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SMA® Althéra® FAQs

What is SMA® Althéra® designed for?

SMA® Althéra® is an extensively hydrolysed formula, ACBS approved for complete nutritional support from birth or supplementary feeding from 6 months and up to 3 years of age for the dietary management of cows' milk allergy (CMA) and/or multiple food protein allergies (MFPA). It designed to be suitable for the majority of formula fed infants with CMA (~90%).

How do I recognise CMA?

CMA can be challenging to diagnose. It typically presents with diverse and non-specific symptoms that affect organ systems.1–5

Non-specific symptoms may include colic, reflux, constipation, eczema, diarrhoea and crying. More information about CMA can be found in the Health Management section. A diagnosis can only be made by a healthcare professional.

Is lactose intolerance similar to CMA?

Lactose intolerance results from a decreased ability to digest and absorb lactose (the sugar present in human milk) due to a lack of the enzyme lactase. It is very rare in infants younger than 5 years,6 even in those with CMA. Guidelines from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) state: “adverse reactions to lactose in CMA are not supported in the literature, and complete avoidance of lactose in CMA is no longer warranted.1 Lactose has been shown to be beneficial for healthy infant growth and development.7,8

What tin size is SMA® Althéra® available in?

SMA®Althéra®is a 450g re-sealable tin (PIP Code 378-7413)
It’s important to know that on some ordering systems Althera is listed as SMA Althera.

Does SMA® Althéra® contain cows’ milk, soy or coconut?

SMA® Althéra® contains purified lactose and hydrolysed whey protein from cows' milk. It does contain coconut oil but is free from coconut protein. It does not contain any soy.

Have any intolerances been observed with SMA® Althéra®?

In two randomised controlled trials (RCTs), SMA® Althéra® has been tolerated by 100% of patients:

In patients with mild-severe CMA, SMA® Althéra® demonstrated similar symptom relief and feeding tolerability to an amino acid formula (AAF; Neocate LCP®). 100% of infants on SMA® Althéra® had no allergic reaction, and vomiting was reported in fewer infants with Althéra® than the AAF.9

In patients with mild-moderate CMA, 100% of patients on SMA® Althéra® had symptom relief and normal growth – with no allergic reactions reported.10

How does SMA® Althéra® compare to a casein-based eHFs?

In a head-to-head clinical trial, SMA® Althéra® (whey-based) was shown to be equally efficacious in terms of symptom improvement and growth as Nutramigen with LGG® (casein-based) but was accepted by more infants.10

What are the benefits of SMA® Althéra®?
SMA® Althéra® is an eHF for the effective first-line dietary management of or mild–moderate CMA and/or multiple food allergies among formula fed babies:9,10
  • The only eHF to show similar efficacy to an AAF in a randomised, controlled trial11*
  • A preferred taste vs Similac Alimentum® and Nutramigen®,12,13 which may help aid feeding acceptance and tolerance9,14
  • With purified lactose which may help:1,15–20
  • improve palatability and mineral absorption
  • support the gut microflora and immune system
  • Supports normal growth and development9,10
  • A cost-effective solution,21,22† that helps support NHS budgets
What is CoMiss?

CoMiSS is a free, simple, fast and easy-to-use HCP awareness tool to aid with earlier diagnosis of CMA for non-IgE mediated (delayed) cows’ milk-related symptoms. A tutorial video and CoMiSS form can be downloaded or completed online at:

CoMiSS is not a diagnostic test for CMA. It does replace a food challenge and its usefulness will need to be evaluated by a prospective randomised study




  1. Koletzko S et al. JPGN 2012;55:221–9.
  2. Fiocchi A et al. World Allergy Organ J 2010; 3: 57–161.
  3. Santos A et al. Pediatr Allergy Immunol 2010; 21: 1127–1134
  4. Høst A & Halken S. Endocr Metab Immune Disord Drug Targets 2014; 14(1): 2–8.
  5. Luyt D, et al. Clin Exp Allergy 2014; 44: 642–672.
  6. Heyman MB et al. Pediatrics 2006; 118(3): 1279–86.
  7. Francavilla R et al. Pediatr Allergy Immunol 2012; 23: 420–27.
  8. Martin C et al. Nutrients 2016; 8: 279.
  9. Niggemann B et al. Pediatr Allergy Immunol 2008; 194(4): 348–354.
  10. Vandenplas Y et al. Acta Paediatr 2013; 102(8): 990–998.
  11. Luyt D et al. Clin Exp Allergy 2014; 44: 642–672.
  12. Data on File, 2015. Althéra® versus Similac Alimentum® competitive benchmarking test.
  13. Data on File, 2012. Althéra® versus Nutramigen Lipil (now LGG) ® competitive benchmarking test.
  14. Rapp M et al. Clin Transl Allergy 2013; 3(3): 132.
  15. Althéra® Product Data Card, NHSc. Updated January 2018.
  16. Abrams S et al. Am J Clin Nutr 2002; 76(2): 442–446.
  17. Ziegler E & Fomon J. J Pediatr Gastroenterol Nutr 1983; 2: 288–294.
  18. Francavilla R et al. Pediatr Allergy Immunol 2012; 23: 420–27.
  19. Waddell L. Clin Nutr 2016; 15(6): 23–28.
  20. dFaO/WhO Food and Nutrition Paper 85, 2006. Probiotics in Food. Health and Nutritional Properties and Guidelines for Evaluation, Rome.
  21. Data on file NHSc.
  22. MIMs, 2018. Available online at: (Accessed June 2019).

Footnotes and abbreviations:

*Althéra® is not recommended where only an amino acid formula is indicated.
†Versus leading competitors.
AAF, amino acid formula
ACBS, Advisory Committee on Borderline Substances
CMA, cows’ milk allergy

What is the Careline number?
Call 0800 0 81 81 80 to speak to a product representative.

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cows' milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows' milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.