TY - JOUR
T1 - Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East
T2 - a modified Delphi-based study
AU - El-Hodhod, Moustafa A.
AU - El-Shabrawi, Mortada H.F.
AU - AlBadi, Ahmed
AU - Hussein, Ahmed
AU - Almehaidib, Ali
AU - Nasrallah, Basil
AU - AlBassam, Ebtsam Mohammed
AU - El Feghali, Hala
AU - Isa, Hasan M.
AU - Al Saraf, Khaled
AU - Sokhn, Maroun
AU - Adeli, Mehdi
AU - Al-Sawi, Najwa Mohammed Mousa
AU - Hage, Pierre
AU - Al-Hammadi, Suleiman
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Consensus Cow’s milk protein allergy
KW - Infant formula
KW - Middle East
KW - Milk hypersensitivity
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U2 - 10.1007/s12519-021-00476-3
DO - 10.1007/s12519-021-00476-3
M3 - Article
C2 - 34817828
AN - SCOPUS:85120672453
SN - 1708-8569
VL - 17
SP - 576
EP - 589
JO - World Journal of Pediatrics
JF - World Journal of Pediatrics
IS - 6
ER -