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Detection and management of milk allergy: Delphi consensus study

Allen, HI; Pendower, U; Santer, M; Groetch, M; Cohen, M; Murch, SH; Williams, HC; Munblit, D; Katz, Y; Gupta, N; et al. Allen, HI; Pendower, U; Santer, M; Groetch, M; Cohen, M; Murch, SH; Williams, HC; Munblit, D; Katz, Y; Gupta, N; Adil, S; Baines, J; de Bont, EGPM; Ridd, M; Sibson, VL; McFadden, A; Koplin, JJ; Munene, J; Perkin, MR; Sicherer, SH; Boyle, RJ (2022) Detection and management of milk allergy: Delphi consensus study. Clinical & Experimental Allergy, 52 (7). pp. 848-858. ISSN 0954-7894 https://doi.org/10.1111/cea.14179
SGUL Authors: Perkin, Michael Richard

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Abstract

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.

Item Type: Article
Additional Information: © 2022 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: 1107 Immunology, 1111 Nutrition and Dietetics, 1117 Public Health and Health Services, Allergy
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Clinical & Experimental Allergy
ISSN: 0954-7894
Language: en
Dates:
DateEvent
7 July 2022Published
10 June 2022Published Online
26 May 2022Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
1158699National Health and Medical Research Councilhttp://dx.doi.org/10.13039/501100000925
URI: https://openaccess.sgul.ac.uk/id/eprint/114498
Publisher's version: https://doi.org/10.1111/cea.14179

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