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Guidelines for the diagnosis and management of cow’s milk protein allergy in infants

¹ Department of Paediatrics, Universitair Ziekenhuis Brussel Kinderen, Vrije Universiteit Brussel, Brussels, Belgium
² Chelsea and Westminster Hospital, London and Child Health at Imperial College Faculty of Medicine, University of London, London, UK
³ Neonatology and Nutrition Department, Université René Descartes Paris V, Hospital Cochin Saint Vincent de Paul, Paris, France
⁴ Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
⁵ University of Turku, Turku, Finland
⁶ Dr. v. Haunersches Kinderspital, Ludwig Maximillians-Universität, Munich, Germany
⁷ Department of Dermatology and Venereology, Erasmus MC, University Medical Centre (Sophia Children's Hospital) Rotterdam, Rotterdam, The Netherlands
⁸ University Federico II of Naples, Naples, Italy

Correspondence to:
Professor Yvan Vandenplas, Department of Paediatrics, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium; yvan.vandenplas{at}uzbrussel.be

ABSTRACT
Our aim was to develop guidance for general paediatricians and primary care physicians in diagnosing and managing cow’s milk protein allergy in infants. The guidelines were developed by discussion based on existing national recommendations and standards, clinical experience and, whenever possible, evidence from the literature. Separate algorithms cover breast-fed and formula-fed infants. The recommendations emphasise the importance of comprehensive history taking and careful physical examination. Patients with severe symptoms need to be referred to a specialist. Elimination of cow’s milk protein from the infant’s or mother’s diet and challenges are the gold standard for diagnosis. This guidance is intended as a basis for local discussion, implementation and prospective evaluation. The algorithms should be regularly assessed using clinical audit standards. Once validated, the diagnostic framework could provide a standardised approach in epidemiological and therapeutic studies.

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