Diagnosis and Management of Cow’s Milk Allergy (CMA) in Infants and Children: From Guidelines to Clinical Practice in Brazil - Abstract
Background: The diagnosis of non-IgE mediated cow’s milk protein allergy (CMA) in infants is based on the elimination of cow’s milk protein from the diet with clinical improvement, followed by reintroduction with relapse of symptoms. Given the potential for reactions to residual allergens in extensively hydrolyzed formula and the lack of real-world evidence on this subject in Brazil, this study aims to determine the role of amino acid formulas (AAFs), in the diagnosis and management of CMA in Brazil using a survey of experts.
Methods: Interviewees answered a survey regarding when AAF should be the first option in cases of suspected CMA, advantages and limitations of this approach, impact of delayed diagnosis and precautions when prescribing AAFs. Results were compiled and presented to validate responses and to collect additional information.
Results: Ten pediatric experts from Brazil participated. There was consensus that elimination of cow’s milk from the diet and oral food challenges are key to diagnose CMA, and that AAF expedites diagnosis. Eighty percent agreed that i) AAF should be the first option for anaphylaxis, multiple food allergies or food protein-induced enterocolitis syndrome; ii) economic burden is the main disadvantage associated with the use of AAF. Most respondents agreed that there is a delay in CMA diagnosis in Brazil that may lead to faltering growth.
Conclusions: In line with current guidelines, this panel agreed that AAF should be recommended for complex presentations and for patients unresponsive to EHF. However, when the diagnosis is unclear, the use of AAF followed by oral challenge may shorten the time to confirm or exclude the diagnosis and to avoid unnecessary pharmacological and other nutritional managements or diagnostic tests. The panel pointed out that reducing psychological and social burdens must be considered when choosing the best approach for each patient.