World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update - XII - Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA

作者全名：Bognanni, Antonio; Fiocchi, Alessandro; Arasi, Stefania; Chu, Derek K.; Ansotegui, Ignacio; Assa'ad, Amal H.; Bahna, Sami L.; Canani, Roberto Berni; Bozzola, Martin; Dahdah, Lamia; Dupont, Christophe; Dziechciarz, Piotr; Ebisawa, Motohiro; Firmino, Ramon T.; Chu, Alexandro; Galli, Elena; Horvath, Andrea; Kamenwa, Rose; Lack, Gideon; Li, Haiqi; Martelli, Alberto; Grzyn, Anna Nowak-We; Papadopoulos, Nikolaos G.; Pawankar, Ruby; Roldan, Yetiani; Said, Maria; Said, Maria; Sanchez-Borges, Mario; Shamir, Raanan; Spergel, Jonathan M.; Szajewska, Hania; Terracciano, Luigi; Vandenplas, Yvan; Venter, Carina; Waffenschmidt, Siw; Waserman, Susan; Warner, Amena; Wong, Gary W. K.; Schuenemann, Holger J.; Brozek, Jan L.

作者地址：[Bognanni, Antonio; Roldan, Yetiani; Waffenschmidt, Siw; Schuenemann, Holger J.; Brozek, Jan L.] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada; [Bognanni, Antonio; Chu, Derek K.; Chu, Alexandro] McMaster Univ, Evidence Allergy Grp, Dept Med, Hamilton, ON, Canada; [Bognanni, Antonio; Schuenemann, Holger J.] Humanitas Univ, Dept Biomed Sci, Milan, Italy; [Fiocchi, Alessandro; Arasi, Stefania; Dahdah, Lamia] Bambino Gesu Pediat Hosp, Div Allergy, Translat Res Pediat Specialties Area, IRCCS, Piazza St Onofrio 4, I-00165 Rome, Italy; [Chu, Derek K.; Bozzola, Martin; Chu, Alexandro; Waserman, Susan; Brozek, Jan L.] McMaster Univ, Dept Med, Div Clin Immunol & Allergy, Hamilton, ON, Canada; [Ansotegui, Ignacio] Hosp Quironsalud Bizkaia, Bilbao Erandio, Spain; [Assa'ad, Amal H.] Univ Cincinnati, Coll Med, Div Allergy & Immunol, Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA; [Canani, Roberto Berni] Univ Naples Federico II, Dept Translat Med Sci, Pediat Allergy Program, Naples, Italy; [Bahna, Sami L.] Louisiana State Univ, Hlth Sci Ctr, Allergy & Immunol Sect, Shreveport, LA USA; [Bozzola, Martin] Paris Descartes Univ, Necker Hosp, Pediat Gastroenterol, Paris, France; [Dupont, Christophe] Clin Marcel Sembat, Boulogne, France; [Dziechciarz, Piotr; Horvath, Andrea; Szajewska, Hania] Med Univ Warsaw, Dept Paediat, Warsaw, Poland; [Ebisawa, Motohiro] Sagamihara Natl Hosp, Clin Res Ctr Allergy & Rheumatol, Natl Hosp Org, Sagamihara, Kanagawa, Japan; [Firmino, Ramon T.] UNIFACISA Univ Ctr, Fac Med Sci Campina Grande, Campina Grande, PB, Brazil; [Galli, Elena] San Pietro Hosp Fatebenefratelli, Pediat Allergy Unit, Rome, Italy; [Kamenwa, Rose] Aga Khan Univ Hosp, Dept Paediat & Child Hlth, Nairobi, Kenya; [Lack, Gideon] Kings Coll London, Asthma UK Ctr Allerg Mech Asthma, Dept Pediat Allergy, St Thomas Hosp, London, England; [Li, Haiqi] Chongqing Med Univ, Childrens Hosp, Dept Primary Child Care, Chongqing, Peoples R China; [Grzyn, Anna Nowak-We] NYU Grossman Sch Med, Hassenfeld Childrens Hosp, Dept Pediat, New York, NY USA; [Grzyn, Anna Nowak-We] Univ Warmia & Mazury, Dept Pediat Gastroenterol & Nutr, Coll Med, Olsztyn, Poland; [Papadopoulos, Nikolaos G.] Univ Manchester, Sch Biol Sci, Div Infect Immun & Resp Med, Manchester, Lancs, England; [Papadopoulos, Nikolaos G.] Natl & Kapodistrian Univ Athens, Allergy Dept, Pediat Clin 2, Athens, Greece; [Pawankar, Ruby] Nippon Med Sch, Dept Pediat, Div Allergy, Tokyo, Japan; [Said, Maria] Allergy & Anaphylaxis Australia, Castle Hill, NSW, Australia; [Sanchez-Borges, Mario] Ctr Med Docente La Trinidad & Clin Avila, Allergy & Clin Immunol Dept, Caracas, Venezuela; [Shamir, Raanan] Tel Aviv Univ, Inst Gastroenterol Nutr & Liver Dis, Schneider Childrens Med Ctr Israel, Fac Med, Tel Aviv, Israel; [Spergel, Jonathan M.] Univ Penn, Sch Med, Childrens Hosp Philadelphia, Div Allergy & Immunol, Philadelphia, PA USA; [Terracciano, Luigi] Natl Pediat Hlth Care Syst, Pediat Primary Care, Milan, Italy; [Vandenplas, Yvan] Univ Ziekenhuis Brussel, Dept Pediat Gastroenterol, Brussels, Belgium; [Schuenemann, Holger J.] McMaster Univ, Dept Med, Div Internal Med, Hamilton, ON, Canada; [Venter, Carina] Univ Colorado, Sch Med, Childrens Hosp Colorado, Sect Allergy & Immunol, Aurora, CO USA; [Waffenschmidt, Siw] Inst Qual & Efficiency Hlth Care, Cologne, Germany; [Warner, Amena] Allergy UK, London, England; [Wong, Gary W. K.] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Paediat, Shatin, Hong Kong, Peoples R China

通信作者：Fiocchi, A (通讯作者)，Bambino Gesu Pediat Hosp, Div Allergy, Translat Res Pediat Specialties Area, IRCCS, Piazza St Onofrio 4, I-00165 Rome, Italy.

来源：WORLD ALLERGY ORGANIZATION JOURNAL

ESI学科分类：IMMUNOLOGY

WOS号：WOS:001215973500001

JCR分区：Q2

影响因子：3.9

年份：2024

卷号：17

期号：4

开始页：　

结束页：　

文献类型：Article

关键词：Milk allergy; Milk replacement formulas; Probiotics; Clinical practice guidelines; GRADE

摘要：Background: 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. Objective: 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. Methods: 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 -toDecision frameworks, which were subject to review by stakeholders. Results: 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. Conclusions: 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.

基金机构：World Allergy Organization

基金资助正文：This document was supported by the World Allergy Organization.