Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: a modified Delphi-based study

Moustafa A. El-Hodhod, Mortada H.F. El-Shabrawi, Ahmed AlBadi, Ahmed Hussein, Ali Almehaidib, Basil Nasrallah, Ebtsam Mohammed AlBassam, Hala El Feghali, Hasan M. Isa, Khaled Al Saraf, Maroun Sokhn, Mehdi Adeli, Najwa Mohammed Mousa Al-Sawi, Pierre Hage, Suleiman Al-Hammadi

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background: This study aimed to develop an expert consensus regarding the epidemiology, diagnosis, and management of cow’s milk protein allergy (CMPA) in the Middle East. Methods: A three-step modified Delphi method was utilized to develop the consensus. Fifteen specialized pediatricians participated in the development of this consensus. Each statement was considered a consensus if it achieved an agreement level of ≥ 80%. Results: The experts agreed that the double-blind placebo-controlled oral challenge test (OCT) should be performed for 2–4 weeks using an amino acid formula (AAF) in formula-fed infants or children with suspected CMPA. Formula-fed infants with confirmed CMPA should be offered a therapeutic formula. The panel stated that an extensively hydrolyzed formula (eHF) is indicated in the absence of red flag signs. At the same time, the AAF is offered for infants with red flag signs, such as severe anaphylactic reactions. The panel agreed that infants on an eHF with resolved symptoms within 2–4 weeks should continue the eHF with particular attention to the growth and nutritional status. On the other hand, an AAF should be considered for infants with persistent symptoms; the AAF should be continued if the symptoms resolve within 2–4 weeks, with particular attention to the growth and nutritional status. In cases with no symptomatic improvements after the introduction of an AAF, other measures should be followed. The panel developed a management algorithm, which achieved an agreement level of 90.9%. Conclusion: This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.

Original languageEnglish
Pages (from-to)576-589
Number of pages14
JournalWorld Journal of Pediatrics
Volume17
Issue number6
DOIs
Publication statusPublished - Dec 2021
Externally publishedYes

Keywords

  • Consensus Cow’s milk protein allergy
  • Infant formula
  • Middle East
  • Milk hypersensitivity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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