Iberian consensus on cow’s milk allergy: The CIBAL Study

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E. Alonso-Lebrero
L. Bento
A. Martorell-Aragonés
L. Ribeiro


Delphi, Consensus, Cow’s milk allergy CMPA, CMPA prevention, CMPA diagnosis, CMPA treatment, CMPA progression, OIT


Background: The present study explores the professional opinion of a wide range of experts from the Iberian Peninsula (Spain and Portugal) and their degree of consensus about CMPA’s prevention, diagnosis, treatment and progression.

Material and methods: A 57-item survey divided in four blocks: Prevention (14 items), Diagnosis (10 items), Treatment (19 items) and Progression (14 items) was completed by 160 panellists, experts in CPMA management (116 Spain, 44 Portugal). Each one answered the questionnaire, formulated in Portuguese and Spanish, by individually accessing an online platform in two consecutive rounds. Five possible answers were possible: ‘‘completely agree’’, ‘‘agree’’, ‘‘neither agree nor disagree’’, ‘‘disagree’’ and ‘‘completely disagree’’. A modified Delphi method was used.

Results: Consensus (more than 66% agree) was reached in 39 items (68.4%) and Discrepancy (less than 50% agree) in nine items (15.7%). Block-separated analysis offers valuable differences regarding consensus. The Prevention block only reached 50%; the Diagnosis block 90%; the Treatment block 73.68%, showing a high degree of agreement on dietary treatment (15/16 items), and discrepancy or less agreement on immunotherapy treatments. The Progression block reached 71.4% consensus with discrepancy with regard to the time to perform oral food challenge and negatives prognosis consequences of accidental milk ingestion.

Conclusions: This study displays the current opinions of a wide group of experts on CMPA from the Iberian Peninsula and evidence discussion lines in CMPA management. The questions on which there were situations of discrepancy, provide us with very useful information for promoting new, rigorous research enabling us to draw conclusions on these controversial aspects.

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