Summary of ESPGHAN's Medical Position Paper

Thursday, Feb 01, 2018

Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children

Reference:

Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y. Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines. J Pediatr Gastroenterol Nutr. 2012 Aug;55(2):221-229. Link to PubMed

Background:
Cow's milk protein (CMP) is the leading cause of food allergy in infants and young children younger than 3 years. Correct diagnosis allows the appropriate diet to be given to affected infants, thus supporting normal growth and development.

ESPGHAN GI Committee Practical Guidelines:
Provide practical approach to managing children with predominantly GI symptoms, and recommendations for the diagnosis and management of suspected cow's milk protein allergy (CMPA) in Europe.


Diagnosis:

  1. Thorough medical history and physical examination;
  2. Suspected CMPA can be followed by CMP elimination;
  3. Improvement of clinical symptoms from CMP elimination from diet should be confirmed by a standardized oral challenge test performed under medical supervision.


Treatment for confirmed CMPA:

  • Breastfed infants:
    - Mothers are encouraged to continue breastfeeding while avoiding all milk and milk products from their own diet.
  • Non-breastfed infants:
    - Extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials.
    - Amino acids-based formula, an option for infants reacting to extensively hydrolyzed formula.
    - Soy protein formula, if tolerated, is an option for infants beyond 6 months of age.
  • Children with CMPA that continues beyond the first 12 months of age need individualized nutritional advice, with dietetic assessment on intakes of protein, calcium, vitamin D, and vitamin A.


Re-evaluation:
Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP, in which most cases outgrow CMPA by 6 years of age.

 

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