Diagnosis and management of cow’s milk protein allergy in Turkey: Region-specific recommendations by an expert-panel
Main Article Content
Keywords
Cow’s milk protein allergy, Consensus report, Turkey
Abstract
Cow’s milk protein allergy (CMPA) is the most common type of food-allergy in younger children. Prognosis is usually good, with most children developing tolerance before school age. Children may present with a wide spectrum of symptoms that range from mild to severe; skin reactions such as angioedema and urticaria and gastrointestinal symptoms are the most common presentations of CMPA. Approximately one-third of CMPA patients suffer from multiple food allergies; severe conditions such as anaphylactic shock (9%), eosinophilic esophagitis (4.7%), and food-protein induced enterocolitis (1%) may also develop in some children. Timely and accurate diagnosis and management is essential for proper growth and development of children with CMPA. In this expert consensus report, we aimed to adapt current understandings in the CMPA field to the specific conditions in Turkey and health system to help physicians with their day-to-day decision making.
References
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2. Gelincik A, Buyukozturk S, Gul H, Isik E, Issever H, Ozseker F, et al. Confirmed prevalence of food-allergy and non-allergic food hypersensitivity in a Mediterranean population. Clin Exp Allergy. 2008;38:1333-41.
3. Kaya A, Erkocoglu M, Civelek E, Cakir B, Kocabas CN. Prevalence of confirmed IgE-mediated food-allergy among adolescents in Turkey. Pediatr Allergy Immunol. 2013;24:456-62.
4. Erkaya T, S¸engül M. Cow’s milk allergens and their control methods. Academic Food J. 2012;10:114-24.
5. Host A, Jacobsen HP, Halken S, Holmenlund D. The natural history of cow’s milk protein allergy/intolerance. Eur J Clin Nutr. 1995;49:S13-8.
6. Fiocchi A, Dahda L, Dupont C, Campoy C, Fierro V, Nieto A. Cow’s milk allergy: towards an update of DRACMA guidelines. World Allergy Organ J. 2016;9:35.
7. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow’smilk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012;55:221-9.
8. Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy. 2014;44:642-72.
9. Fiocchi A, Brozek J, Schunemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Pediatr Allergy Immunol. 2010;21:1-125.
10. Factors associated with treatment compliance in children with malnutrition. Ozdener F, Kirbiyik F, Dogan A, Baygul A, editors. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting. 2018.
11. Guldal D, Ulusel B, Ozc¸akar N, Yenic¸eri N, Dontlu C. The challenge of clinical interviewing and physical examination performance for general practitioners in Turkey. Fam Med. 2005;37:354-9.
12. Gerrard JW, MacKenzie JW, Goluboff N, Garson JZ, Maningas CS. Cow’s milk allergy: prevalence and manifestations in an unselected series of newborns. Acta Paediatr Scand Suppl. 1973;234:1-21.
13. Host A, Halken S. Cow’s milk allergy: where have we come from and where are we going? Endocr Metab Immune Disord Drug Targets. 2014;14:2-8.
14. Dogruel D, Bingol G, Altintas DU, Yilmaz M, Guneser Kendirli S. Clinical Features of Food-allergy during the 1st Year of Life: the ADAPAR Birth Cohort Study. Int Arch Allergy Immunol. 2016;169:171-80.
15. Altintas D, Guneser S, Evliyaoglu N, Yuksel B, Atici A, Serbest M. A prospective study of cow’s milk allergy in Turkish infants. Acta Paediatr. 1995;84:1320-1.
16. Bingöl A, Uygun DFK, Akdemir M, Erengin H, Do˘gruel D, Bostancı I, et al. C¸ocuklarda Besin Allerjisinin Karakteristik Özellikleri: Ulusal C¸ok Merkezli C¸alıs¸ma. Asthma Allergy Immunol. 2017;15:10-1.
17. Barlık F, Güner ¸N, S Barlık M, Sö˘güt A, Sancak R. Prevalence of food-allergy in nursery and kindergarten children in Samsun. Turk Arch Ped. 2013;48:288-93.
18. Orhan F, Karakas T, Cakir M, Aksoy A, Baki A, Gedik Y. Prevalence of immunoglobulin E-mediated food-allergy in 6-9-year-old urban schoolchildren in the eastern Black Sea region of Turkey. Clin Exp Allergy. 2009;39:1027-35.
19. Dogruel D, Bingol G, Yilmaz M, Altintas DU. The ADAPAR birth cohort study: food-allergy results at five years and new insights. Int Arch Allergy Immunol. 2016;169:57-61.
20. Schoemaker AA, Sprikkelman AB, Grimshaw KE, Roberts G, Grabenhenrich L, Rosenfeld L, et al. Incidence and natural history of challenge-proven cow’s milk allergy in European children-EuroPrevall birth cohort. Allergy. 2015;70:963-72.
21. Wood RA, Sicherer SH, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013;131:805-12.
22. Savilahti EM, Savilahti E. Development of natural tolerance and induced desensitization in cow’s milk allergy. Pediatr Allergy Immunol. 2013;24:114-21.
23. Yavuz ST, Sahiner UM, Buyuktiryaki B, Soyer OU, Tuncer A, Sekerel BE, et al. Phenotypes of IgE-mediated food-allergy in Turkish children. Allergy Asthma Proc. 2011;32:47-55.
24. Ayc¸in GD, Altıntas¸ DU. Contribution of the method of diagnosis and the range of IgE -non IgE at cow’s milk allergy in daily practice. J Turgut Ozal Med Cent. 2016;23:288-92.
25. Fiocchi A, Schunemann HJ, Brozek J, Restani P, Beyer K, Troncone R, et al. Diagnosis and Rationale for Action Against Cow’s Milk Allergy (DRACMA): a summary report. J Allergy Clin Immunol. 2010;126:1119-28.
26. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012;32:165-95.
27. Cetinkaya F, Incioglu A, Birinci S, Karaman BE. Hospital admissions for anaphylaxis in Istanbul, Turkey. Allergy. 2013;68:128-30.
28. Do˘gru M, Bostancı ˙I, Özmen S, Ginis¸ T, S¸enol HD. The features of anaphylaxis cases followed in the pediatric allergy clinic. J Curr Pediatr. 2017;15:12-8.
29. Krugman S, Chiaramonte D, Matsui E. Diagnosis and management of food-induced anaphylaxis: a national survey of pediatricians. Pediatrics. 2006;118:554-60.
30. Ross M, Ferguson M, Street D, Klontz K, Schroeder T, Luccioli S. Analysis of food allergic and anaphylactic events in the National Electronic Injury Surveillance System. J Allergy Clin Immunol. 2008;121:166-71.
31. Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol.
2005;115:149-56.
32. Mehr S, Frith K, Campbell DE. Epidemiology of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14:208-16.
33. Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: a large-scale, prospective population based study. J Allergy Clin Immunol. 2011;127:647-53.
34. Savilahti E. Food-induced malabsorption syndromes. J Pediatr Gastroenterol Nutr. 2000;30:S61-6.
35. Özbek YO, Canan O, Ozcay F, Bilezikci B. Cows milk protein enteropathy and granulomatous duodenitis in a newborn. J Pediatr Child Health. 2007;43:494-6.
36. Hill DA, Dudley JW, Spergel JM. The prevalence of eosinophilic esophagitis in pediatric patients with IgE-mediated food allergy. J Allergy Clin Immunol Pract. 2017;5:369-75.
37. Bakirtas A, Arga M, Egritas O, Topal E, Sari S, Poyraz A, et al. The first experience of eosinophilic esophagitis in Turkish children.
Turk J Gastroenterol. 2012;23:1-7.
38. Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr. 2000;30:S58-60.
39. Fedakar A. Cases of food-allergy presented with rectal bleeding. Göztepe Tıp Dergisi. 2011;26:83-6.
40. Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:9-17.
41. Asilsoy S, Ceylan Ö, Soylu ÖB, Can D, Altınöz S, A˘gın H. Clinical findings in patients with cow’s milk allergy. Izmir Tepecik E˘gitim Hastanesi Dergisi. 2007;17:83-7.
42. S¸enol HD, Köksal BT. Van’da Besin Alerjik C¸ocukların Klinik Özellikleri. Van Tıp Dergisi. 2015;22:266-72.
43. Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, et al. National prevalence and risk factors for food-allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126:798-806.
44. Novembre E, Vierucci A. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy. 2001;56:105-8.
45. Huang SW. Follow-up of children with rhinitis and cough associated with milk allergy. Pediatr Allergy Immunol. 2007;18:81-5.
46. Arik Yilmaz E, Cavkaytar O, Buyuktiryaki B, Soyer O, Sahiner UM, Sekerel BE, et al. Factors affecting food-allergy related quality of life from parents’ perception in Turkish children. Allergy Asthma Immunol Res. 2018;10:379-86.
47. Altıntas¸ DU, Günes¸er Kendirli S, Evliyao˘glu N, Atıcı A, Evrüke C. ˙Inek sütü allerjisi olan c¸ocuklarda en sık rastlanan bulgular. Turk Arch Ped. 1996;31:239-43.
48. Keskin O, Tuncer A, Adalioglu G, Sekerel BE, Sackesen C, Kalayci O. Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow’s milk allergy. Ann Allergy Asthma Immunol. 2005;94: 553-60.
49. Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, et al. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow’s milk according to age: a systematic review. Ital J Pediatr. 2017;43:93.
50. Akac¸in F, Ersoy R, Demirtürk M, Is¸ık SR. A rare presentation of anaphylactic reaction after a skin prick test with egg allergen: a case report and review of the literature. Med Bull Haseki. 2015;53:162-4.
51. Karaman S, Bahceci SE, Nacaroglu HT, Karaman CS, Can D. Is oral food challenge (OFC) test safe for preschool children? Asian Pac J Allergy Immunol. 2017;35:220-3.
52. Hill DJ, Murch SH, Rafferty K, Wallis P, Green CJ. The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: a systematic review. Clin Exp Allergy. 2007;37:808-22.
53. Vanderhoof J, Moore N, de Boissieu D. Evaluation of an amino acid-based formula in infants not responding to extensively hydrolyzed protein formula. J Pediatr Gastroenterol Nutr. 2016;63:531-3.
54. Antunes J, Borrego LM, Queiroz A, Chambel M, Rosa S, Romeira A, et al. Allergy to extensively hydrolysed formulas. Allergol
Immunopathol (Madr). 2009;37:272-4.
55. Chauveau A, Nguyen-Grosjean VM, Jacquenet S, Richard C, Mouton-Faivre C. Immediate hypersensitivity to extensively hydrolyzed formulas: an important reminder. Pediatr Allergy Immunol. 2016;27:541-3.
56. Morais MB, Spolidoro JV, Vieira MC, Cardoso AL, Clark O, Nishikawa A, et al. Amino acid formula as a new strategy for diagnosing cow’s milk allergy in infants: is it cost-effective? J Med Econ. 2016;19:1207-14.
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Mar 15, 2020
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Guler, N., Cokugras, F., Sapan, N., Selimoglu, A., Turktas, I., Cokugras, H., Aydogan, M., & Beser, O. (2020). Diagnosis and management of cow’s milk protein allergy in Turkey: Region-specific recommendations by an expert-panel. Allergologia Et Immunopathologia, 48(2), 202-210. https://all-imm.com/index.php/aei/article/view/229
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How to Cite
Guler, N., Cokugras, F., Sapan, N., Selimoglu, A., Turktas, I., Cokugras, H., Aydogan, M., & Beser, O. (2020). Diagnosis and management of cow’s milk protein allergy in Turkey: Region-specific recommendations by an expert-panel. Allergologia Et Immunopathologia, 48(2), 202-210. https://all-imm.com/index.php/aei/article/view/229