Detection and management of milk allergy: Delphi consensus study

Allen, Hilary; Pendower, Ursula; Santer, Miriam; Groetch, Marion; Cohen, Mitchell B.; Murch, Simon; Williams, Hywel C; Munblit, Daniel; Katz, Yitzhak; Gupta, Neeraj; Adil, Sabeen; Baines, Justine; Bont, Eefje de; Ridd, Matthew J; Sibson, Victoria; McFadden, Alison; Koplin, Jennifer J.; Munene, Josephine; Perkin, Michael R.; Sicherer, Scott H.; Boyle, Robert

doi:10.1111/cea.14179

Cited by 12 publications

(31 citation statements)

References 28 publications

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“…Our data do not allow us to link purchases to infant diagnoses but does align with other studies that have shown that CMPA in infants is likely over‐diagnosed 41 due to guidelines that label potentially normal infant symptoms as a possible milk allergy 42–45 . In fact, an independent expert consensus recently suggested that narrower criteria are needed to diagnose milk CMPA to avoid unnecessary use of hypoallergenic formula 46 . Unnecessary use of a hypoallergenic formula in the US is additionally concerning as it also means consumption of lactose‐free formula and is more expensive for the consumer.…”

Section: Discussionsupporting

confidence: 59%

“…[42][43][44][45] In fact, an independent expert consensus recently suggested that narrower criteria are needed to diagnose milk CMPA to avoid unnecessary use of hypoallergenic formula. 46 Unnecessary use of a hypoallergenic formula in the US is additionally concerning as it also means consumption of lactose-free formula and is more expensive for the consumer.…”

Section: 5% Hypoallergenicmentioning

confidence: 99%

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Protein and carbohydrate content of infant formula purchased in the United States

Järvinen

Schmidt

Young

2022

Clin Experimental Allergy

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Background The protein and carbohydrate composition of formula fed infants' diets in the United States (US) has not been described. The aims of this study were to characterize these dietary exposures in infant formula purchased in the US and to estimate the proportion of formula purchased which is hypoallergenic or lactose‐reduced formula. Methods Powdered infant formula purchase data from all major physical stores in the US prior to the COVID‐19 pandemic, between 2017 and 2019, were obtained from Information Resources, Inc. Protein and carbohydrate composition and scoop sizes for each formula were obtained from manufacturers. Ready to feed liquid products, products for premature infants and products for over 1 year old were not included. Results Total volumes of term formula purchased were 216 million kg of formula powder (equivalent to 1.65 billion litres) over 3 years. Intact protein formula was 67.9% of formula purchased, 26.6% was partially hydrolysed and 5.5% was hypoallergenic (5.2% extensively hydrolysed protein; 0.3% amino acid based). Soy protein formula represented 5.1% of formula purchased. Carbohydrate content overall was 52.7% lactose, 42.3% glucose polymers and 5.0% sucrose. 23.7% of formula purchased included sucrose as a carbohydrate. Of all formula purchased, 59.0% was lactose reduced, containing a non‐lactose carbohydrate. Of ‘standard’ formula, defined as intact protein, non‐thickened, cow's milk formula, 32.3% was lactose reduced. The proportion of hypoallergenic formula purchased significantly exceeded the prevalence of cow's milk protein allergy and increased over the 3‐year study period from 4.9% to 7.6% of all formula sold. Conclusions US infants are exposed to unnecessarily high levels of non‐lactose carbohydrates and hypoallergenic formula, and this may represent a significant nutritional health risk.

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Section: Discussionsupporting

confidence: 59%

Section: 5% Hypoallergenicmentioning

confidence: 99%

Protein and carbohydrate content of infant formula purchased in the United States

Järvinen

Schmidt

Young

2022

Clin Experimental Allergy

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“…When breastmilk is not available or insufficient an extensively hydrolysed formula (EHF) is the first‐choice formula for mild‐to‐moderate CMA and an aminoacidic formula (AAF) if EHF fails 33–38 . Restrictive criteria for milk allergy diagnosis have been proposed in order to avoid overdiagnosis and excessive use of milk formula substitutes 16,39,40 …”

Section: Management Optionsmentioning

confidence: 99%

Management of IgE‐mediated food allergy in the 21st century

Cafarotti

Giovannini

Bégin

et al. 2022

Clin Experimental Allergy

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Food allergy is defined as an immune-mediated adverse reaction to food 1 consisting in a loss of tolerance to harmless environmental substances.An increase in food allergy epidemiological burden has been reported in the last few decades. 2 In parallel, hospital admissions for food-induced anaphylaxis appear to be increased. 3,4 A systematic review estimated the pooled lifetime and point prevalence of self-reported food allergy in Europe as 17.3% (95% CI: 17.0-17.6) and 5.9% (95% CI: 5.7-6.1), respectively. However, positive oral food challenge (OFC) rate was estimated as 0.9% (95%

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“…In this issue, Allen et al present new milk allergy guidance. 6 They evaluated whether a non-conflicted, multidisciplinary panel of experts informed by patient perspectives might come to different conclusions, compared with milk allergy guidelines associated with formula industry conflicts. They found that guidance produced without formula industry conflicts leads to narrower criteria for detecting milk allergy, more explicit support for breastfeeding women in the context of milk allergy diagnosis, and more restrictive indications for specialized formula use.…”

Section: Clinical and Experimental Allergy Boycotts Formula Advertisingmentioning

confidence: 99%

“…Milk allergy guidelines are often supported or disseminated by the formula industry and usually written by experts who have received funding from the formula industry. In this issue, Allen et al present new milk allergy guidance 6 . They evaluated whether a non‐conflicted, multidisciplinary panel of experts informed by patient perspectives might come to different conclusions, compared with milk allergy guidelines associated with formula industry conflicts.…”

Section: Figurementioning

confidence: 99%