Guidelines for the diagnosis and management of cow’s milk protein allergy in infants

Our aim was to develop guidance for general paediatricians and primary care physicians in diagnosing and managing cow’s milk protein allergy in infants. The guidelines were developed by discussion based on existing national recommendations and standards, clinical experience and, whenever possible, evidence from the literature. Separate algorithms cover breast-fed and formula-fed infants. The recommendations emphasise the importance of comprehensive history taking and careful physical examination. Patients with severe symptoms need to be referred to a specialist. Elimination of cow’s milk protein from the infant’s or mother’s diet and challenges are the gold standard for diagnosis. This guidance is intended as a basis for local discussion, implementation and prospective evaluation. The algorithms should be regularly assessed using clinical audit standards. Once validated, the diagnostic framework could provide a standardised approach in epidemiological and therapeutic studies.

[1]  B. Niggemann,et al.  Vorgehen bei Säuglingen mit Verdacht auf Kuhmilchproteinallergie , 2009, Monatsschrift Kinderheilkunde.

[2]  M. Thomson,et al.  Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study , 2007, Archives of Disease in Childhood.

[3]  B. Drumm,et al.  Outcome for children with cyclical vomiting syndrome , 2007, Archives of Disease in Childhood.

[4]  B. Koletzko,et al.  Soy Protein Infant Formulae and Follow-On Formulae: A Commentary by the ESPGHAN Committee on Nutrition , 2006, Journal of pediatric gastroenterology and nutrition.

[5]  A. Knulst,et al.  Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets , 2006, Allergy.

[6]  P. J. Allen,et al.  The diagnosis and management of cow milk protein intolerance in the primary care setting. , 2005, Pediatric nursing.

[7]  S. Strobel,et al.  Food allergy in children. , 2005, Indian journal of pediatrics.

[8]  M. Mäkelä,et al.  Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status. , 2005, The Journal of allergy and clinical immunology.

[9]  K. Grimshaw,et al.  Exposure of the fetus and infant to hens' egg ovalbumin via the placenta and breast milk in relation to maternal intake of dietary egg , 2005, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[10]  B. Björkstén Genetic and environmental risk factors for the development of food allergy , 2005, Current opinion in allergy and clinical immunology.

[11]  R. Zeiger,et al.  The role of breast-feeding in the development of allergies and asthma. , 2005, The Journal of allergy and clinical immunology.

[12]  B. Niggemann,et al.  The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges , 2005, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[13]  A. Ventura,et al.  Fatal allergy as a possible consequence of long‐term elimination diet , 2004, Allergy.

[14]  R. Wood The natural history of food allergy. , 2003, Pediatrics.

[15]  H. Sampson,et al.  Food protein-induced enterocolitis syndrome caused by solid food proteins. , 2003, Pediatrics.

[16]  L. Shek,et al.  Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy. , 2003, The Journal of allergy and clinical immunology.

[17]  A. Høst Frequency of cow's milk allergy in childhood. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[18]  S. Bahna Cow's milk allergy versus cow milk intolerance. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[19]  P. Restani,et al.  Cross-reactivity between mammalian proteins. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[20]  H. Wichmann,et al.  Effect of exclusive breast‐feeding and early solid food avoidance on the incidence of atopic dermatitis in high‐risk infants at 1 year of age , 2002, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[21]  C. Dupont,et al.  Allergy to extensively hydrolyzed cow's milk proteins in infants: safety and duration of amino acid-based formula. , 2002, The Journal of pediatrics.

[22]  K. Turjanmaa "Atopy patch tests" in the diagnosis of delayed food hypersensitivity. , 2002, Allergie et immunologie.

[23]  R. Korpela,et al.  Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy: a prospective, randomized study with a follow-up to the age of 2 years. , 2002, The Journal of pediatrics.

[24]  A. Burks,et al.  Hypoallergenicity and efficacy of an amino acid-based formula in children with cow's milk and multiple food hypersensitivities. , 2001, The Journal of pediatrics.

[25]  W. Wouters-Wesseling,et al.  Hypoallergenicity of an extensively hydrolyzed whey formula , 2001, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[26]  E. Valovirta,et al.  The patch test, skin prick test, and serum milk‐specific IgE as diagnostic tools in cow's milk allergy in infants , 1999, Allergy.

[27]  Beretta,et al.  Cross‐reactivity between milk proteins from different animal species , 1999, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[28]  A. Muraro,et al.  Dietary products used in infants for treatment and prevention of food allergy. , 1999, Archives of disease in childhood.

[29]  E. Isolauri,et al.  Elimination diet in cow's milk allergy: risk for impaired growth in young children. , 1998, The Journal of pediatrics.

[30]  D. Mack,et al.  Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants. , 1997, The Journal of pediatrics.

[31]  F. Brémont,et al.  Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges , 1997, Allergy.

[32]  J. Forster,et al.  Allergenicity of α‐caseins from cow, sheep, and goat , 1997 .

[33]  M. Kajosaari,et al.  Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old , 1995, The Lancet.

[34]  A. Høst,et al.  Bovine β‐1actoglobulin in human milk from atopic and non‐atopic mothers. Relationship to maternal intake of homogenized and unhomogenized milk , 1990, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[35]  N. Krebs,et al.  Hypoallergenic Infant Formulas , 1989, Pediatrics.

[36]  R. Bush,et al.  Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. , 1988, The Journal of allergy and clinical immunology.

[37]  M. Shelton,et al.  Manifestations of milk allergy in infancy: clinical and immunologic findings. , 1986, The Journal of pediatrics.

[38]  I. Jakobsson,et al.  Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. , 1983, Pediatrics.

[39]  J. Warner Food allergy in fully breast‐fed infants , 1980, Clinical allergy.

[40]  Z. Hui Guidelines for Diagnosis and Management of Cow's Milk Protein Allergy in Infants , 2009 .

[41]  M. Yarıktaş,et al.  The role of allergy in recurrent otitis media with effusion. , 2004, Journal of investigational allergology & clinical immunology.

[42]  S. Salvatore,et al.  Symptoms, Diagnosis, and Management of Colicky Infants with Regurgitation , 2002 .

[43]  T. Peltola,et al.  Breast-feeding of allergic infants. , 1999, The Journal of pediatrics.

[44]  O. Alho,et al.  Cow's milk allergy is associated with recurrent otitis media during childhood. , 1999, Acta oto-laryngologica.

[45]  J. Forster,et al.  Allergenicity of alpha-caseins from cow, sheep, and goat. , 1997, Allergy.

[46]  American Academy of Pediatrics Committee on Nutrition: Hypoallergenic infant formulas. , 1989, Pediatrics.

[47]  K. Fälth‐magnusson,et al.  Natural history of food allergy. , 1988, Annals of allergy.