Differences in Diagnosis and Management of Non-IgE Mediated Cow’s Milk Allergy between Pediatric Gastroenterologists and Immunologists
2Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel, ישראל
3Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel, ישראל
4Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, ישראל
Objectives: Infants with Non-IgE mediated food allergy are followed by primary pediatricians, gastroenterologists, or immunologists. We hypothesized that there are practice variations between those disciplines in the care of infants with non-IgE mediated cow`s milk protein allergy.
Methods: A computerized questionnaire was distributed between pediatric gastroenterologists and immunologists. The questions addressed diagnosis, management, and follow-up in three scenarios of infants with concern for food protein induced allergic proctocolitis (FPIAP).
Results: Fifty eights pediatric gastroenterologists and 32 immunologists completed the questionnaire. The first case illustrated an infant consuming cow’s milk-based formula, who presented with symptoms suggestive of FPIAP. Eighty three percent of gastroenterologists recommended to transfer the patient to an extensively hydrolyzed formula and only 10% recommended just follow up without dietary changes, in contrast to 41% and 28% of immunologists, respectively (P<0.001). In a breast-fed infant, about 50% of gastroenterologists and immunologists advised that the mother restrains from milk products, but 22% of gastroenterologists vs. 45% of immunologists recommended just follow up (P=0.02). Re-challenge to confirm diagnosis was recommended by only 35% and 50% of gastroenterologists and immunologists, respectively (P=0.02). Time of re-exposure of these infants to cow’s milk products was recommended by most immunologists as early as age ≤6 months, while most gastroenterologists recommended it at 9-12 months of age (P=0.002).
Conclusions: We identified lack of adherence to guidelines and differences in diagnosis and management of non-IgE mediated cow’s milk allergy between pediatric gastroenterology and immunology subspecialties. Joint guidelines should be published and implemented by both groups of physicians.