Milk Protein Allergy In Infants Research Articles

Cow's milk protein allergy in infants and children.

Cow's milk protein allergy (CMPA) is an immune-mediated reaction to cow's milk proteins, which can involve multiple organ systems including the gastrointestinal tract. Immunoglobulin E (IgE)-mediated response results in rapid onset of allergic symptoms that are easily recognizable. However, delayed (i.e., non-IgE/cell-mediated) or mixed (IgE- and cell-mediated) reactions produce a host of symptoms that overlap with other conditions and vary widely in onset and severity. Determining whether symptoms represent immune-mediated CMPA, non-immunologic reaction to cow's milk, or are unrelated to cow's milk exposure is challenging yet essential for effective management. While the clinical presentation of non-IgE-mediated CMPA can vary, this condition is usually self-limited and resolves by 1 to 6 years of age. Food antigen-specific immunoglobulin G (IgG) panels that are not evidence-based should be avoided because they can lead to overdiagnosis of presumed food intolerances. Overdiagnosis of CMPA can result in overuse of extensively hydrolyzed formulas and have significant cost implications for families. This statement focuses on delayed non-IgE/cell-mediated CMPA and assists health care providers to distinguish between and identify varied reactions to cow's milk, discusses the role of diagnostic testing, and provides management recommendations based on best evidence.

Management of cow's-milk protein allergy in infants and children. What's new in 2023?

The World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy in 2022 and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition in 2023 updated their guidelines for cow's-milk protein allergy (CMPA) management in infants and children. The objective of this paper is to underline the main points of these new guidelines and debate about some of them.

Early identification of cow’s milk protein allergy in infants in Kirkuk, Iraq, using milk-related symptom scores

Abstract Background: Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders. Cow’s milk protein allergy (CMPA) is the most common food allergy, especially in infancy and childhood, which may persist into adulthood. Objectives: The aim of this study was to evaluate the effect of cow’s milk protein allergy (CMPA) in infants in its early identification using CMPA scoring system. Materials and Methods: We carried out an observational study at Azadi teaching Children’s Hospital’s pediatric gastrointestinal clinic from March to December 2021. Children seen in our pediatric GI clinic between the ages of 1 and 12 months were included. Infants with suspected CMPA were evaluated by cow’s milk-related symptom score (CoMiSS) tool. An allergic reaction, a gastrointestinal, respiratory, or dermatologic presentation, excluding an acute infectious disease, and at least one of the following conditions were required for a diagnosis of suspected CMPA. All participating doctors received the required training on CoMiSS, the oral challenge test procedure, and CMPA diagnosis and treatment guidelines before subject recruitment. Results: In this study, most of studied infants were men, and no significant difference between CMPA and non-CMPA infants regarding sex, age, and weight was found. In this study, 17.85% of infants with CMPA score suffered from occult blood in their fecal samples compared with 11.15% of non-CMPA infants (P < 0.05). In this study, most of infants with CMPA have score 12, and the mean was 13.65 and the maximum value was 18. Conclusions: The CMPA score system provides primary healthcare clinicians with a simple, fast, and easy-to-use awareness tool for cow’s milk-related symptoms.

Natural history and risk factors of IgE-mediated cow's milk protein allergy in infants

Objective: To investigate the natural history and risk factors for continued allergy in infants with IgE-mediated cow's milk protein allergy (CMPA). Methods: This was a prospective cohort study that included 72 infants under 24 months of age diagnosed with IgE-mediated CMPA in the allergy clinic of the Children's Hospital, Capital Institute of Pediatrics from October 2019 to November 2020. General information, clinical manifestations, serum total IgE, cow's milk specific IgE, and cow's milk protein component specific IgE were collected. Follow-ups were conducted at 24 and 36 months of age, and the patients were divided into the persistent allergy group and the tolerance group based on whether they developed cow's milk tolerance at 36 months of age. Mann-Whitney U test, chi-square test, and binary Logistic regression were used for intergroup comparison and multivariate analysis. Results: Among the 72 CMPA children, there were 42 boys and 30 girls, with an age of 10 (7, 15) months at enrollment. Cow's milk protein tolerance was observed in 32 cases (44%) and 46 cases (64%) at 24 and 36 months of age, respectively. There were 26 cases in the persistent allergy group and 46 cases in the tolerance group. The proportion of respiratory symptoms, history of wheezing, positive specific IgE for α-lactalbumin and the total IgE level in the persistent allergy group were higher than that in the tolerance group (7 cases (27%) vs. 0, 6 cases (23%) vs. 2 cases (4%), 67% (14/21) vs. 26% (10/39), 225 (151, 616) vs. 48 (21, 185) kU/L, χ2=10.82, 4.16, 9.57, Z=4.07, all P<0.05). Multivariate Logistic regression analysis showed that anaphylaxis (OR=21.14, 95%CI 2.55-175.14, P=0.005), a history of allergic rhinitis (OR=5.94, 95%CI 1.54-22.86, P=0.005), elevated milk specific IgE (OR=1.04, 95%CI 1.01-1.08, P=0.024), and positive casein specific IgE (OR=6.64, 95%CI 1.39-31.69, P=0.018) were risk factors for continuous CMPA. Conclusions: Most infants with IgE-mediated CMPA can achieve tolerance within 3 years. Anaphylaxis, a history of allergic rhinitis, elevated milk specific IgE levels, and casein sensitization are risk factors for continuous allergy.

Consensus document on the primary prevention of cow’s milk protein allergy in infants aged less than 7 days

IntroductionCow’s milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. The purpose of this document is to issue a recommendation on the use of extensively hydrolyzed CMP formulas in the first week of life for the primary prevention of CMPA. MethodsA group of experts was formed with members proposed by the Spanish Association of Pediatrics (AEP), the Spanish Society of Clinical Immunology and Allergology and Pediatric Asthma (SEICAAP), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Neonatology (SENEO). The group conducted a critical review of the evidence on the subject published in the last 10 years. ResultsThe search yielded 72 studies, of which 66 were rejected for not meeting the inclusion criteria. The final review included 6 documents: 3 clinical trials and 3 systematic reviews, 2 of them with meta-analysis. There was no evidence of a statistically significant reduction in the incidence of CMPA in the infants who received hypoallergenic formulae or exclusive breastfeeding. ConclusionBased on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population.

Current Methods of Dietotherapy of Cow's Milk Protein Allergy in Infants

Nowadays there is progressive increase in the number of patients with allergy around the world. It was revealed that microbiome composition changes at early age correlate with the frequency of atopic diseases development. Various clinical studies have shown that variety of factors (even from prenatal development) influence microbiota composition. Children with atopic diseases have certain features of microflora development that can precede the disease debut. Cow’s milk protein is one of the major allergens in the first year of life. Such sensitization may be present in children on both formula and breastfeeding, however it is not the indication for its interruption. In cases when breastfeeding is not possible, we should use specialized therapeutic formulas in children with cow’s milk protein allergy. The use of the “Nutrilon Amino acids Syneo" formula effectively eliminates allergy symptoms and improves the gut microbiota composition in young children. Moreover, its use additionally reduce the frequency of infectious diseases and the use of antibacterial drugs.

PE-30: The Prevalence of Cow’s Milk Protein Allergy in Infants with Gastroschisis and Intestinal Failure type 2 and 3

Introduction: The prevalence of cow’s milk protein allergy (CMPA) in infants with gastroschisis has been reported as high as 45% [1], which is significantly higher than in the general infant population (0.5-1% of breast fed babies and 5-7% in formula-fed babies)[2]. We aimed to define the prevalence of CMPA in infants with gastroschisis and type 2 or 3 intestinal failure (IF) and compare this to other groups of infants with type 2 or 3 IF. Methods: We obtained parenteral nutrition (PN) prescriptions for infants born between July 2015 and June 2020 who had been on PN for more than 28 days (with type 2 or 3 IF) in our tertiary intestinal rehabilitation centre. We only included infants presenting in the first year of life with type 2 or 3 IF related to a gastrointestinal disorder, other than enteropathies. We recorded the underlying cause of IF and the number of patients clinically diagnosed with CMPA. The diagnosis of CMPA was made by the clinical team on the basis of gastrointestinal symptoms, presence of macroscopic blood in the stools and lack of any other alternative diagnosis with symptom resolution after initiation of a hydrolysed or amino acid based formula. We then obtained the feeding records of the patients and noted the number of infants on a hydrolysed and amino acid based formula during their hospitalisation and at the latest dietetic follow up. Results: Of 112 infants assessed, 23 (21%) were diagnosed with gastroschisis and 29 (26%) with necrotising enterocolitis (NEC); 25/29 (86%) of these were surgically managed. CMPA was diagnosed in 3/23 (13%) infants with gastroschisis, 5/25 (20%) of infants with surgically managed NEC and 5/64 (8%) of infants with other causes of type 2 and 3 IF. Out of 23 patients with gastroschisis, only one was discharged on home PN with no concerns of CMPA. Of the total 112 infants, 98 (88%) presented with type 2 IF and only 7 (7%) were also diagnosed with CMPA, while 14 (14%) infants were discharged on home PN and 6 (43%) were also diagnosed with CMPA. An amino acid based formula was trialled in 30/112 (27%) infants at some point during their hospitalisation. A hydrolysed formula was used in 54/112 (48%) infants with type 2 or 3 IF, in order to treat fat and sugar malabsorption, with 57% of children continuing to take a hydrolysed formula at the last recorded dietetic follow up. Three out of the 13 infants with CMPA (two with gastroschisis) have tolerated a dairy containing diet later on. Conclusions: The prevalence of CMPA in infants with gastroschisis and type 2 or 3 IF is much lower than previously reported. CMPA is most prevalent in infants with surgically managed NEC and type 2 or 3 IF, whilst the prevalence of CMPA in type 3 IF in general is significantly higher. The use of hydrolysed formula for the management of malabsorption may be masking the diagnosis of CMPA in children with type 2 IF.

Effect of maternal immune level at different pregnancy stages on cow's milk protein allergy in infants

OBJECTIVE To study the association between maternal Th1/Th2 immune level at different pregnancy stages and cow's milk protein allergy (CMPA) in infants. METHODS The healthy women with a singleton pregnancy, as well as their offspring, who attended Yidu Central Hospital of Weifang and Qingzhou Traditional Chinese Medicine Hospital from July 2016 to December 2018 were enrolled. The maternal levels of interleukin-2 (IL-2), interferon gamma (IFN-γ), interleukin-4 (IL-4), and interleukin-10 (IL-10) at the second and third trimesters of pregnancy were measured. A CMPA questionnaire survey was conducted within one year after birth. Food avoidance and cow's milk oral challenge tests were performed in infants suspected of CMPA. The 48 infants who met the diagnostic criteria for CMPA were included in the observation group, and the remaining 977 normal infants were included in the control group. A univariate analysis was performed on the infants with CMPA. A Poisson regression analysis was used to determine the association between maternal Th1/Th2 immune factors at different pregnancy stages and CMPA. RESULTS The detection rate of CMPA was 4.68%. The clinical manifestations included the symptoms of the digestive system, skin, and respiratory system and other symptoms. The univariate analysis showed that compared with the control group, the observation group had significantly higher incidence rates of maternal food allergy and maternal history of allergic diseases (P<0.05) and a significantly lower breastfeeding rate (P<0.05). The observation group had significantly lower maternal levels of IL-2 (second and third trimesters) and IFN-γ (third trimester) than the control group (P<0.05). Maternal low IFN-γ at the third trimester and maternal low IL-2 at the second and third trimesters were significantly associated with CMPA in infants (P<0.05). After correction of the factors of breastfeeding, maternal food allergy, and maternal history of allergic diseases, it was found that maternal low IL-2 and IFN-γ at the third trimester were still significantly associated with CMPA in infants (P<0.05). CONCLUSIONS The maternal decrease in Th1 level at the third trimester of pregnancy may lead to the change in fetal immunity and thus increase the risk of CMPA in offspring.

Antibacterial potential of donkey’s milk disclosed by untargeted proteomics

Donkey's milk (DM) has been extensively investigated as a valuable substitute of breast milk, often suitable to manage cow's milk protein allergy in infants. DM exhibits potent inhibitory properties against numerous microbial species. Although oligosaccharides and lipids might contribute to the antimicrobial potential, the current inventory of proteins is not able to justify the low count of microorganisms generally observed in DM.The shotgun proteomic analysis of fractionated DM disclosed a set of 94 gene products, 41% of which have documented antimicrobial activity or are involved in transferring the passive immunity to the donkey offspring. The concerted action of lysozyme, lactoferrin, immunoglobulins provides the molecular basis for part of the DM antibacterial potential. The pH -4.6 insoluble fraction contained significant levels of L-amino acid oxidase, identified with 11 unique peptides matching the horse homologue gene product. This enzyme catalyses the oxidative deamination of amino acids into ketoacids, producing ammonia and H2O2. κ-casein, likely occurring as a fully O-glycosylated protein, may concur to inhibit the adhesion of pathogenic microorganisms, along with other glycoproteins.Proteomics supports the alimentary use of DM not only as a substitute of human milk in early infancy, but also for growing children, convalescent, elderly people and general population. SignificanceDonkey's milk (DM) is acquiring increasing popularity because it is a suitable substitute of the human milk, when breastfeeding is not possible and infants suffer from cow's milk allergy.DM is characterized by a much lower microbial load compared to ruminants' milk. This feature has been traditionally attributed to the high content of lysozyme. DM exhibits potent activity against a broad range of bacteria, viruses and fungi, suggesting that other protein components can be responsible of the antimicrobial potential. The gel-free proteomic analysis of pH 4.6-insoluble and soluble (whey) fractions demonstrated that DM contains a large number of gene products involved in antimicrobial mechanisms and in transferring passive immunity to the donkey offspring.DM contains relatively high levels of L-amino acid oxidase that catalyses the oxidative deamination of amino acid substrates into ketoacids, with production of ammonia and H2O2. In combination with lysozyme, lactoferrin and immunoglobulins, the presence of L-amino acid oxidase provides the molecular basis of the antibacterial potential observed for DM. Considered the low microbial load, DM can be sanitated at mild conditions, thereby preserving many of the native nutritional traits.Thus, DM can be considered a safe and nutritionally valid alimentary resource for growing children, convalescent, elderly people and general population.Data of this study represent the largest inventory of proteins identified in Equidae milk, so far.

Efficacy of protein leakage scintigraphy in diagnosing milk protein allergy in infants: A case report

Efficacy of protein leakage scintigraphy in diagnosing milk protein allergy in infants: A case report

Knowledge and practice of pediatricians and nutritionists regarding treatment of cow’s milk protein allergy in infants

ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow’s milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow’s milk protein allergy, including goat’s milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p&lt;0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow’s milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow’s milk protein allergy.

Diagnostic approach and management of cow’s milk protein allergy in infants

Diagnostic approach and management of cow’s milk protein allergy in infants

National practical guidelines for management of cow’s milk protein allergy in infants and children. Brief overview

Professional medical communities create clinical recommendations based on principles of «evidencebased medicine» to optimize the provision of medical care to patients with various pathologies. Following these recommendations allows doctors to avoid mistakes in the management of patients and to achieve a positive result of treatment in most of the patients. Early started and properly administered treatment of children with cow’s milk protein allergy (CMPA) significantly improves the prognosis of the disease and can interrupt the socalled «allergic march». The purpose of the publication is to introduce the current national clinical guidelines for the provision of medical care to children with CMPA to wide range of pediatricians and physicians of other specialties.

Controversies on Special Products for Managing Cow’s Milk Protein Allergy in Infants: Safety and Suitability

The aim of the symposium was to share learnings from the recently established European Academy of Allergy and Clinical Immunology (EAACI) Task Force on special products for cow’s milk protein allergy (CMPA), with the intention of providing an overview on controversies regarding extensively hydrolysed formulas (eHFs), their utility, and the validity of the definition ‘special products for CMPA’. Dr Rosan Meyer opened the symposium by discussing the evidence for appropriate dietary management in CMPA, emphasising the importance of breastfeeding and dietary management of breastfed children with CMPA, hypoallergenic formula, and the current controversies and debate around formula choice. Dr Martinas Kuslys covered the current interpretations and ranges for definitions for eHFs, and presented data from an analytical programme that aims to improve understanding of the wide range of commercially available formulas, with the objective of defining eHFs in a more consistent, meaningful, and practical way. Prof Antonella Muraro and Prof Arne Høst closed the session with a discussion around the need for updated guidelines to ensure safe products for infants with CMPA, summarising some of the issues with currently available hypoallergenic formulas.

The prevalence and characteristics of cow's milk protein allergy in infants and young children with iron deficiency anemia

The clinical presentation of cow's milk protein allergy (CMPA) in children varies. This retrospective study aimed to investigate the prevalence and clinical manifestations of CMPA in young children who visited for evaluation of iron deficiency anemia (IDA). Patients aged <4 years who were diagnosed as having IDA (serum ferritin <12ng/mL) at the National Cheng Kung University Hospital, Taiwan in the period 2005-2015 were reviewed. Their clinical presentations, laboratory data, endoscopy findings, and prognosis were analyzed. Seven of 51 IDA patients (13.7%) had CMPA. The pallor (100%), failure to thrive (43%), and general edema (43%) were the common features. Six (86%) had hypoalbuminemia and four (57%) had positive occult blood in the stool. Of the five patients who underwent skin prick test, four (80%) had positive results. Most of the colonoscopies revealed erosive and hemorrhagic colitis and lymphoid hyperplasia, but none of the biopsies demonstrated eosinophilia in the lamina propria. All of the patients recovered from their IDA within seven months of cow's milk protein elimination and iron supplementation. CMPA should be considered in young children with undetermined IDA. Cow's milk protein elimination and iron supplementation help in the recovery.

The establishment of cow's milk protein allergy in infants is related with a deficit of regulatory T cells (Treg) and vitamin D.

Cow's milk protein allergy (CMPA) is the most common food allergy in infants. However, little is known about which specific immune mechanisms are related with the CMPA onset. The objective was to investigate which immune alterations constitute differential factors between allergy and tolerance, and hence could be implicated in the CMPA establishment in infants. An extensive analysis of immune subsets, including Treg and cytokine-secreting cells was performed in blood samples from 28 infants younger than 9 mo obtained 1-4 d after the first adverse reaction to milk. Less than 4 d after first allergic reaction, infants who developed CMPA had decreased Treg counts and increased frequency of IL4-secreting CD4 T cells compared to controls. The deficit of Tregs was correlated with decreased serum levels of vitamin D. Values of Tregs, IL4-secreting cells and vitamin D were good predictors of CMPA diagnosis. Basal vitamin D levels in CMPA infants also predicted those CMPA patients developing spontaneous tolerance in the first year. Establishment of CMPA in infants was related with lower Treg and vitamin D levels. These immune alterations would be crucial factors behind the CMPA establishment and they could constitute a therapeutic target for treatment of CMPA.

The clinical characteristics and related factors of cow's milk protein allergy in infants less than 3 months old in Guangxi District

Objective To study the clinical characteristics and risk factors of cow's milk protein allergy(CMPA) in infants less than 3 months old in Guangxi District. Methods From July 1, 2012, to December 30, 2014, infants less than 3 months old suspected of CMPA visiting the pediatric outpatient department of Maternal and Children Hospital of Guangxi Zhuang Autonomous Region were recruited, which included initial diagnosis and being transported from peripheral hospitals.Observation scale was formulated, attending physician screened patients and their senior made a definite diagnosis.All the infants underwent diagnostic algorithms and were followed up constantly. Results A total of 137 cases were divided into allergy group(n=51) and control group(n=86). Two groups shared some common symptoms such as diarrhea, constipation, bloody stool, stomachache, gastroesophageal reflux(GER), indigestion, anorexia, feeding difficulties.Between the allergy group and control group the parameters such as feeding patterns (including breast feeding, mix feeding, formula feeding), improper deeding of food supplement, long- term use of antibiotics in neonatal period and parental atopy showed no significant differences(P>0.05). The parameters in neonatal period including GER[20 cases(39.2%) vs.7 cases(8.1%)], intake of cow's milk formula[51 cases(100%)vs.71 cases(82.6%)], feeding intolerance(including GER)[17 cases(33.3%)vs.11 cases(12.8%)], gut infection[8 cases(15.7%)vs.4 cases(4.7%)], transfusion of blood or/and bloody products[12 cases(23.5%)vs.11 cases(12.8%)] showed statistically significant differences between the allergy group and control group(χ2=19.538, P=0.000; χ2=9.989, P=0.002; χ2=8.308, P=0.004; χ2=4.691, P=0.030; χ2=5.198, P=0.023). Conclusion Symptoms of CMPA in infants no more than 3 months old involve mainly digestive system such as diarrhea, bloody stool, GER.Intake of cow milk formula in neonatal period play an important role in triggering CMPA. Key words: Cow's milk protein allergy; Cow milk formula; Infant; Diarrhea; Bloody stool

Iron Requirements for Infants with Cow Milk Protein Allergy

H istorically, cow milk has been used as a major source of protein and balanced nutrition for infants and children in resource-rich and resource-constrained countries. It is a rich source of energy, protein, and calcium. It is also an important source of fat; many of its fatty acids are readily metabolized to essential omega-3 fatty acids. Regular consumption of milk during childhood has been shown to enhance bone density later in life. However, reliance upon whole pasteurized cow milk as the sole or major source of nutrition for infants during the first year of life can increase the risk for iron deficiency and, in extreme cases, iron-deficient anemia (IDA) for a number of reasons. In 1972, Woodruff et al showed that 7 of 12 infants (ages 7-17 months) with IDA who ingested between 720 and 1920 mL whole milk daily had higher albumin turnover rates than a group of 5 normal infants. Parenteral iron had no effect on albumin turnover, but replacing whole milk with reconstituted evaporated milk or soy formula decreased the high albumin turnover rates to normal levels, suggesting that large amounts of cow milk protein could result in iron and protein loss in the gastrointestinal tract. Cow milk contains low levels of ascorbic acid, a factor that increases iron absorption, and certain proteins that negatively impact iron absorption. Cow milk contains about 4 times more calcium than human milk, and calcium negatively impacts iron absorption. Furthermore, cow milk has a higher protein concentration than human milk, and ingestion of large amounts can lead to metabolic and fluid imbalances, particularly in children with febrile illnesses. Thus, several entities have recommended against whole cow milk ingestion until 9-12 months and then, only when given in moderate amounts in conjunction with appropriate complementary foods.

Food protein-induced enterocolitis syndrome and allergic proctocolitis.

Non-IgE-mediated food allergic disorders account for up to 40% of milk protein allergy in infants and young children. We aim to review the recent literature and to provide an update on diagnosis and management of food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). The peer-reviewed articles indexed in PubMed have been reviewed. FPIES manifests in infants as profuse, repetitive vomiting and lethargy, often with diarrhea, leading to acute dehydration, or weight loss and failure to thrive, in chronic form. FPIES is caused most commonly by cow's milk (CM) and soy proteins; rice, oat, and other solid foods may also trigger FPIES. FPIES rarely occurs in the exclusively breastfed infants. FPIES is underrecognized; children are often mismanaged as having acute viral gastrointestinal illness, sepsis, or surgical disease, delaying diagnosis of FPIES for many months. Approximately 25% of children with FPIES develop food-specific IgE antibodies and some transition to immediate food allergy; IgE positivity is associated with a more protracted course. FPIES is a self-limiting condition, with most cases resolving by age three to five years. Ondansetron may be helpful in managing acute FPIES. FPIAP is a benign condition of bloody stools in a well-appearing infant, with usual onset between one and four weeks of age. Up to 60% of cases occur in exclusively breastfed infants and resolve with maternal elimination of CM and soy proteins. The majority of cases resolve by age 12 months. FPIES may transition to IgE-mediated food allergy in some patients; IgE positivity to the FPIES food is a marker of a more persistent disease. FPIAP is benign and resolves by age 12 months in most patients.

The development and implementation of a training package for dietitians on cow's milk protein allergy in infants and children based on UK RCPCH competencies for food allergies - a pilot study.

BackgroundMany food allergy guidelines have been published worldwide over recent years. The United Kingdom National Institute of Health and Clinical Excellence guidelines and The Royal College of Paediatrics and Child Health food allergy care pathways require dietitians to assist with the diagnosis and management of food allergies, which highlighted the need for further education of dietitians to meet these competencies. The aim of this study was to design a competence based one day education course for dietitians on the diagnosis and management of cow’s milk protein allergy in infants and children.MethodsA one day training course was developed. Dietitians’ knowledge was assessed via multiple choice questions before and on the day of the course and retention of knowledge was assessed one month after the course. Pre course reading was given once the first assessment was completed.ResultsThirty seven dietitians attended the course and 32 completed all three assessments. A significant improvement in assessment scores was seen between the pre course and on the day assessments of 7.2% (p < 0.001) and between pre course and post course assessments of 8.9% (p < 0.001). In delegates who rated their perceived level of knowledge as high, a significant increase was seen between pre course and on the day and between pre course and post course (both p < 0.001). Actual increase in knowledge was seen alongside a significant increase in high rating of perceived level of confidence between pre course and on the day and between pre course and post course (both p < 0.001).ConclusionsEducating dietitians using the format of one day teaching with pre and post course assessment has improved both knowledge and competencies in the diagnosis and management of cow’s milk protein allergy. Further courses in other areas of food allergy could be developed using this approach within the UK and worldwide.