Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

doi:10.1186/s13601-017-0162-y

Review

. 2017 Aug 23:7:26.

doi: 10.1186/s13601-017-0162-y. eCollection 2017.

Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

Carina Venter^#¹, Trevor Brown^#², Rosan Meyer³, Joanne Walsh⁴, Neil Shah⁵, Anna Nowak-Węgrzyn⁶, Tong-Xin Chen⁷, David M Fleischer¹, Ralf G Heine⁸, Michael Levin⁹, Mario C Vieira¹⁰, Adam T Fox^{11

12}

Affiliations

¹ Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado , Box B518, 13123 East 16th Avenue, Anschutz Medical Campus, Aurora, CO 80045 USA.
² Children's Allergy Service, Ulster Hospital, Belfast, BT16 1RH Northern Ireland, UK.
³ Department Paediatrics, Imperial College, London, London, W2 1NY UK.
⁴ Gurney Surgery, Castle Partnership, 101-103 Magdalen Street, Norwich, NR3 1LN UK.
⁵ Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH UK.
⁶ Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.
⁷ Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127 China.
⁸ Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, Parkville, VIC 3052 Australia.
⁹ Division of Paediatric Allergy and Asthma, Red Cross War Memorial Children's Hospital, University of Cape Town, Room 516, ICH Building, Cape Town, South Africa.
¹⁰ Centro de Gastroenterologica Pediatrica, Department of Paediatrics, Hospital Pequeno Principe, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
¹¹ Department of Paediatric Allergy, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK.
¹² Division of Asthma, Allergy and Lung Biology, King's College, London, London, UK.

^# Contributed equally.

PMID: 28852472
PMCID: PMC5567723
DOI: 10.1186/s13601-017-0162-y

Review

Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

Carina Venter et al. Clin Transl Allergy. 2017.

. 2017 Aug 23:7:26.

doi: 10.1186/s13601-017-0162-y. eCollection 2017.

Authors

Affiliations

¹ Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado , Box B518, 13123 East 16th Avenue, Anschutz Medical Campus, Aurora, CO 80045 USA.
² Children's Allergy Service, Ulster Hospital, Belfast, BT16 1RH Northern Ireland, UK.
³ Department Paediatrics, Imperial College, London, London, W2 1NY UK.
⁴ Gurney Surgery, Castle Partnership, 101-103 Magdalen Street, Norwich, NR3 1LN UK.
⁵ Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH UK.
⁶ Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.
⁷ Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127 China.
⁸ Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, Parkville, VIC 3052 Australia.
⁹ Division of Paediatric Allergy and Asthma, Red Cross War Memorial Children's Hospital, University of Cape Town, Room 516, ICH Building, Cape Town, South Africa.
¹⁰ Centro de Gastroenterologica Pediatrica, Department of Paediatrics, Hospital Pequeno Principe, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
¹¹ Department of Paediatric Allergy, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK.
¹² Division of Asthma, Allergy and Lung Biology, King's College, London, London, UK.

^# Contributed equally.

PMID: 28852472
PMCID: PMC5567723
DOI: 10.1186/s13601-017-0162-y

Erratum in

Correction to: Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline.
Venter C, Brown T, Meyer R, Walsh J, Shah N, Nowak-Węgrzyn A, Chen TX, Fleischer DM, Heine RG, Levin M, Vieira MC, Fox AT. Venter C, et al. Clin Transl Allergy. 2018 Jan 25;8:4. doi: 10.1186/s13601-017-0189-0. eCollection 2018. Clin Transl Allergy. 2018. PMID: 29416848 Free PMC article.

Abstract

Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, 'Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide' was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow's milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise.

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Figures

**Fig. 1**
Taking and allergy focussed clinical history: Adapted from the UK NICE guideline CG116 on food allergy

**Fig. 2**
Presentation of suspected cow’s milk allergy (CMA) in the 1st year of Life

**Fig. 3**
Management of mild to moderate non-IgE cow’s milk allergy (CMA)

See this image and copyright information in PMC

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References

1. Boyce JA, Assa’a A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Nutrition. 2011;27(2):253–267. doi: 10.1016/j.nut.2010.12.001. - DOI - PubMed
1. Godwin H, et al. The quality of life of children with food protein induced gastrointestinal allergies. Abstract presented at European Society for Paediatric Gastroenterology, Hepatology and Nutrition ESPGHAN 2013.
1. Flokstra-de Blok BM, van der Velde JL, Vlieg-Boerstra BJ, Oude Elberink JN, DunnGalvin A, Hourihane JO, et al. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy. 2010;65(8):1031–1038. doi: 10.1111/j.1398-9995.2009.02304.x. - DOI - PubMed
1. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–836. doi: 10.1016/j.jaci.2003.12.591. - DOI - PubMed
1. Turner PJ, Baumert JL, Beyer K, Boyle R, Chan CH, Clark A, et al. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy. 2016;71:1241–1255. doi: 10.1111/all.12924. - DOI - PubMed

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[1] Boyce JA, Assa’a A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Nutrition. 2011;27(2):253–267. doi: 10.1016/j.nut.2010.12.001. - DOI - PubMed

[2] Boyce JA, Assa’a A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Nutrition. 2011;27(2):253–267. doi: 10.1016/j.nut.2010.12.001. - DOI - PubMed

[3] Godwin H, et al. The quality of life of children with food protein induced gastrointestinal allergies. Abstract presented at European Society for Paediatric Gastroenterology, Hepatology and Nutrition ESPGHAN 2013.

[4] Godwin H, et al. The quality of life of children with food protein induced gastrointestinal allergies. Abstract presented at European Society for Paediatric Gastroenterology, Hepatology and Nutrition ESPGHAN 2013.

[5] Flokstra-de Blok BM, van der Velde JL, Vlieg-Boerstra BJ, Oude Elberink JN, DunnGalvin A, Hourihane JO, et al. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy. 2010;65(8):1031–1038. doi: 10.1111/j.1398-9995.2009.02304.x. - DOI - PubMed

[6] Flokstra-de Blok BM, van der Velde JL, Vlieg-Boerstra BJ, Oude Elberink JN, DunnGalvin A, Hourihane JO, et al. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy. 2010;65(8):1031–1038. doi: 10.1111/j.1398-9995.2009.02304.x. - DOI - PubMed

[7] Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–836. doi: 10.1016/j.jaci.2003.12.591. - DOI - PubMed

[8] Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–836. doi: 10.1016/j.jaci.2003.12.591. - DOI - PubMed

[9] Turner PJ, Baumert JL, Beyer K, Boyle R, Chan CH, Clark A, et al. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy. 2016;71:1241–1255. doi: 10.1111/all.12924. - DOI - PubMed

[10] Turner PJ, Baumert JL, Beyer K, Boyle R, Chan CH, Clark A, et al. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy. 2016;71:1241–1255. doi: 10.1111/all.12924. - DOI - PubMed

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Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

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Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

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