Use of Partially Hydrolysed Whey Formula in Cow’s Milk Allergy: Real-World Evidence from a Multinational Survey in China and the Middle East

Background/Objectives: International guidelines recommend a short-term milk-free elimination diet and oral food challenge (OFC), with or without specific IgE testing, for diagnosing cow’s milk allergy (CMA), with extensively hydrolysed formulas (eHF) or amino acid formulas (AAF) as first-line nutritional therapy. In some countries, par-tially hydrolysed whey formula (pHF-W) is used as a step-down, or bridge, to intact cow’s milk protein (CMP), despite limited supporting evidence. This study explored real-world diagnostic practices and experiences with pHF-W step-down use among healthcare professionals (HCPs) in China and the Middle East. Methods: An online cross-sectional survey was conducted among 600 HCPs including paediatricians, gas-troenterologists, allergists/immunologists, and dermatologists, from China, Bahrain, Kuwait, Saudi Arabia, and United Arab Emirates. IPSOS translated the 25-item ques-tionnaire into local languages, were responsible for HCP selection and implementation. Results: While 71% of respondents used a food elimination diet, OFCs were only used by 46%. The majority relied on history/physical examination (91%) and/or specific IgE testing (85%), raising concerns about misdiagnosis. While most respondents reported using eHF or AAF for first-line nutritional management, 20% used pHF-W, diverging from guideline recommendations. Seventy-seven percent of HCPs employed pHF-W as a step-down formula before intact CMP, citing improved tolerance and reduced re-currence. Over 80% of HCPs using pHF-W in this way expressed satisfaction, with 53% recommending it for 3–6 months. Conclusions: CMA diagnostic and management practices in China and the Middle East show variable adherence to international guidelines. Frequent pHF-W use highlights the need for educational interventions, better guideline dissemination, and further research to evaluate its safety and efficacy in step-down approach for CMA management.