Pediatr Gastroenterol Hepatol Nutr.  2014 Jun;17(2):61-73.

Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy

• Vandenplas Y
• Abuabat A
• Al-Hammadi S
• Aly GS
• Miqdady MS
• Shaaban SY
• Torbey PH

Abstract

Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

Keyword

Allergy and immunology; Breast feeding; Hypersensitivity; Infant formula; Milk hypersensitivity

MeSH Terms

Allergy and Immunology
Breast Feeding
Caregivers
Consensus*
Delivery of Health Care
Diagnosis*
Diet
Food Hypersensitivity
Humans
Hypersensitivity*
Infant
Infant Formula
Middle East*
Milk Hypersensitivity
Milk Proteins*
Milk Proteins

Figure

• 

  Fig. 1 An algorithm for the prevention of infant allergy. *eHF also has proven efficacy in prevention of allergy and can be used; however, pHF is recommended due to cost and palatability considerations. CMF: cow's milk formula, pHF: partially hydrolyzed formula, eHF: extensively hydrolyzed formula.

• 

  Fig. 2 An algorithm for the treatment of CMPA. *Breastfeeding mothers should exclude all products containing CMP from their diet and take calcium supplements. †IgE-specific test or skin prick test can be performed if laboratory facilities are available. ‡Soy formula can be used if eHF is unavailable or unpalatable. CMPA: cow's milk protein allergy, AAF: amino acid formula, CMF: cow's milk formula, eHF: extensively hydrolyzed formula, +VE: positive, -VE: negative.

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