TY - JOUR
T1 - Detection and management of milk allergy
T2 - Delphi consensus study
AU - Allen, Hilary I.
AU - Pendower, Ursula
AU - Santer, Miriam
AU - Groetch, Marion
AU - Cohen, Mitchell
AU - Murch, Simon H.
AU - Williams, Hywel C.
AU - Munblit, Daniel
AU - Katz, Yitzhak
AU - Gupta, Neeraj
AU - Adil, Sabeen
AU - Baines, Justine
AU - de Bont, Eefje G. P. M.
AU - Ridd, Matthew
AU - Sibson, Victoria L.
AU - McFadden, Alison
AU - Koplin, Jennifer J.
AU - Munene, Josephine
AU - Perkin, Michael R.
AU - Sicherer, Scott H.
AU - Boyle, Robert J.
N1 - Funding Information:
This study was funded through an Irish College of General Practice Research Fellowship awarded to Dr Allen.
Publisher Copyright:
© 2022 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.
PY - 2022/7
Y1 - 2022/7
N2 - Background: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.Methods: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.Findings: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialized formula.Interpretation: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialized formula, compared with current guidelines.
AB - Background: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.Methods: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.Findings: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialized formula.Interpretation: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialized formula, compared with current guidelines.
KW - Cow's milk allergy
KW - Delphi consensus
KW - breastfeeding
KW - overdiagnosis
UR - http://www.scopus.com/inward/record.url?scp=85131541271&partnerID=8YFLogxK
U2 - 10.1111/cea.14179
DO - 10.1111/cea.14179
M3 - Article
C2 - 35615972
SN - 0954-7894
VL - 52
SP - 848
EP - 858
JO - Clinical and Experimental Allergy
JF - Clinical and Experimental Allergy
IS - 7
ER -