Science & Research

Food Allergy/Intolerance

Else Toddler formula contains almond butter and buckwheat.  While these are not common allergens, healthcare professionals should be aware of potential cross-allergenicity related to these ingredients. Else Toddler formula is free of soy, gluten, and dairy allergens. Below are some suggested readings for healthcare professionals for more information related to these topics:


Suggested Readings:

Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111-26. This article highlights defining features and symptoms of food protein-induced enterocolitis (FPIES) and identified by an international expert consensus group.  It provides empiric guidelines for weaning food for infants with emphasis on practices that optimize development and minimize adverse risks.  Notably, this expert panel highlights that no studies have identified threshold doses of trigger foods for FPIES, it is thought to be high and therefore it is not indicated to routinely avoid products with precautionary statements. Experts also recommend use of a hypoallergenic formula in formula-fed infants with cow’s milk induced FPIES or those no longer able to be breastfed. Ultimately, experts identify best practices for early management of FPIES. 
This study explores childhood incidence of asthma or recurrent wheeze in breast-fed newborns fed amino acid-based formula for volume supplementation (BM+AAF) compared to those fed cow’s milk-based formula for volume supplementation (BM+CMF).  Further analyses stratified subgroups by 25-OH-D and IgE levels in those who received extended follow-up due to atopic conditions. For both highest IgE quartile and above-median 25-OH-D levels, those fed BM+AAF for volume supplementation had significantly lower incidence of asthma or recurrent wheeze at 24 months of age compared to those fed BM+CMF.   


C D Salpietro, S Gangemi, S Briuglia, A Meo, M V Merlino, G Muscolino, G Bisignano, D Trombetta, A Saija. The almond milk: a new approach to the management of cow-milk allergy/intolerance in infants. Minerva Pediatrica 2005;57:173-80

This randomized study conducted in 52 infants with documented CMI/CMA tested the safety and efficacy of a new almond-based milk comparing soy-based formula and extensively hydrolyzed formula. The main efficacy outcomes were the improvement in clinical symptoms and the decrease in serum levels of soluble CD30  (a potential marker of atopic disorders,sCD30). The authors find that elimination of milk proteins and the supplementation with milk protein free formula resulted in considerable improvement of clinical manifestations within 5-12 days in all cases examined. No difference in growth rates between the groups . in the soy-based formula and extensively 

Almond Allergenicity

Suggested Readings:
Mandalari G, Mackie AR. Almond allergy: an overview on prevalence, thresholds, regulations and allergen detection. Nutrients. 2018;10(11):1706.  This narrative review article explores the unknowns regarding detection sensitivity required for testing foods for almond allergens, largely related to insufficient population-based threshold dose data.  The threshold dose empirically used in quality testing to detect allergens is typically less than 1 ppm as this threshold has been used for other potential allergens.  The authors explore existing quantitative dated related specifically to almonds relevant to label regulation and consumer protection. 

Baker MG, Kattan JD. Review of 400 consecutive oral food challenges to almond. Annal Allergy Asthma Immunol. 2019;122(2):189-92. Due to the high rate of false-positive skin-prick tests for almond allergy, it is important to explore the safety of oral food challenges in those with suspected sensitization.  Authors found a 94% (375/400) passed the oral food challenge, quantified by sIgE and skin prick wheal size, for those with suspected almond allergy, 4% (16/400) failed the oral food challenge, and 2% (9/400) had indeterminant reactions. This study found that anaphylaxis requiring epinephrine was rare (0.005%; 2/400 oral food challenge participants), and that pruritis was the most common symptom among those who experienced a reaction. Since almonds can serve as a popular source of nutrients for dairy-free or plant-based protein foods, oral food challenge may be feasible to help minimize potentially unnecessary avoidance of almonds. 

Buckwheat Allergenicity

Suggested Readings:

Sammut D, Dennison P, Venter C, Kurukulaaratchy RJ. Buckwheat allergy: a potential problem in 21st century Britain. BMJ Case Reports. 2011;10.1136/bcr.09.2011.4882. These authors summarize background of buckwheat as a potential food allergen, noting that is rare outside of Japan or other Asian countries.  Since it is taxonomically unrelated to wheat, it is suitable for those requiring a gluten-free diet. The most common reactions include angioedema, anaphylaxis, uticaria, asthma/rhinitis, and GI disturbance. Authors also present the first two adult case reports of buckwheat sensitization in the United Kingdom, confirmed by sIgE and skin-prick test and identified upon post-prandial IgE-mediated reactions.  


Badiu I, Olivieri E, Montagni M, et al. Italian study on buckwheat allergy: prevalence and clinical features of buckwheat-sensitized patients in Italy. Int J Immunol Pharmacol. 2013;26(3):801-806. Due to limited data on prevalence of buckwheat allergy in non-Asian countries, these authors conducted an epidemiological study across 18 Italian allergy clinics.  Of included patients, 61.3% (1198/1954) were atopic and 3.6% (70/1954) had a positive skin-prick test for buckwheat. The authors found differences in mean buckwheat allergy prevalence across regions, with sensitization being more common in northern Italy.