International Cross-Sectional Survey among Healthcare Professionals on the Management of Cow’s Milk Protein Allergy and Lactose Intolerance in Infants and Children
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Purpose: The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow’s milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods: A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results: Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion: The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.
Abstract
Purpose: The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow’s milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods: A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results: Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion: The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.
참고문헌 (27)
- Luyt D, "BSACI guideline for the diagnosis and management of cow’s milk allergy", Clin Exp Allergy, 44, pp.642~672 (2014)
- Flom JD, "Epidemiology of cow’s milk allergy", Nutrients, 11, pp.1051~ (2019)
- Nwaru BI, "The epidemiology of food allergy in Europe : a systematic review and meta-analysis", Allergy, 69, pp.62~75 (2014)
- Schoemaker AA, "Incidence and natural history of challenge-proven cow’s milk allergy in European children--EuroPrevall birth cohort", Allergy, 70, pp.963~972 (2015)
- Gupta RS, "The public health impact of parent-reported childhood food allergies in the United States", Pediatrics, 142, pp.e20181235~ (2018)
- Heine RG, "Cow’s milk allergy in infancy", Curr Opin Allergy Clin Immunol, 2, pp.217~225 (2002)
- Heine RG, "Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children-common misconceptions revisited", World Allergy Organ J, 10, pp.41~ (2017)
- Wauters L, "Cow’s milk allergy prescribing is influenced by regional and national guidance", J Pediatr Gastroenterol Nutr, 62, pp.765~770 (2016)
- Johansson SG, "Revised nomenclature for allergy for global use : report of the Nomenclature Review Committee of the World Allergy Organization, October 2003", J Allergy Clin Immunol, 113, pp.832~836 (2004)
- Heyman MB; Committee on Nutrition, "Lactose intolerance in infants, children, and adolescents", Pediatrics, 118, pp.1279~1286 (2006)
- Fiocchi A, "World Allergy Organization(WAO)Diagnosis and Rationale for Action against Cow’s Milk Allergy(DRACMA)guidelines", World Allergy Organ J, 3, pp.57~161 (2010)
- Deng Y, "Lactose intolerance in adults : biological mechanism and dietary management", Nutrients, 7, pp.8020~8035 (2015)
- Hegar B, "Lactose intolerance in Indonesian children", Asia Pac J Clin Nutr, 24(1), pp.31~40 (2015)
- Szilagyi A, "Redefining lactose as a conditional prebiotic", Can J Gastroenterol, 18, pp.163~167 (2004)
- Francavilla R, "Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy", Pediatr Allergy Immunol, 23, pp.420~427 (2012)
- Werkstetter K, "Diagnosis and management of cow’s milk protein allergy-how big is the gap between ideal and reality? A quality-of-care survey in Europe", J Pediatr Gastroenterol Nutr, 66(2), pp.399~ (2018)
- Celik-Bilgili S, "The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges", Clin Exp Allergy, 35, pp.268~273 (2005)
- Verstege A, "The predictive value of the skin prick test weal size for the outcome of oral food challenges", Clin Exp Allergy, 35, pp.1220~1226 (2005)
- Walsh J, "Differentiating milk allergy(IgE and non-IgE mediated)from lactose intolerance : understanding the underlying mechanisms and presentations", Br J Gen Pract, 66, pp.e609~11 (2016)
- Alibardi L, "Microscopical observations on the regenerating tail in the tuatara Sphenodon punctatus indicate a tendency to scarring, but also influence from somatic growth", J Morphol, 280, pp.411~422 (2019)
- Muraro A, "Controversies on special products for managing cow’s milk protein allergy in infants : safety and suitability", EMJ Allergy Immunol, 2, pp.46~51 (2017)
- Koletzko S, "Diagnostic approach and management of cow’s-milk protein allergy in infants and children : ESPGHAN GI Committee practical guidelines", J Pediatr Gastroenterol Nutr, 55, pp.221~229 (2012)
- Egan M, "Partially hydrolyzed whey formula intolerance in cow’s milk allergic patients", Pediatr Allergy Immunol, 28, pp.401~405 (2017)
- Chauveau A, "Immediate hypersensitivity to extensively hydrolyzed formulas : an important reminder", Pediatr Allergy Immunol, 27, pp.541~543 (2016)
- Kvammen JA, "Micronutrient status and nutritional intake in 0-to 2-year-old children consuming a cows’ milk exclusion diet", J Pediatr Gastroenterol Nutr, 66, pp.831~837 (2018)
- Mehta H, "Growth and nutritional concerns in children with food allergy", Curr Opin Allergy Clin Immunol, 13, pp.275~279 (2013)
- Meyer R, "International survey on growth indices and impacting factors in children with food allergies", J Hum Nutr Diet, 32, pp.175~184 (2019)
