J Vandenplas et al. JPGN 2024; 78: 386-413. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow’s Milk Allergy

In this lengthy report, the authors provide 72 recommendations/statements -as such it does not do a great job focusing on key points.

Some of the points:

• Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow’s milk.
• Overdiagnosis of CMA occurs much more frequently than underdiagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2–4 weeks is recommended as the cornerstone of the diagnosis

Conclusions: “Accurate diagnosis, avoiding under- and overdiagnosis, is mandatory but remains challenging due to the lack of specific symptoms and adequate diagnostic tests…Reintroduction of CM protein in non-IgE-mediated allergy and OFC [oral food challenge] in IgE-mediated allergy are the “gold standard” diagnostic tests, yet these are often not performed by caregivers. As a result, there is a risk of overdiagnosis and the implementation of long-term elimination diets, posing potential nutritional risks. The choice of formula for the treatment of CMA should take into consideration cost and availability of the therapeutic formula. Cow’s milk eHF is the first choice treatment option.”

My take: Only a tiny number of individuals are going to remember 72 recommendations.

Related blog posts:

• Good Bowel Sound Podcasts: Cow’s Milk Intolerance and Hirschspurng Disease
• Overdiagnosis of Milk Allergy in Infancy and New Consensus Recommendations
• Best of Allergy Articles 2021 -Cow’s Milk Allergy/Allergic proctocolitis (Part 4)
• Best Allergy Articles 2021 -Cow’s Milk Allergy (Part 3)
• Best Allergy Articles 2021 -Cow’s Milk Allergy (Part 2)
• Best Allergy Articles 2021-Cow’s Milk Allergy
• Overdiagnosis of Cow’s Milk Protein Allergy in Infants and Formula Industry Influence

Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.