Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey
The present paper aims to provide experts' consensus on diagnosis and management of cow's milk protein allergy (CMPA) among infants and children in Turkey, based on review of available evidence-based guidelines, publications and experts' clinical experience. The experts agreed...
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| Format: | Article |
| Language: | English |
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Hacettepe University Institute of Child Health
2016-02-01
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| Series: | The Turkish Journal of Pediatrics |
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| Online Access: | https://turkjpediatr.org/article/view/1063 |
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| author | Aydan Kansu Aysel Yüce Buket Dalgıç Bülent Enis Şekerel Fügen Çullu-Çokuğraş Haluk Çokuğraş |
| author_facet | Aydan Kansu Aysel Yüce Buket Dalgıç Bülent Enis Şekerel Fügen Çullu-Çokuğraş Haluk Çokuğraş |
| author_sort | Aydan Kansu |
| collection | DOAJ |
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The present paper aims to provide experts' consensus on diagnosis and management of cow's milk protein allergy (CMPA) among infants and children in Turkey, based on review of available evidence-based guidelines, publications and experts' clinical experience. The experts agreed that CMPA diagnosis should be based on symptomatic evaluation and diagnostic elimination diet as followed by implementation of an open challenge test after disappearance of symptoms and confirmation of CMPA diagnosis in re-appearance of symptoms. For breastfed infants, differential diagnosis involves withdrawal of cow's milk-containing products from the mother's diet, while calcium supplements and appropriate dietary advice are given to mothers to prevent nutritional deficiency. For infants not breastfed exclusively, cow's milk-based formula and any complementary food containing cow's milk protein (CMP) should be avoided. The first line treatment should be extensively hydrolyzed formula (eHF) with use of amino acid-based formula (AAF) in severe cases such as anaphylaxis, enteropathy, eosinophilic esophagitis and food protein induced enterocolitis along with cases of multiple system involvement, multiple food allergies and intolerance to eHF. Introduction of supplementary foods should not be delayed in CMPA, while should be made one by one in small amounts and only after the infant is at least 17 weeks of age. Infants who are at-risk can be identified by family history of atopic disease. Exclusive breastfeeding for 4-6 months (17-27 weeks) is recommended as the best method of infant allergy prevention. There is no evidence that modifying the mother's diet during pregnancy and/or breast-feeding and delaying solid or even potentially allergic foods beyond 4-6 months in infants may be protective against allergy among at-risk infants. When exclusive breastfeeding is not possible, at-risk infants should get a partially or extensively hydrolyzed formula (pHF or eHF) to prevent allergy until risk evaluation by a health professional. In conclusion, the present consensus statement provides recommendations regarding diagnosis, prevention and management of CMPA in infants and children in Turkey, and thus expected to guide physicians to optimize their approach to CMPA and decrease burden of the disease on infants and their caregivers.
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| format | Article |
| id | doaj-art-e74f11c6eb5b40fb8b57dd1b76807314 |
| institution | OA Journals |
| issn | 0041-4301 2791-6421 |
| language | English |
| publishDate | 2016-02-01 |
| publisher | Hacettepe University Institute of Child Health |
| record_format | Article |
| series | The Turkish Journal of Pediatrics |
| spelling | doaj-art-e74f11c6eb5b40fb8b57dd1b768073142025-08-20T02:01:53ZengHacettepe University Institute of Child HealthThe Turkish Journal of Pediatrics0041-43012791-64212016-02-0158110.24953/turkjped.2016.01.001Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in TurkeyAydan Kansu0Aysel Yüce1Buket Dalgıç2Bülent Enis Şekerel3Fügen Çullu-Çokuğraş4Haluk Çokuğraş5Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.Division of Pediatric Gastroenterology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.Division of Pediatric Gastroenterology, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.Division of Pediatric Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.Division of Pediatric Gastroenterology, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.Division of Pediatric Allergy, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey. The present paper aims to provide experts' consensus on diagnosis and management of cow's milk protein allergy (CMPA) among infants and children in Turkey, based on review of available evidence-based guidelines, publications and experts' clinical experience. The experts agreed that CMPA diagnosis should be based on symptomatic evaluation and diagnostic elimination diet as followed by implementation of an open challenge test after disappearance of symptoms and confirmation of CMPA diagnosis in re-appearance of symptoms. For breastfed infants, differential diagnosis involves withdrawal of cow's milk-containing products from the mother's diet, while calcium supplements and appropriate dietary advice are given to mothers to prevent nutritional deficiency. For infants not breastfed exclusively, cow's milk-based formula and any complementary food containing cow's milk protein (CMP) should be avoided. The first line treatment should be extensively hydrolyzed formula (eHF) with use of amino acid-based formula (AAF) in severe cases such as anaphylaxis, enteropathy, eosinophilic esophagitis and food protein induced enterocolitis along with cases of multiple system involvement, multiple food allergies and intolerance to eHF. Introduction of supplementary foods should not be delayed in CMPA, while should be made one by one in small amounts and only after the infant is at least 17 weeks of age. Infants who are at-risk can be identified by family history of atopic disease. Exclusive breastfeeding for 4-6 months (17-27 weeks) is recommended as the best method of infant allergy prevention. There is no evidence that modifying the mother's diet during pregnancy and/or breast-feeding and delaying solid or even potentially allergic foods beyond 4-6 months in infants may be protective against allergy among at-risk infants. When exclusive breastfeeding is not possible, at-risk infants should get a partially or extensively hydrolyzed formula (pHF or eHF) to prevent allergy until risk evaluation by a health professional. In conclusion, the present consensus statement provides recommendations regarding diagnosis, prevention and management of CMPA in infants and children in Turkey, and thus expected to guide physicians to optimize their approach to CMPA and decrease burden of the disease on infants and their caregivers. https://turkjpediatr.org/article/view/1063Turkeyclinical practicecow’s milk protein allergydiagnosisguidelinesprevention |
| spellingShingle | Aydan Kansu Aysel Yüce Buket Dalgıç Bülent Enis Şekerel Fügen Çullu-Çokuğraş Haluk Çokuğraş Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey The Turkish Journal of Pediatrics Turkey clinical practice cow’s milk protein allergy diagnosis guidelines prevention |
| title | Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey |
| title_full | Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey |
| title_fullStr | Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey |
| title_full_unstemmed | Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey |
| title_short | Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey |
| title_sort | consensus statement on diagnosis treatment and follow up of cow s milk protein allergy among infants and children in turkey |
| topic | Turkey clinical practice cow’s milk protein allergy diagnosis guidelines prevention |
| url | https://turkjpediatr.org/article/view/1063 |
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