Nutritional Management of Cow's Milk Allergy in Infants: A Comparison of DRACMA, ESPGHAN, and AAP Guidelines

Emely L Barrera,Carlett Ramirez-Farias,Barbara J Marriage

doi:10.2174/1874288202115010001

Abstract

Cow’s Milk Allergy (CMA) is one of the most common food allergies presented during infancy and childhood. The diagnosis and management of CMA is a complex task. First and foremost, CMA is manifested by a variety of symptoms classified by their type of mediation (either IgE and/or non-IgE responses), organ systems involved, and the onset of the reaction. Second, although several guidelines for the management of CMA have been published worldwide, they differ in their recommendations. To our knowledge, no global consensus exists for the management of the different symptoms associated with CMA. This review provides a table to compare three widely accepted published guidelines to enable the reader to easily navigate and compare the nutritional recommendations to be followed depending on the symptomatology. This review is intended to represent a practical tool to assess the nutritional recommendations for the management of CMA.

Highlights

The nutritional management of infants and children diagnosed with Cow’s Milk Allergy (CMA) is a complex task for healthcare practitioners
It is important to mention that since ESPGHAN and Academy of Pediatrics (AAP) make general rather than symptom-specific recommendations to use Extensively hydrolyzed protein-based formula (EHF) formula as a first line of treatment for CMA, a limitation of this review is that Table 3 includes author interpreted recommendations for specific symptoms to align with the clinical presentations discussed in the latest DRACMA publication [13, 14, 24]
If the infant/child does not tolerate EHF, DRACMA, ESPGHAN, and AAP recommend the use of acid-based formula (AAF)

Summary

Introduction

The nutritional management of infants and children diagnosed with Cow’s Milk Allergy (CMA) is a complex task for healthcare practitioners. There is a need for a resource that, in a practical manner, presents, compares, contrasts, and interprets the nutritional recommendations for infants and children diagnosed with CMA based on international consensus guidelines. The nutritional management of CMA is reviewed, and a practical comparison table is presented.

Methods

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Discussion

Conclusion