The development of early-onset cow’s milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow’s milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow’s milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.

Allergic diseases are on the increase worldwide, incurring a high socioeconomic burden on patients, families, and healthcare systems. As a permanent cure for most allergies is still lacking, prevention is of paramount importance. So far, several strategies, including nutritional interventions, have been proposed to halt this phenomenon with inconclusive results. The use of partially hydrolyzed formulas (pHFs) for non-exclusively breastfed infants has been proposed by several scientific bodies; however, most have withdrawn this suggestion based on the concept of insufficient evidence. During the last few years, emerging evidence suggests that specific pHFs may reduce the risk of allergies in individuals at high risk for allergy development based on their heredity. In this article, we review the role of pHFs and propose that in non-exclusively breastfed infants at high-risk for allergy, the use of pHFs remains one of the most targeted interventions, as consistent data indicate a possible role in allergy prevention.