The use of amino acid formulas in pediatric patients with allergy to cow’s milk proteins: Recommendations from a group of experts

Ribes-Koninckx, Carmen; Amil‐Dias, Jorge; Espín, Beatriz; Molina, Manuel; Segarra, Óscar; Diaz-Martin, Juan J.

doi:10.3389/fped.2023.1110380

Cited by 9 publications

(7 citation statements)

References 123 publications

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“…A recent review of Ribes-Koninckx et al confirms this statement and suggests the use of AAF when treatment with eHF is unsuccessful or in the case of severe CMA, particularly with associated nutritional deficiencies ( 3 ). IgE-mediated anaphylaxis associated with CMA, acute and chronic food protein induced enterocolitis syndrome (FPIES), multiple food allergies associated with CMA, and eosinophilic esophagitis unresponsive to a prolonged exclusion diet are a few examples ( 3 ). Five to ten percent of children with an IgE-mediated CMA react to eHF ( 2 , 3 ).…”

Section: Discussionmentioning

confidence: 91%

“…Due to these negative factors, CMA and the use of AAF must be frequently re-evaluated. Patient's age at diagnosis, symptoms, serum IgE level, and nutritional status are involved in this reassessment (3). Some guidelines propose a step-down strategy.…”

Section: Espghan (N = 13)mentioning

confidence: 99%

“…Cow's milk allergy (CMA) is one of the most prevalent food allergies in infants and children under the age of 3 years (1)(2)(3)(4). CMA is an immune-mediated hypersensitivity response to several proteins in cow's milk (CM), mainly casein and lactoglobulin.…”

Section: Introductionmentioning

confidence: 99%

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

Robert,

Al-Hashmi,

Al-Mehaidib

et al. 2024

Front. Allergy

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IntroductionThe 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).MethodsThese Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared.ResultsOverall, 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.DiscussionDifferences 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.

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Section: Discussionmentioning

confidence: 91%

Section: Espghan (N = 13)mentioning

confidence: 99%

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

Robert,

Al-Hashmi,

Al-Mehaidib

et al. 2024

Front. Allergy

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“…Because of severity of symptoms at the one hand, and because of failure of the CM-based eHF at the other hand, there is a subset of children where an AAF may be indicated: (i) anaphylaxis; (ii) faltering growth; (iii) multiple and severe complex GI food allergies; (iv) acute and chronic severe FPIES; (v) eosinophilic esophagitis not responding to an extended exclusion diet; (vi) to avoid any risk of sensitization; (vii) symptom persistence on eHF (even partially) (137,163,164).…”

Section: Diagnostic Elimination Diet In Non-breastfed Infantsmentioning

confidence: 99%

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Vandenplas

Broekaert

Domellöf

et al. 2024

J. pediatr. gastroenterol. nutr.

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A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 1 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost and quality of life.

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“…This consensus is in line with a recently published expert consensus focusing on this type of formulation. 58 Other guidelines and consensuses have also recommended AAF as a second option or as first line, considering various situations. 8,29,59,60…”

Section: Amino Acid-based Formulas (Aaf)mentioning

confidence: 99%

Mexican consensus on cow’s milk protein allergy

Ramírez Mayans,

Ignorosa Arellano,

Toro Monjaraz

et al. 2024

Allergol Immunopathol

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Background: The aim of this study is to present the current views of a diverse group of experts on the diagnosis and treatment of Cow’s Milk Protein Allergy (CMPA) in children under 2 years of age in Mexico. Material and methods: The study, led by a scientific committee of five experts in CMPA, was divided into six phases, including a modified Delphi process. A total of 20 panelists, all of whom were pediatric specialists, participated in administering a comprehensive 38-item questionnaire. The questionnaire was divided into two blocks: Diagnosis and Treatment (20 items each). Results: Consensus was reached on all the proposed items, with an agreement rate of over 70% for each of them. As a result, a diagnostic and treatment algorithm was developed that emphasized the reduction of unnecessary diagnostic studies and encouraged breastfeeding whenever possible. In cases where breast milk is not available, appropriate use of hypoallergenic formulas was recommended. In addition, recommendations on treatment duration and gradual reintroduction of cow’s milk protein were provided. Conclusions: The recommendations endorsed by 20 Mexican pediatricians through this study are applicable to everyday clinical practice, thereby enhancing the diagnosis and treatment of children under 2 years of age with CMPA. This, in turn, will foster improved health outcomes and optimize the utilization of healthcare resources.

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The use of amino acid formulas in pediatric patients with allergy to cow’s milk proteins: Recommendations from a group of experts

Cited by 9 publications

References 123 publications

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

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

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Mexican consensus on cow’s milk protein allergy

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