Is there a TF Formula Without Milk or Soy?

Jolie, BSN · Aug 30, 2008

I don't know diddly about adult formulas, but in the infant world, there are formulas available for many "intolerances" and allergies including Nutramigen and Pregestimil which are elemental formulas and Lacto-Free which is milk-based, but lactose free.

Can you contact sales reps from a few formula companies? I bet they could offer some suggestions and perhaps some samples.

SweetOldWorld, BSN, RN · Aug 30, 2008

Can you contact sales reps from a few formula companies? I bet they could offer some suggestions and perhaps some samples.

Great idea, Jolie! I didn't think of doing that!

JazzyRN · Aug 30, 2008

Yes there is we gave babies a formula called Alimentum, when they can't tolerate soy or milk formulas.

SweetOldWorld, BSN, RN · Aug 30, 2008

Yes there is we gave babies a formula called Alimentum, when they can't tolerate soy or milk formulas.

Thanks, Jazzy!

BittyBabyGrower, MSN, RN · Aug 30, 2008

I think there is an adult one called Compleat....I am thinking I used it on the Comp Care Peds floor. Maybe try a cross topic over on the Developmental Disabilities board and the Peds board.

vampiregirl, BSN, RN · Aug 30, 2008

You might try contacting the Food Allergy and Anaphylaxis network http://www.foodallergy.org. They might be able to point you in the right direction, I know they have a wealth of resources and connections.

core0 · Aug 31, 2008

I have a patient who is unable to swallow, and has a G-tube. This patient is allergic to milk, soy and eggs. The dietician says there is no formula which does not contain milk or soy, and is recommending the patient go home on TPN through a central line. I can't believe there is no formula made for people with such allergies! Does anyone know of a suitable formula?
:typing
Thanks for your help!

What you want is Vivonex of something similar. It has soy bean oil but does not have soy proteins (what most people are allergic to). We used it for tube feeds and oral feeds for kids with food allergies (including celiac, milk and soy).

http://www.nestle-nutrition.com/Products/Product.aspx?ProductId=33478da1-b20a-4fc8-9113-b4b2c3082d0b

It is an elemental formula which means that the proteins are broken down so you don't have exposure to allergens. There is also a book that I believe that Nestle puts out that essentially tells you how to design a specific formula to avoid specific conditions or allergies. For example I had a patient that could not tolerate long chain fatty acids (due to a metabolic condition). We designed a formula that allowed her to do very well. Her mom just mixed in the blender and ran it over night.

If you call the Nestle dieticians they will be happy to help you (as are the dietitians with all the major feeding companies - not endorsing any specific product). You also might consider consulting a pediatric dietician if you have a peds hospital nearby. They are usually more in tune with food allergies.

I don't know diddly about adult formulas, but in the infant world, there are formulas available for many "intolerances" and allergies including Nutramigen and Pregestimil which are elemental formulas and Lacto-Free which is milk-based, but lactose free.
Can you contact sales reps from a few formula companies? I bet they could offer some suggestions and perhaps some samples.

Just be aware that while Pregestimil, Nutramigen and Alimentum are advertised as hypoallergenic they all contain modified caesin. Caesin and Whey are the two protiens in cows milk. Most children are allergic to Whey so they will do fine with these (whey is also similar to soy protien which is why there is a high cross reactivity with soy formulas). Infants with a true milk allergy may also react to the modified caesin as well. In that case you need to move to an elemental formula such as Neocate (or liquid gold as we used to call it). This is the infant version of Vivonex and has no protiens in it only amino acids.

For that matter the patient in the original post may be able to tolerate a modified casein formula such as Peptimen. Someone with a true milk and soy allergy as an adult is pretty rare. Lactose intolerance is sometimes labelled as a milk allergy. Hopefully an allergist has been consulted on this patient to determine the nature and severity of the illness.

David Carpenter, PA-C

wooh, BSN, RN · Aug 31, 2008

Just a dose of reality though, the infant formulas that are cooked up in labs without all the allergens are SUPER expensive for babies, that would need a fraction of the volume an adult would. Once you get into specialty formulas, TPN and lipids may actually end up being cheaper, even if not the preferred solution. So even if you get the problem solved, you may end up in the world of problems of how to pay for it.

SweetOldWorld, BSN, RN · Aug 31, 2008

Thanks to everyone who replied to this thread. Unfortunately, I don't have much of an update, since it is a holiday weekend. They did place a PICC line on this patient and start TPN but I hope there is a different solution for the long-term. This is a super place to come for information... thanks again!

morte, LPN, LVN · Aug 31, 2008

it would be important to detemine if they are indeed ALLERGIC to milk , or have a lactose intolerance.....some celiacs will have issues with caesin....but the lactose is commonly the problem in adults....good luck

lorimar75 · Aug 31, 2008

I don't know about use in adults, but the the only truly hypoallergenic formulas for infants are Neocate and Elecare. They are amino acid based formulas which contain NO form of casein (whereas Nutramigen, Alimentum and Pregestemil contain a "hypoallergenic form of casein")---this still cause a reaction in my severely allergic baby. Just FYI. I do know that Neocate produces products for older children, so maybe check to see if one of those would work?