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Front. Allergy
Sec. Food Allergy
Volume 5 - 2024 | doi: 10.3389/falgy.2024.1348769

Symptoms and management of cow's milk allergy: perception and evidence Provisionally Accepted

Emma Robert1 HA Al-Hashmi2 A Al-Mehaidib3 M Al-Turaiki4 W Aldekhail5  Waleed Al-Herz6 A Alkhabaz7 Khalid O. Bawakid8 A Elghoudi9  Mostafa El-Hodhod10 Ali A. Hussain11  Naglaa M. Kamal12 L T. Goronfolah7 B Nasrallah13 K Sengupta14 Ilse Broekaert15  Magnus Domellöf16  FLAVIA INDRIO17  Alexandre Lapillonne18  Corina Pienar19 Carmen Ribes20  Raanan Shamir21  Hania Szajewska22  Nikhil Thapar23 RA Thomassen24  Christina E. West16  Elvira Verduci25  Yvan Vandenplas1*
  • 1Vrije University Brussels, Belgium
  • 2King Abdulaziz University, Saudi Arabia
  • 3King Faisal Specialist Hospital and Research Centre, Saudi Arabia
  • 4King Salman bin Abdulaziz Hospital, Saudi Arabia
  • 5Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Saudi Arabia
  • 6Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait
  • 7Mubarak Al Kabeer Hospital, Kuwait
  • 8Al Aziziya Medical Center, Saudi Arabia
  • 9Sheikh Khalifa Medical City, United Arab Emirates
  • 10Faculty of Medicine, Ain Shams University, Egypt
  • 11Al Salam Hospital, Kuwait
  • 12Department of Paediatrics & Paediatric Hepatology, Kasr Alainy Faculty of Medicine, Egypt
  • 13Department of Paediatrics, American Hospital Dubai, United Arab Emirates
  • 14NMC Specialty Hospital, Al Nahda, United Arab Emirates
  • 15Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Germany
  • 16Department of Clinical Science, Faculty of Medicine, Umeå University, Sweden
  • 17University of Salento, Italy
  • 18Hôpital Necker-Enfants Malades, France
  • 19Victor Babes University of Medicine and Pharmacy, Romania
  • 20Coeliac Disease and Gastrointestinal Immunopathology Research Unit. Hospital La Fe Research Institute Valencia, Spain
  • 21Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Paediatric Research, Faculty of Medicine, Tel-Aviv University,, Israel
  • 22Medical University of Warsaw, Poland
  • 23Queensland Children's Hospital, Children's Health Queensland, Australia
  • 24Paediatric Research Institute, Division of Paediatric and Adolecent Medicine, Oslo University Hospital, Norway
  • 25Department of Pediatrics, Vittore Buzzi Children's' Hospital, Italy

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Introduction: The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. Our aim was to compare the opinions of expert groups from the Middle East (n=14) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n=13).Methods: These Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared.Results: Overall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g. malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow's milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence. Discussion: Differences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area.

Keywords: cow's milk allergy, infants, Extensively hydrolysed formula, Amino acid-based formula, Soy formula, Rice hydrolysed formula, Pro-, pre-and synbiotics

Received: 03 Dec 2023; Accepted: 18 Apr 2024.

Copyright: © 2024 Robert, Al-Hashmi, Al-Mehaidib, Al-Turaiki, Aldekhail, Al-Herz, Alkhabaz, Bawakid, Elghoudi, El-Hodhod, Hussain, Kamal, Goronfolah, Nasrallah, Sengupta, Broekaert, Domellöf, INDRIO, Lapillonne, Pienar, Ribes, Shamir, Szajewska, Thapar, Thomassen, West, Verduci and Vandenplas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Yvan Vandenplas, Vrije University Brussels, Brussels, 1050, Brussels, Belgium