National Heart and Lung Institute, Imperial College London, London, UK.
Primary Care Research Centre, University of Southampton, Southampton, UK.
Clin Exp Allergy. 2022 Jul;52(7):848-858. doi: 10.1111/cea.14179. Epub 2022 Jun 10.
There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized 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.
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.
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 specialized formula.
These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialized formula, compared with current guidelines.
在一些国家，幼儿牛奶过敏存在严重的过度诊断现象，导致不必要地使用特殊配方奶粉。本指南由无商业利益关联的专家制定，旨在减少牛奶过敏的过度诊断，并为疑似牛奶过敏的儿童的照护者提供支持。
德尔菲研究，包括两轮匿名共识建立和 2021 年 1 月至 7 月期间的一次公开会议。来自欧洲、北美、中东、非洲、澳大利亚和亚洲的 17 名普通科、营养、助产、健康访视、哺乳支持和相关儿科领域的专家参与了研究，他们没有与配方奶粉行业有商业联系。五位先前牛奶过敏指南的作者和七位家长提供了反馈意见。
通过共识，参与者就 38 项基本建议达成一致。建议强调了在有急性或延迟症状且与牛奶蛋白摄入时间相关的儿童中，诊断牛奶过敏时重现性和特异性的重要性；并区分了直接摄入牛奶蛋白的儿童和纯母乳喂养的婴儿。共识达成，管理牛奶过敏通常不需要母亲进行饮食限制，对于有慢性症状的纯母乳喂养婴儿，只有在特定、罕见的情况下才应考虑牛奶过敏的诊断。共识达成，对于没有与牛奶蛋白摄入时间相关的粪便变化、厌恶喂养或粪便中偶尔出现血迹的情况，不需要考虑牛奶过敏的诊断。与之前的指南相比，这些共识建议导致了更严格的牛奶过敏检测标准，以及更有限的母亲饮食排除和特殊配方奶粉的作用。
这些来自无利益冲突的多学科专家的新牛奶过敏建议，与当前指南相比，建议更严格的标准、更突出的母乳喂养支持以及更少使用特殊配方奶粉。
