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Aim  Cow's milk protein allergy ( CMPA ) is treated using an elimination diet with an extensive protein hydrolysate. We explored whether a thickened or nonthickened version was best for infants with suspected  CMPA , which commonly causes regurgitation/vomiting.    Methods  Diagnosis of  CMPA  was based on a positive challenge test. We compared the efficacy of two casein extensive hydrolysates ( eCH ), a nonthickened version ( NT ‐ eCH ) and a thickened version ( T ‐ eCH ), using a symptom‐based score covering regurgitation, crying, stool consistency, eczema, urticarial and respiratory symptoms.    Results  A challenge was performed in 52/72 infants with suspected  CMPA  and was positive in 65.4%. All confirmed  CMPA  cases tolerated  eCH . The symptom‐based score decreased significantly in all infants within a month, and the highest reduction was in those with confirmed  CMPA . Regurgitation was reduced in all infants (6.4 ± 3.2–2.8 ± 2.9, p < 0.001), but fell more with the T‐ eCH  (−4.2 ± 3.2 regurgitations/day vs. −3.0 ± 4.5, ns), especially in infants with a negative challenge (−3.9 ± 4.0 vs. −1.9 ± 3.4, ns).    Conclusion   eCH  fulfilled the criteria for a hypoallergenic formula, and the  NT ‐ eCH  and  T ‐ eCH  formulas both reduced  CMPA  symptoms. The symptom‐based score is useful for evaluating how effective dietary treatments are for  CMPA .

Extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow's milk allergy