Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey

DALGIÇ, Buket; Yüce, Aysel; ÇOKUĞRAŞ, HALUK CEZMİ; Şekerel, Bülent; ÇULLU-ÇOKUĞRAŞ, Fügen; KANSU, Aydan

Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey

Aydan KANSU, (Ankara University)

Aysel YÜCE, (Hacettepe University)

Buket DALGIÇ, (Gazi University)

Bülent Enis ŞEKEREL, (Hacettepe University)

Fügen ÇULLU-ÇOKUĞRAŞ, (Istanbul University)

HALUK CEZMİ ÇOKUĞRAŞ (Istanbul University)

Turkish Journal of Pediatrics

4 2

Yıl: 2016 Cilt: 58 Sayı: 1 Sayfa Aralığı: 1 - 11 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey

Öz:

Kansu A, Yüce A, Dalgıç B, Şekerel BE, Çullu-Çokuğraş F, Çokuğraş H. Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turk J Pediatr 2016; 58: 1-11. 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

Anahtar Kelime:

Konular: Pediatri

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID sponsored expert panel. J Allergy Clin Immunol 2010; 126: S1-58.
2. Boyce JA, Assa’ad A, Burks AW, et al. NIAID-Sponsored Expert Panel. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol 2010; 126: 1105-1118.
3. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: report of the nomenclature review committee of the world allergy organization, October 2003. J Allergy Clin Immunol 2004; 113: 832-836.
4. Venter C, Brown T, Shah N, Walsh J, Fox AT. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy - a UK primary care practical guide. Clin Transl Allergy 2013; 3: 23.
5. Koletzko S, Niggemann B, Arato A, et al. European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 2012; 55: 221-229.
6. Sicherer SH, Noone SA, Koerner CB, Christie L, Burks AW, Sampson HA. Hypoallergenicity and efficacy of an amino acid-based formula in children with cows’ milk and multiple food hypersensitivities. J Pediatr 2001; 138: 688-693.
7. Fiocchi A, Brozek J, Schünemann H, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010; 3: 57-161.
8. Vandenplas Y, Abuabat A, Al-Hammadi S, et al. Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow’s Milk Protein Allergy. Pediatr Gastroenterol Hepatol Nutr 2014; 17: 61-73.
9. Eggesbo M, Botten G, Halvorsen R, Magnus P. The prevalence of CMA/CMPI in young children: the validity of parentally perceived reactions in a population-based study. Allergy 2001; 56: 393-402.
10. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121: 183-191.
11. Kemp AS, Hill DJ, Allen KJ, et al. Guidelines for the use of infant formulae to treat cow’s milk protein allergy: an Australian consensus panel opinion. Med J Aust 2008; 188: 109-112.
12. Allen KJ, Davidson GP, Day AS, et al. Management of cow’s milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health 2009; 45: 481-486.
13. Vandenplas Y, Brueton M, Dupont C. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child 2007; 92: 902-908.
14. Venter C, Pereira B, Voigt K, et al. Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy 2008, 63: 354-359.
15. Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127: 594-602.
16. Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 2007; 120: 638-646.
17. Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 2002; 13: 23-28.
18. Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Immunol 2002; 89: 33-37.
19. Vandenplas Y, De Greef E, Devreker T. Treatment of cow’s milk protein allergy. Pediatr Gastroenterol Hepatol Nutr 2014; 7: 1-5.
20. Brill H. Approach to milk protein allergy in infants. Can Fam Physician 2008; 54: 1258-1264.
21. Assa’ad AH, Putnam PE, Collins MH, et al. Pediatric patients with eosinophilic esophagitis: an 8-year followup. J Allergy Clin Immunol 2007; 119: 731-738.
22. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990; 31: 54-58.
23. Shek LP, Bardina L, Castro R, Sampson HA, Beyer K. Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and nonIgE-mediated disorders. Allergy 2005; 60: 912-919.
24. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2006; 3: CD000133.
25. Host A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of foo allergy. Joint statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulae and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999; 81: 80-84.
26. Jarvinen KM, Chatchatee P. Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis. Curr Opin Allergy Clin Immunol 2009; 9: 251-258.
27. Celik-Bilgili S, Mehl A, Verstege A, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005; 35: 268-273.
28. Verstege A, Mehl A, Rolinck-Werninghaus C, et al. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy 2005; 35: 1220-1226.
29. Stapel SO, Asero R, Ballmer-Weber BK, et al.; EAACI Task Force. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI task force report. Allergy 2008; 63: 793-796.
30. Nielsen RG, Fenger C, Bindslev-Jensen C, Husby S. Eosinophilia in the upper gastrointestinal tract is not a characteristic feature in cow’s milk sensitive gastro-oesophageal reflux disease. Measurement by two methodologies. J Clin Pathol 2006; 59: 89-94.
31. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106: 346-349.
32. Giampietro PG, Kjellman NI, Oldaeus G, WoutersWesseling W, Businco L. Hypoallergenicity of an extensively hydrolyzed whey formula. Pediatr Allergy Immunol 2001;12: 83-86.
33. Isolauri E, Sutas Y, Makinen-Kiljunen S, Oja SS, Isosomppi R, Turjanmaa K. Efficacy and safety of hydrolyzed cow milk and amino acid-derived formulas in infants with cow milk allergy. J Pediatr 1995; 127: 550-557.
34. Halpern SR, Sellars WA, Johnson RB, Anderson DW, Saperstein S, Reisch JS. Development of childhood allergy in infants fed breast, soy, or cow milk. J Allergy Clin Immunol 1973; 51: 139-151.
35. Bhatia J, Greer F; American Academy of Pediatrics Committee on Nutrition. Use of soy protein-based formulas in infant feeding. Pediatrics 2008; 121: 1062- 1068.
36. Vandenplas Y, Castrellon PG, Rivas R, et al. Safety of soya-based infant formulas in children. Br J Nutr 2014; 111: 1340-1360.
37. Agostoni C, Axelsson I, Goulet O, et al; ESPGHAN Committee on Nutrition. Soy protein infant formulae and follow-on formulae: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2006; 42: 352-361.
38. Ehlayel M, Bener A, Abu Hazeima K, Al-Mesaifri F. Camel milk is a safer choice than goat milk for feeding children with cow milk allergy. ISRN Allergy 2011; 2011: 391641.
39. Agostoni C, Decsi T, Fewtrell M, et al. ESPGHAN Committee on Nutrition. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46: 99-110.
40. Agostoni C, Braegger C, Decsi T, et al. ESPGHAN Committee on Nutrition. Breast-feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2009; 49: 112-125.
41. Laitinen K, Kalliomaki M, Poussa T, Lagström H, Isolauri E. Evaluation of diet and growth in children with and without atopic eczema: follow-up study from birth to 4 years. Br J Nutr 2005; 94: 565-574.
42. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 2007; 120: 1172-1177.
43. Ludman S, Shah N, Fox AT. Managing cows’ milk allergy in children. BMJ 2013; 347: f5424.
44. von Berg A, Filipiak-Pittroff B, Krämer U, et al. GINIplus study group. Allergies in high-risk schoolchildren after early intervention with cow’s milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol 2013; 131: 1565-1573.
45. Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br J Dermatol 2009; 161: 373-383.
46. Fälth-Magnusson K, Kjellman NI. Allergy prevention by maternal elimination diet during late pregnancy—a 5-year follow-up of a randomized study. J Allergy Clin Immunol 1992; 89: 709-713.
47. Lilja G, Dannaeus A, Foucard T, Graff-Lonnevig V, Johansson SG, Oman H. Effects of maternal diet during late pregnancy and lactation on the development of IgE and egg- and milk-specific IgE and IgG antibodies in infants. Clin Exp Allergy 1991; 21: 195-202.
48. Crittenden RG, Bennett LE. Cow’s milk allergy: a complex disorder. J Am Coll Nutr 2005; 24: 582S-591S.
49. Marini A, Agosti M, Motta G, Mosca F. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years’ follow-up. Acta Paediatr Suppl 1996; 414: 1-21.
50. Vandenplas Y, Hauser B, Van den Borre C, et al. The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease. Eur J Pediatr 1995; 154: 488-494.
51. Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003; 361: 1869-1871.
52. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr 2008; 138: 1091-1095.
53. Osborn DA, Sinn JK. Prebiotics in infants for prevention of allergy. Cochrane Database Syst Rev 2013; 3: CD006474.

APA	KANSU A, Yüce A, DALGIÇ B, Şekerel B, ÇULLU-ÇOKUĞRAŞ F, ÇOKUĞRAŞ H (2016). Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. , 1 - 11.
Chicago	KANSU Aydan,Yüce Aysel,DALGIÇ Buket,Şekerel Bülent,ÇULLU-ÇOKUĞRAŞ Fügen,ÇOKUĞRAŞ HALUK CEZMİ Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. (2016): 1 - 11.
MLA	KANSU Aydan,Yüce Aysel,DALGIÇ Buket,Şekerel Bülent,ÇULLU-ÇOKUĞRAŞ Fügen,ÇOKUĞRAŞ HALUK CEZMİ Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. , 2016, ss.1 - 11.
AMA	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. . 2016; 1 - 11.
Vancouver	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. . 2016; 1 - 11.
IEEE	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H "Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey." , ss.1 - 11, 2016.
ISNAD	KANSU, Aydan vd. "Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey". (2016), 1-11.

APA	KANSU A, Yüce A, DALGIÇ B, Şekerel B, ÇULLU-ÇOKUĞRAŞ F, ÇOKUĞRAŞ H (2016). Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turkish Journal of Pediatrics, 58(1), 1 - 11.
Chicago	KANSU Aydan,Yüce Aysel,DALGIÇ Buket,Şekerel Bülent,ÇULLU-ÇOKUĞRAŞ Fügen,ÇOKUĞRAŞ HALUK CEZMİ Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turkish Journal of Pediatrics 58, no.1 (2016): 1 - 11.
MLA	KANSU Aydan,Yüce Aysel,DALGIÇ Buket,Şekerel Bülent,ÇULLU-ÇOKUĞRAŞ Fügen,ÇOKUĞRAŞ HALUK CEZMİ Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turkish Journal of Pediatrics, vol.58, no.1, 2016, ss.1 - 11.
AMA	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turkish Journal of Pediatrics. 2016; 58(1): 1 - 11.
Vancouver	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turkish Journal of Pediatrics. 2016; 58(1): 1 - 11.
IEEE	KANSU A,Yüce A,DALGIÇ B,Şekerel B,ÇULLU-ÇOKUĞRAŞ F,ÇOKUĞRAŞ H "Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey." Turkish Journal of Pediatrics, 58, ss.1 - 11, 2016.
ISNAD	KANSU, Aydan vd. "Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey". Turkish Journal of Pediatrics 58/1 (2016), 1-11.