A synbiotic-containing amino acid-based formula improves gut microbiota in non-IgE-mediated allergic infants

BACKGROUND: Prebiotics and probiotics (synbiotics) can modify gut microbiota and have potential in allergy management when combined with amino acid-based formula (AAF) for infants with cow's milk allergy (CMA). METHODS: This multicenter, double-blind, randomized controlled trial investigated the effects of an AAF including synbiotic blend on percentages of bifidobacteria and Eubacterium rectale/Clostridium coccoides group (ER/CC) in feces from infants with suspected non-IgE-mediated CMA. Feces from age matched healthy breastfed infants were used as reference (HBR) for primary outcomes. CMA subjects were randomized and received test or control formula for 8 weeks. Test formula was a hypoallergenic, nutritionally complete AAF including a prebiotic blend of fructo-oligosaccharides and the probiotic strain Bifidobacterium breve M-16V. Control formula was AAF without synbiotics. RESULTS: Thirty-five (test) and 36 (control) subjects were randomized; HBR included 51 infants. At week 8, median percentage of bifidobacteria was higher in test group vs control group (35.4 vs. 9.7%, respectively P<0.001), whereas ER/CC was lower (9.5 vs. 24.2%, respectively; P<0.001). HBR levels of bifidobacteria and ER/CC were 55 and 6.5%, respectively. CONCLUSION: AAF including specific synbiotics, which results in levels of bifidobacteria and ER/CC approximating levels in HBR group, improves the fecal microbiota of infants with suspected non-IgE-mediated CMA.