Recommendations for Soy Infant Formula: A Review of the Literature and a Survey of Pediatric Allergists

Abstract

ABSTRACT

Statements in the pediatric and gastroenterology literature to the effect that use of soybean formula should be avoided because of its high "allergenicity" seem to be unfounded. A review of the literature as well as personal experience in practice and with two dietary prophylactic studies spanning 15 years suggest that the availability of soybean formula constitutes a useful contribution to our knowledge of the handling of many nutritional problems of infants and children. The availability of soybean formula provides parents of infants with cow's milk allergy a nutritional food that can be used in the preparation of many kinds of food dishes and desserts to provide variety for children on restrictive diets. Over the past four decades, the use of soybean formula as a part of a dietary prophylaxis against the development of atopy in children of allergic families has been well accepted by the vast majority of infants who have received it. A survey of pediatric allergists showed the limits of what can be obtained by even the least demanding questionnaire. Given the rarity of reactions and the difficulty in identifying a clear causal agent, the average allergist is "overasked" by even a simple one-page set of questions. If anything, the wide range of answers indicates widespread confusion. A definitive answer about the existence of soybean allergies cannot be obtained without a detailed protocol for reporting and cross-validating such observations in a collaborative study. The use of soybean in infant feeding goes back many centuries in Chinese and Japanese cultures. In modern Japan, soy formula is commonly used either as a substitute for human breast milk or as a postweaning protein source in the first year of life. The first reported use of a soybean preparation for feeding infants with milk allergy was reported by Hill and Stuart in 1929.⁽¹⁾ Yet recommendations for soybean formula have remained controversial. We review the evidence for and against soybean formula and present data from a survey of pediatric allergists.