An ESPGHAN position paper on the diagnosis, management and prevention of cow's milk allergy.

Fecha de publicación: 26/07/2023 Fecha Ahead of Print: 26/07/2023

Autores de IIS La Fe

• 

  Carmen Ribes Koninckx

  Autor

Participantes ajenos a IIS La Fe

• Vandenplas, Yvan
• Broekaert, Ilse
• Domellof, Magnus
• Indrio, Flavia
• Lapillonne, Alexandre
• Pienar, Corina
• Shamir, Raanan
• Szajewska, Hania
• Thapar, Nikhil
• Thomassen, Rut Anne
• Verduci, Elvira
• West, Christina

Grupos

• Enfermedad celíaca e Inmunopatología digestiva

  

  Investigador Principal

  Carmen Ribes Koninckx

• Unidad Mixta De Investigación en Nutrición de Precisión para patologías digestivas (NUTRICURA PDig)

  

  Investigador Principal

  Carmen Ribes Koninckx

Abstract

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.

Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Keywords

• CMA, amino acid formula, breastfeeding, diagnosis, disorder of gut-brain interaction