PDF(Pubmed)
Abstract：
UNASSIGNED: The diagnosis and management of cow\'s milk allergy (CMA) is a topic of debate and controversy. Our aim was to compare the opinions of expert groups from the Middle East (n = 14) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n = 13).
UNASSIGNED: These Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared.
UNASSIGNED: Overall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g., malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow\'s milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence.
UNASSIGNED: Differences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area.
UNASSIGNED: These Expert groups voted on statements that were developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared.
UNASSIGNED: Overall, there was consensus amongst both groups of experts. Experts agreed that symptoms of crying, irritability and colic, as single manifestation, are not suggestive of CMA. They agreed that amino-acid based formula (AAF) should be reserved for severe cases (e.g., malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no unanimous consensus on the statement that a cow\'s milk based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role for hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle-East region. All ESPGHAN experts agreed that there is insufficient evidence that the addition of probiotics, prebiotics and synbiotics increase the efficacy of elimination diets regarding CMA symptoms (despite other benefits such as decrease of infections and antibiotic intake), whereas 3/14 of the Middle East group thought there was sufficient evidence.
UNASSIGNED: Differences in voting are related to geographical, cultural and other conditions, such as cost and availability. This emphasizes the need to develop region-specific guidelines considering social and cultural conditions, and to perform further research in this area.
摘要：
■牛奶过敏（CMA）的诊断和管理是一个争论和争议的话题。我们的目的是比较来自中东（n=14）和欧洲儿科胃肠病学会的专家组的意见，肝病学和营养学（ESPGHAN）（n=13）。
■这些专家组对ESPGHAN小组制定并在最近的立场文件中发表的声明进行了投票。比较了投票结果。
■总的来说，两组专家之间达成了共识。专家们一致认为，哭泣的症状，烦躁和绞痛，作为单一的表现，不暗示CMA。他们同意，基于氨基酸的配方（AAF）应保留用于严重病例（例如，营养不良和过敏反应），并且没有足够的证据建议采用逐步方法。在轻度/中度病例中，基于牛奶的广泛水解配方（eHF）应作为诊断消除饮食的首选，这一说法没有达成一致共识。尽管关于水解大米配方作为诊断和治疗消除饮食的作用的陈述被接受，3/27不同意。关于大豆配方的投票强调了大豆蛋白在CMA饮食治疗中的作用的意见分歧。一般来说,以大豆为基础的配方在中东地区很少可用。所有ESPGHAN专家都同意，没有足够的证据表明添加益生菌，益生元和合生元增加消除CMA症状饮食的功效（尽管其他益处，如减少感染和抗生素摄入量），而3/14的中东集团认为有足够的证据。
■投票的差异与地域有关，文化和其他条件，比如成本和可用性。这强调需要考虑到社会和文化条件，制定针对特定地区的指导方针，并在这方面进行进一步的研究。
■这些专家组对ESPGHAN小组制定并在最近的立场文件中发表的声明进行了投票。比较了投票结果。
■总的来说，两组专家之间达成了共识。专家们一致认为，哭泣的症状，烦躁和绞痛，作为单一的表现，不暗示CMA。他们同意，基于氨基酸的配方（AAF）应保留用于严重病例（例如，营养不良和过敏反应），并且没有足够的证据建议采用逐步方法。在轻度/中度病例中，基于牛奶的广泛水解配方（eHF）应作为诊断消除饮食的首选，这一说法没有达成一致共识。尽管关于水解大米配方作为诊断和治疗消除饮食的作用的陈述被接受，3/27不同意。关于大豆配方的投票强调了大豆蛋白在CMA饮食治疗中的作用的意见分歧。一般来说,以大豆为基础的配方在中东地区很少可用。所有ESPGHAN专家都同意，没有足够的证据表明添加益生菌，益生元和合生元增加消除CMA症状饮食的功效（尽管其他益处，如减少感染和抗生素摄入量），而3/14的中东集团认为有足够的证据。
■投票的差异与地域有关，文化和其他条件，比如成本和可用性。这强调需要考虑到社会和文化条件，制定针对特定地区的指导方针，并在这方面进行进一步的研究。
