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- Robert, E., et al.
(författare)
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Symptoms and management of cow's milk allergy : perception and evidence
- 2024
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Ingår i: Frontiers in Allergy. - : Frontiers Media S.A.. - 2673-6101. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: 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).Methods: 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.Results: 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.Discussion: 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.
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| 5. |
- De Wilde, J., et al.
(författare)
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Is the Community as method approach gender sensitive? : Client and treatment characteristics in European Therapeutic Communities. Results of the BIOMED II (IPTRP) project.
- 2006
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Ingår i: International Journal of Social Welfare. - : Wiley. - 1369-6866 .- 1468-2397. ; 15:2, s. 150-161
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Tidskriftsartikel (refereegranskat)abstract
- The BIOMED II project, ‘Improving Psychiatric Treatment in Residential Programmes for Newly Dependent Groups through Relapse Prevention’, provided a large database of characteristics of men and women in European therapeutic communities (TCs). One of the aims of the project was to improve the treatment of ‘emerging dependency groups’ through better assessment. Although American TC research has shown that there are important differences between men and women that should be taken into account when organising treatment, the BIOMED project failed to report on gender differences. This article tries to fill this gap by presenting an overview of the gender differences in the TC clients and lists the characteristics of the participating European TCs. The two overviews are given for each country separately. Descriptive methods were used. The authors discuss whether the TC programme considers the differences between men and women and whether the ‘community as method’ approach is gender sensitive.
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- Vandenplas, Yvan, et al.
(författare)
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An ESPGHAN position paper on the diagnosis, management, and prevention of cow's milk allergy
- 2024
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : John Wiley & Sons. - 0277-2116 .- 1536-4801. ; 78:2, s. 386-413
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Tidskriftsartikel (refereegranskat)abstract
- A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2–4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
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