Diagnostic approach and management of cow's-milk protein allergy in infants and children

Espghan gi committee practical guidelines

S. Koletzko, B. Niggemann, A. Arató, J. A. Dias, R. Heuschkel, S. Husby, M. L. Mearin, A. Papadopoulou, F. M. Ruemmele, A. Staiano, M. G. Schäppi, Y. Vandenplas

Research output: Contribution to journalArticle

307 Citations (Scopus)

Abstract

OBJECTIVES:: This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA. DIAGNOSIS:: If CMPA is suspected by history and examination, then strict allergen avoidance is initiated. In certain circumstances (eg, a clear history of immediate symptoms, a life-threatening reaction with a positive test for CMP-specific IgE), the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis of CMPA. TREATMENT:: In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast-fed infants with confirmed CMPA should receive an extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials; amino acids-based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth are mandatory in all age groups requiring CMP exclusion. REEVALUATION:: Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by 3 years of age and >90% by 6 years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and incur unnecessary health care costs.

Original languageEnglish
Pages (from-to)221-229
Number of pages9
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume55
Issue number2
DOIs
Publication statusPublished - Aug 2012

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Milk Hypersensitivity
Milk Proteins
Cytidine Monophosphate
Guidelines
Soybean Proteins
Growth
Health Care Costs
Allergens
Immunoglobulin E
Counseling
Milk
Breast
Age Groups
History
Mothers
Quality of Life
Clinical Trials
Diet
Amino Acids
Food

Keywords

  • amino acid formula
  • cow's-milk protein allergy
  • elimination diet
  • hydrolyzed formula
  • oral challenge
  • skin prick test
  • soy formula

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

Diagnostic approach and management of cow's-milk protein allergy in infants and children : Espghan gi committee practical guidelines. / Koletzko, S.; Niggemann, B.; Arató, A.; Dias, J. A.; Heuschkel, R.; Husby, S.; Mearin, M. L.; Papadopoulou, A.; Ruemmele, F. M.; Staiano, A.; Schäppi, M. G.; Vandenplas, Y.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 55, No. 2, 08.2012, p. 221-229.

Research output: Contribution to journalArticle

Koletzko, S, Niggemann, B, Arató, A, Dias, JA, Heuschkel, R, Husby, S, Mearin, ML, Papadopoulou, A, Ruemmele, FM, Staiano, A, Schäppi, MG & Vandenplas, Y 2012, 'Diagnostic approach and management of cow's-milk protein allergy in infants and children: Espghan gi committee practical guidelines', Journal of Pediatric Gastroenterology and Nutrition, vol. 55, no. 2, pp. 221-229. https://doi.org/10.1097/MPG.0b013e31825c9482
Koletzko, S. ; Niggemann, B. ; Arató, A. ; Dias, J. A. ; Heuschkel, R. ; Husby, S. ; Mearin, M. L. ; Papadopoulou, A. ; Ruemmele, F. M. ; Staiano, A. ; Schäppi, M. G. ; Vandenplas, Y. / Diagnostic approach and management of cow's-milk protein allergy in infants and children : Espghan gi committee practical guidelines. In: Journal of Pediatric Gastroenterology and Nutrition. 2012 ; Vol. 55, No. 2. pp. 221-229.
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