\u2019s milk allergy","volume":"14","author":"Vandenplas","year":"2021","journal-title":"J. Asthma Allergy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/cea.13087","article-title":"A patient-specific approach to develop an exclusion diet to manage food allergy in infants and children","volume":"48","author":"Venter","year":"2018","journal-title":"Clin. Exp. Allergy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100717","DOI":"10.1016\/j.waojou.2022.100717","article-title":"Hydrolyzed rice formula for dietary management of infants with cow\u2019s milk allergy","volume":"15","author":"Fiocchi","year":"2022","journal-title":"World Allergy Organ. J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ramirez-Farias, C., Oliver, J.S., Schlezinger, J., and Stutts, J.T. (2024). Tolerance of infants fed a hydrolyzed rice infant formula with 2\u2019-fucosyllactose (2\u2019-FL) human milk oligosaccharide (HMO). Nutrients, 16.","DOI":"10.3390\/nu16121863"},{"key":"ref_28","unstructured":"National Institute for Health and Clinical Excellence (2025, September 12). Faltering Growth: Recognition and Management of Faltering Growth in Children. NICE Guideline. Reference Number: NG75. Available online: https:\/\/www.nice.org.uk\/guidance\/ng75\/resources\/faltering-growth-recognition-and-management-of-faltering-growth-in-children-pdf-1837635907525."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/8\/1225\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:12:54Z","timestamp":1776312774000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/8\/1225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nu18081225"],"URL":"https:\/\/doi.org\/10.3390\/nu18081225","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]}}}