Which formula in cow's milk protein intolerance? The dietitian's dilemma.

During the last century a wide range of protein sources have been used to replace cow's milk to provide an alternative milk in the treatment of cow's milk protein intolerance. These include soya (Businco et al., 1992), ass's milk (Iacono et al., 1992), soya/beef hydrolysate (Dean et al., 1993), almonds (Moll, 1923), poppy seeds (Findelstein 1930), cereals (Wolpe & Silverstone, 1942), whey hydrolysate (Walker-Smith, Digeon & Phillips, 1989) casein hydrolysate (Walker-Smith et al., 1989) and taro (Feingold, 1942). Important factors influencing the choice of milk substitute include nutritional composition, evidence of successful use with particular reference to satisfactory growth and nutritional status, palatablility, ease of preparation, cost, availability and allergenicity.