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Title: Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: a modified Delphi-based study
Authors: El-Hodhod, Moustafa A
El-Shabrawi, Mortada H F
AlBadi, Ahmed
Hussein, Ahmed
Almehaidib, Ali
Nasrallah, Basil
AlBassam, Ebtsam Mohammed
El Feghali, Hala
Isa, Hasan M
Al Saraf, Khaled
Sokhn, Maroun
Adeli, Mehdi
Al-Sawi, Najwa Mohammed Mousa
Hage, Pierre
Al-Hammadi, Suleiman
Affiliations: Faculty of Medicine 
Keywords: Consensus Cow’s milk protein allergy
Infant formula
Middle East
Milk hypersensitivity
Issue Date: 2021
Part of: World Journal of Pediatrics
Volume: 17
Start page: 576
End page: 589
This study aimed to develop an expert consensus regarding the epidemiology, diagnosis, and management of cow’s milk protein allergy (CMPA) in the Middle East.

A three-step modified Delphi method was utilized to develop the consensus. Fifteen specialized pediatricians participated in the development of this consensus. Each statement was considered a consensus if it achieved an agreement level of ≥ 80%.

The experts agreed that the double-blind placebo-controlled oral challenge test (OCT) should be performed for 2–4 weeks using an amino acid formula (AAF) in formula-fed infants or children with suspected CMPA. Formula-fed infants with confirmed CMPA should be offered a therapeutic formula. The panel stated that an extensively hydrolyzed formula (eHF) is indicated in the absence of red flag signs. At the same time, the AAF is offered for infants with red flag signs, such as severe anaphylactic reactions. The panel agreed that infants on an eHF with resolved symptoms within 2–4 weeks should continue the eHF with particular attention to the growth and nutritional status. On the other hand, an AAF should be considered for infants with persistent symptoms; the AAF should be continued if the symptoms resolve within 2–4 weeks, with particular attention to the growth and nutritional status. In cases with no symptomatic improvements after the introduction of an AAF, other measures should be followed. The panel developed a management algorithm, which achieved an agreement level of 90.9%.

This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.
ISSN: 17088569
DOI: 10.1007/s12519-021-00476-3
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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