PDF(Pubmed)
Abstract：
UNASSIGNED: Cow\'s milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow\'s milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit.
UNASSIGNED: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA.
UNASSIGNED: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders.
UNASSIGNED: After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow\'s milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as \"conditional\" following the GRADE approach due to the very low certainty about the health effects based on the available evidence.
UNASSIGNED: If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients\' and caregivers\' values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.
UNASSIGNED: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA.
UNASSIGNED: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders.
UNASSIGNED: After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow\'s milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as \"conditional\" following the GRADE approach due to the very low certainty about the health effects based on the available evidence.
UNASSIGNED: If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients\' and caregivers\' values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.
摘要：
■牛奶过敏（CMA）是婴儿中最常见的食物过敏。用专门的配方代替是一种既定的临床方法，以确保足够的生长并在不可能母乳喂养时将严重过敏反应的风险降至最低。尽管如此，考虑到多种选择的可用性，如广泛水解牛乳蛋白配方(eHF-CM)，氨基酸配方（AAF），水解大米配方（HRF）和大豆配方（SF），在健康结果方面，最合适的选择存在一些不确定性。此外，已提出将益生菌添加到配方中作为一种潜在的方法来最大化获益.
■世界过敏组织（WAO）的这些基于证据的指南旨在支持患者，临床医生,和其他人在决定使用牛奶专用配方时，有和没有益生菌，对于有CMA的个人。
■WAO成立了一个多学科指南小组，以平衡所有利益相关者的观点，并最大程度地减少来自竞争利益的潜在偏见。麦克马斯特大学年级中心支持指导方针制定过程，包括更新或执行系统的证据审查。小组根据临床医生和患者的重要性，优先考虑临床问题和结果。建议评估的分级，采用开发和评估(GRADE)方法，包括等级证据到决策框架，受到利益相关者的审查。
■在回顾了总结的证据并彻底讨论了不同的管理方案之后，WAO指南小组建议:a)使用广泛水解(牛奶)配方或水解大米配方作为管理未母乳喂养的免疫球蛋白E(IgE)和非IgE介导的CMA婴儿的首选方案。氨基酸配方或大豆配方可分别被视为第二和第三选择；b）对于患有IgE或非IgE介导的CMA的婴儿，使用不含益生菌的配方或包含鼠李糖乳杆菌GG（LGG）的基于酪蛋白的广泛水解配方。根据现有证据，由于对健康影响的确定性非常低，因此按照分级方法，发布的建议被标记为“有条件的”。
■如果没有母乳喂养，临床医生,病人,他们的家庭成员可能想讨论每种配方奶粉对CMA婴儿的所有潜在的期望和不良后果，将它们与患者和护理人员的价值观和偏好相结合，本地可用性,和成本，在决定治疗方案之前。我们还建议需要进行哪些研究才能更确定地确定哪些公式可能最有益，成本效益高,和公平。
■世界过敏组织（WAO）的这些基于证据的指南旨在支持患者，临床医生,和其他人在决定使用牛奶专用配方时，有和没有益生菌，对于有CMA的个人。
■WAO成立了一个多学科指南小组，以平衡所有利益相关者的观点，并最大程度地减少来自竞争利益的潜在偏见。麦克马斯特大学年级中心支持指导方针制定过程，包括更新或执行系统的证据审查。小组根据临床医生和患者的重要性，优先考虑临床问题和结果。建议评估的分级，采用开发和评估(GRADE)方法，包括等级证据到决策框架，受到利益相关者的审查。
■在回顾了总结的证据并彻底讨论了不同的管理方案之后，WAO指南小组建议:a)使用广泛水解(牛奶)配方或水解大米配方作为管理未母乳喂养的免疫球蛋白E(IgE)和非IgE介导的CMA婴儿的首选方案。氨基酸配方或大豆配方可分别被视为第二和第三选择；b）对于患有IgE或非IgE介导的CMA的婴儿，使用不含益生菌的配方或包含鼠李糖乳杆菌GG（LGG）的基于酪蛋白的广泛水解配方。根据现有证据，由于对健康影响的确定性非常低，因此按照分级方法，发布的建议被标记为“有条件的”。
■如果没有母乳喂养，临床医生,病人,他们的家庭成员可能想讨论每种配方奶粉对CMA婴儿的所有潜在的期望和不良后果，将它们与患者和护理人员的价值观和偏好相结合，本地可用性,和成本，在决定治疗方案之前。我们还建议需要进行哪些研究才能更确定地确定哪些公式可能最有益，成本效益高,和公平。
