For healthcare professionals only.

This formulary decision guide was developed from content provided by Mead Johnson Nutrition in a format developed by Guidelines in Practice.

Key points

Nutramigen Puramino Index Image

Combined logos

  • CMA is a common yet complex food allergy, seen in early childhood, with mild-to-moderate or severe presentation1
  • Clinical guidelines recommend an AAF in formula-fed infants with severe CMA, multiple food allergies, or when an eHF is ineffective1­,2
  • Nutramigen* Puramino* has proven efficacy in infants with severe CMA and multiple food allergies, supporting normal growth:3[A]
    • contains 33%[D] MCT oil to provide an easily available source of fats and energy in case of fat malabsorption4,5
    • lactose free
    • contains DHA to support normal visual development6-8[B]
    • certified halal and kosher.

Download a PDF of this formulary decision guide here

Product name

Nutramigen* PURAMINO*

Indications

  • For the dietary management of infants with severe CMA, multiple food allergies, failure to respond to an eHF, or other indications requiring an elemental diet
  • Nutritionally complete from birth to 6 months, and as part of a varied diet from 6 months onwards.

Feeding guide

Age

Tins per month

0–6 months

9–10

6–12 months

6–8

≥1 year

6–8

See tin label for detailed feeding guidance; HCP to determine the formula intake based on the individual situation

Preparation and storage

  • Wash hands thoroughly and sterilise bottles, teats, caps, and utensils
  • Boil fresh water; leave to cool for 30 minutes prior to mixing; do not use softened water
  • Feed immediately or cover and store in a refrigerator at 2–4°C for ≤24 hours
  • Store tin in a cool, dry place; after opening, keep tightly covered and use within 1 month.

Precautions

  • Do not freeze prepared formula and do not use if unrefrigerated for >2 hours
  • Use formula that has been in contact with baby’s mouth within 1 hour and do not refrigerate
  • Do not heat prepared formula in a microwave.

About CMA

  • CMA is an adverse immune reaction to cow’s milk protein presenting with immediate and/or delayed symptoms2,9
  • CMA is the most common childhood food allergy affecting 2-7.5% of infants9
  • Quality of life is profoundly reduced for patients with CMA and their families10
  • For formula-fed infants, management comprises avoidance of cow’s milk and use of suitable hypoallergenic formulas.2

Guideline recommendations

  • Expert guidelines recommend AAFs for formula-fed infants with severe CMA, multiple food allergies, or when an eHF is ineffective as initial treatment for mild-to-moderate CMA1,2
  • A critical expert review suggests that AAF is also warranted in the following conditions:11
    • failure on an eHF
    • eosinophilic oesophagitis
    • faltering growth (particularly with GI tract/skin involvement and multiple food eliminations)
    • anaphylaxis.

Evidence for use

  • Nutramigen* PURAMINO* has proven efficacy in infants with severe CMA and multiple food allergies;3 it is:
    • 100% amino acid formula
    • effective management of CMA symptoms3[C]
    • proven to support normal growth3[A]
    • well accepted: 100% of infants had no allergic reactions or adverse events3[C]
    • lactose free
    • contains DHA to support normal visual development6-8[B]
    • certified halal and kosher.
  • MCT oil (33%[D]) provides an easily available source of fats and energy in case of fat malabsorption:4,5
    • increased MCT supply is important in patients with disturbances in digestion and absorption (e.g. SBS)12
    • the balance of MCTs and LCTs is expected to provide fast energy absorption, while also stimulating gut adaptation.12,13

Caution

  • Not recommended for premature babies unless directed and supervised by an HCP.

Order and contact information

UK pharmacy PIP order code

Description

New NHS price

338-3304

Nutramigen* PURAMINO* 400g

£22.98

If you have any questions or comments, please call the Mead Johnson Careline +44 (0)1895 230575.

AAF=amino acid-based formula; CMA=cow’s milk allergy; eHF=extensively hydrolysed formula; GI=gastrointestinal; HCP=healthcare professional; MCT=medium chain triglycerides; LCT=long chain triglycerides; SBS=short bowel syndrome.

[A] in healthy, full-term infants, before the addition of MCT;

[B] with an intake of 100 mg DHA/day;

[C] in infants with CMA, before the addition of MCT;

[D] of total fatty acids.

References

  1. Fox A, Brown T, Walsh J et al. An update to the milk allergy in primary care guideline. Clinical and translational allergy 2019; 9 (1): 1–7.
  2. Luyt D, Ball H,  Makwana M et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy 2014; 44 (5): 642­­–672.
  3. Burks W, Jones S, Berseth C et al. Hypoallergenicity and effects on growth and tolerance of a new amino acid-based formula with docosahexaenoic acid and arachidonic acid J Pediatr 2008; 153 (2): 266–271.
  4. Bach AC, Babayan VK. Medium-chain triglycerides: an update. Am J Clin Nutr. 1982 Nov; 36 (5): 950-62
  5. Akoh CC (editor). Handbook of functional lipids. Boca Raton, FL. CRC Press 2005: p177.
  6. Birch EE, Carlson SE, et al. The DIAMOND (DHA Intake And Measurement Of Neural Development) Study: a double-masked, randomized controlled clinical trial of the maturation of infant visual acuity as a function of the dietary level of docosahexaenoic acid. Am J Clin Nutr. 2010 Apr; 91 (4): 848-59.
  7. Morale SE, Hoffman DR, et al. Duration of long-chain polyunsaturated fatty acids availability in the diet and visual acuity. Early Hum Dev. 2005 Feb; 81 (2): 197-203.
  8. Scientific opinion. DHA and ARA and visual development. EFSA J 2009;941:1–14 Available at: onlinelibrary.wiley.com/doi/pdfdirect/10.2903/j.efsa.2009.941
  9. Vandenplas Y, Brueton M, Dupont C et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants Arch Dis Child 2007; 92 (10): 902–908.
  10. Cummings A, Knibb R, King R, Lucas J. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review Allergy 2010; 65 (8): 933–945.
  11. Meyer R, Groetch M, Venter C. When should infants with cow’s milk protein allergy use an amino acid formula? A practical guide. J Allergy Clin Immunol Pract 2018; 6 (2): 383–399.
  12. Los-Rycharska E, Kieraszewicz Z, Czerwionka-Szaflarska M. Medium chain triglycerides (MCT) formulas in paediatric and allergological practice Prz Gastroenterol 2016; 11 (4): 226–231.
  13. Shaw V (editor). Clinical Paediatric Dietetics. 2014; John Wiley & Sons. Available at: onlinelibrary.wiley.com/doi/book/10.1002/9781118915349

*Trademark of Mead Johnson & Company, LLC. © 2020 Mead Johnson & Company, LLC. All rights reserved. Mead Johnson Nutrition is a company of Reckitt Benckiser.

Important notice:  Breastfeeding provides the best nutrition for babies. 

RB-M-18261

Date of preparation: October 2020

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