A new expert-driven framework published on Apr. 17 aims to help clinicians decide when hydrolyzed rice formula may be the most suitable option for infants in the United Kingdom with cow’s milk allergy.
Cow’s milk allergy is among the most common allergies in infancy, typically resolving by ages three to five. Its symptoms can affect both children and their caregivers, leading many families to seek alternatives to standard cow’s milk formulas. A recent concept paper in Nutrients presents an expert consensus on using hydrolyzed rice formula (HRF) as a way to support healthy growth and development in these children.
For non-breastfed infants diagnosed with cow’s milk allergy, current first-line recommendations include extensively hydrolyzed cow’s milk-based formulas or HRFs. When symptoms persist despite these options, clinicians are advised to rule out other causes before considering amino acid formulas, which are usually reserved for severe cases such as eosinophilic esophagitis.
The decision tree outlined in the paper was developed after two UK expert meetings held in 2025 that discussed international guidelines and local prescribing practices. The tool is designed to help clinicians select appropriate specialist formulas rather than guide diagnosis or treatment of the allergy itself. "This decision tree is not intended as a replacement for current or future published official guidelines on CMA," according to the authors.
Key factors influencing a switch toward HRF include persistent symptoms after multiple formula changes, parental preferences based on lifestyle or faith, specialist recommendations, potential sensitivity to traces of cow's milk protein beta-lactoglobulin, faltering growth due to intolerance of extensively hydrolyzed formulas, and infant acceptance issues—especially after six months of age when taste becomes more important.
The paper also highlights that HRF has been used safely in Europe for over two decades without reported adverse effects but notes that more high-quality research is needed regarding its long-term impact on growth and immunity. The authors recommend making HRF widely accessible across all segments of society while calling for further studies into its benefits and potential risks.
