title: Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines.
abstract: OBJECTIVE
  This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA.
  
  
  METHODS
  If CMPA is suspected by history and examination, then strict allergen avoidance is initiated. In certain circumstances (eg, a clear history of immediate symptoms, a life-threatening reaction with a positive test for CMP-specific IgE), the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis of CMPA.
  
  
  METHODS
  In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast-fed infants with confirmed CMPA should receive an extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials; amino acids-based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth are mandatory in all age groups requiring CMP exclusion. REEVALUATION: Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by 3 years of age and >90% by 6 years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and incur unnecessary health care costs.
authors.affiliation: Division of Pediatric Gastroenterology and Hepatology, Dr von Haunersches Kinderspital, Ludwig-Maximilians-University, Munich, Germany. sibylle.koletzko@med.uni-muenchen.de
authors.forename: S
authors.initials: S
authors.lastname: Koletzko
authors.forename: B
authors.initials: B
authors.lastname: Niggemann
authors.forename: A
authors.initials: A
authors.lastname: Arato
authors.forename: J A
authors.initials: JA
authors.lastname: Dias
authors.forename: R
authors.initials: R
authors.lastname: Heuschkel
authors.forename: S
authors.initials: S
authors.lastname: Husby
authors.forename: M L
authors.initials: ML
authors.lastname: Mearin
authors.forename: A
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: F M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: A
authors.initials: A
authors.lastname: Staiano
authors.forename: M G
authors.initials: MG
authors.lastname: Schäppi
authors.forename: Y
authors.initials: Y
authors.lastname: Vandenplas
mesh_terms: D000367:Age Factors; D000465:Algorithms; D000596:Amino Acids / Q000008:administration & dosage; D000818:Animals; D001942:Breast Feeding; D002648:Child; D003376:Counseling; D004032:Diet; D006128:Growth / Q000187:drug effects; D006130:Growth Disorders / Q000209:etiology; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D041943:Infant Formula; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000178:diet therapy*; D008894:Milk Proteins / Q000276:immunology*; D010353:Patient Education as Topic; D011492:Protein Hydrolysates / Q000008:administration & dosage; D011788:Quality of Life; D030262:Soybean Proteins / Q000008:administration & dosage
chemical_list: D000596:Amino Acids; D008894:Milk Proteins; D011492:Protein Hydrolysates; D030262:Soybean Proteins