Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Symptoms and Management of Cow’s Milk Allergy: Perception and Evidence

Emma Robert
,
Hani Al-Hashmi
,
Ali I Al-Mehaidib
,
Muath Al-Turaiki
,
Wajeed Aldekhail
,
Waleed Al-Herz
,
A Alkhabaz
,
Khalid O Bawakid
,
Ahmed Elghoudi
,
Mostafa El-Hodhod
,
Ahmad Ali Hussain
,
Nagla M Kamal
,
T Loie Goronfalah
,
Basil Nasrallah
,
Kalpani Segupta
,
Ilse Broekaert
,
Magnus Domellof
,
Flavia Indrio
,
Alexandre Lapilonne
ORCID logo ,
Corina Pienar
,
Carmen Ribes_Koninckx
,
Ranaan Shamir
,
Hania Szajewska
,
Nikhil Thapar
ORCID logo ,
Rut Anne Thomassen
,
Elvira Verduci
ORCID logo ,
Cristina E West
,
Yvan Vandenplas
* ORCID logo
Version 1 : Received: 4 September 2023 / Approved: 6 September 2023 / Online: 7 September 2023 (13:25:27 CEST)

How to cite: Robert, E.; Al-Hashmi, H.; Al-Mehaidib, A.I.; Al-Turaiki, M.; Aldekhail, W.; Al-Herz, W.; Alkhabaz, A.; Bawakid, K.O.; Elghoudi, A.; El-Hodhod, M.; Ali Hussain, A.; Kamal, N.M.; Loie Goronfalah, T.; Nasrallah, B.; Segupta, K.; Broekaert, I.; Domellof, M.; Indrio, F.; Lapilonne, A.; Pienar, C.; Ribes_Koninckx, C.; Shamir, R.; Szajewska, H.; Thapar, N.; Thomassen, R.A.; Verduci, E.; West, C.E.; Vandenplas, Y. Symptoms and Management of Cow’s Milk Allergy: Perception and Evidence. Preprints 2023, 2023090500. https://doi.org/10.20944/preprints202309.0500.v1 Robert, E.; Al-Hashmi, H.; Al-Mehaidib, A.I.; Al-Turaiki, M.; Aldekhail, W.; Al-Herz, W.; Alkhabaz, A.; Bawakid, K.O.; Elghoudi, A.; El-Hodhod, M.; Ali Hussain, A.; Kamal, N.M.; Loie Goronfalah, T.; Nasrallah, B.; Segupta, K.; Broekaert, I.; Domellof, M.; Indrio, F.; Lapilonne, A.; Pienar, C.; Ribes_Koninckx, C.; Shamir, R.; Szajewska, H.; Thapar, N.; Thomassen, R.A.; Verduci, E.; West, C.E.; Vandenplas, Y. Symptoms and Management of Cow’s Milk Allergy: Perception and Evidence. Preprints 2023, 2023090500. https://doi.org/10.20944/preprints202309.0500.v1

Abstract

The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. We aimed to compare the opinions of expert groups from the Middle East (n=14) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n=13). These Expert groups voted on statements developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared. Overall, there was consensus amongst both groups of experts. Most experts agreed that symptoms of crying, irritability and colic, as single manifestations, do not suggest 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 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 of 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 was no added value of probiotics, prebiotics, and synbiotics to the efficacy of elimination diets, whereas 3/14 of the Middle East group thought there was sufficient evidence. Therefore, there is not a consensus on the optimal diagnostic and therapeutic elimination diet for CMA, but the first-choice elimination diet and the stepwise management approach reveal some differences.

Keywords

Cow's milk allergy; Infants; Extensively hydrolysed formula; Amino acid-based formula; Soy formula; Rice hydrolysed formula; Probiotic; Prebiotic; Synbiotic

Subject

Public Health and Healthcare, Public Health and Health Services

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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