Detection and management of milk allergy: Delphi consensus study

Hilary I Allen; Ursula Pendower; Miriam Santer; Marion Groetch; Mitchell Cohen; Simon H Murch; Hywel C Williams; Daniel Munblit; Yitzhak Katz; Neeraj Gupta; Sabeen Adil; Justine Baines; Eefje G P M de Bont; Matthew Ridd; Victoria L Sibson; Alison McFadden; Jennifer J Koplin; Josephine Munene; Michael R Perkin; Scott H Sicherer; Robert J Boyle

doi:10.1111/cea.14179

Detection and management of milk allergy: Delphi consensus study

Hilary I Allen, Ursula Pendower, Miriam Santer, Marion Groetch, Mitchell Cohen, Simon H Murch, Hywel C Williams, Daniel Munblit, Yitzhak Katz, Neeraj Gupta, Sabeen Adil, Justine Baines, Eefje G P M de Bont, Matthew Ridd, Victoria L Sibson, Alison McFadden, Jennifer J Koplin, Josephine Munene, Michael R Perkin, Scott H SichererRobert J Boyle^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialised formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.

METHODS: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia, and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.

FINDINGS: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding, or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula.

INTERPRETATION: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialised formula, compared with current guidelines.

Original language	English
Pages (from-to)	848-858
Number of pages	11
Journal	Clinical and Experimental Allergy
Volume	52
Issue number	7
Early online date	26 May 2022
DOIs	https://doi.org/10.1111/cea.14179
Publication status	Published - Jul 2022

Keywords

Cow's milk allergy
DIAGNOSIS
Delphi consensus
FOOD ALLERGY
FORMULA
GUIDELINES
breastfeeding
overdiagnosis

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Cite this

Allen, H. I., Pendower, U., Santer, M., Groetch, M., Cohen, M., Murch, S. H., Williams, H. C., Munblit, D., Katz, Y., Gupta, N., Adil, S., Baines, J., Bont, E. G. P. M. D., Ridd, M., Sibson, V. L., McFadden, A., Koplin, J. J., Munene, J., Perkin, M. R., ... Boyle, R. J. (2022). Detection and management of milk allergy: Delphi consensus study. Clinical and Experimental Allergy, 52(7), 848-858. https://doi.org/10.1111/cea.14179

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title = "Detection and management of milk allergy: Delphi consensus study",

abstract = "BACKGROUND: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialised formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.METHODS: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia, and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.FINDINGS: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding, or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula.INTERPRETATION: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialised formula, compared with current guidelines.",

keywords = "Cow's milk allergy, DIAGNOSIS, Delphi consensus, FOOD ALLERGY, FORMULA, GUIDELINES, breastfeeding, overdiagnosis",

author = "Allen, {Hilary I} and Ursula Pendower and Miriam Santer and Marion Groetch and Mitchell Cohen and Murch, {Simon H} and Williams, {Hywel C} and Daniel Munblit and Yitzhak Katz and Neeraj Gupta and Sabeen Adil and Justine Baines and Bont, {Eefje G P M de} and Matthew Ridd and Sibson, {Victoria L} and Alison McFadden and Koplin, {Jennifer J} and Josephine Munene and Perkin, {Michael R} and Sicherer, {Scott H} and Boyle, {Robert J}",

year = "2022",

month = jul,

doi = "10.1111/cea.14179",

language = "English",

volume = "52",

pages = "848--858",

journal = "Clinical and Experimental Allergy",

issn = "0954-7894",

publisher = "Wiley-Blackwell",

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Allen, HI, Pendower, U, Santer, M, Groetch, M, Cohen, M, Murch, SH, Williams, HC, Munblit, D, Katz, Y, Gupta, N, Adil, S, Baines, J, Bont, EGPMD, Ridd, M, Sibson, VL, McFadden, A, Koplin, JJ, Munene, J, Perkin, MR, Sicherer, SH & Boyle, RJ 2022, 'Detection and management of milk allergy: Delphi consensus study', Clinical and Experimental Allergy, vol. 52, no. 7, pp. 848-858. https://doi.org/10.1111/cea.14179

TY - JOUR

T1 - Detection and management of milk allergy

T2 - Delphi consensus study

AU - Allen, Hilary I

AU - Pendower, Ursula

AU - Santer, Miriam

AU - Groetch, Marion

AU - Cohen, Mitchell

AU - Murch, Simon H

AU - Williams, Hywel C

AU - Munblit, Daniel

AU - Katz, Yitzhak

AU - Gupta, Neeraj

AU - Adil, Sabeen

AU - Baines, Justine

AU - Bont, Eefje G P M de

AU - Ridd, Matthew

AU - Sibson, Victoria L

AU - McFadden, Alison

AU - Koplin, Jennifer J

AU - Munene, Josephine

AU - Perkin, Michael R

AU - Sicherer, Scott H

AU - Boyle, Robert J

PY - 2022/7

Y1 - 2022/7

N2 - BACKGROUND: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialised formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.METHODS: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia, and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.FINDINGS: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding, or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula.INTERPRETATION: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialised formula, compared with current guidelines.

AB - BACKGROUND: There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialised formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.METHODS: Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia, and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback.FINDINGS: Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding, or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialised formula.INTERPRETATION: These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialised formula, compared with current guidelines.

KW - Cow's milk allergy

KW - DIAGNOSIS

KW - Delphi consensus

KW - FOOD ALLERGY

KW - FORMULA

KW - GUIDELINES

KW - breastfeeding

KW - overdiagnosis

U2 - 10.1111/cea.14179

DO - 10.1111/cea.14179

M3 - Article

C2 - 35615972

SN - 0954-7894

VL - 52

SP - 848

EP - 858

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

IS - 7

ER -