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Bahbah WA, ElHodhod M, Salah M, AlRefaee F, AlTuraiki M, Mousa S, Al Mehaidib A, Ayesh WH, El-Bazzar AN, El Haddad J, El Khashab HY, El Zawahry A, Hasosah M, Shaaban SY, Vandenplas Y. A Survey to Identify the Current Management of Cow’s Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region. Nutrients 2022; 14:nu14051067. [PMID: 35268042 PMCID: PMC8912394 DOI: 10.3390/nu14051067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cow’s milk allergy (CMA) and cow’s milk intolerance (CMI) are the major cow’s milk disorders observed in infants and young children. This study investigates, for the first time, physician knowledge regarding CMA and CMI prevalence, diagnosis, and management in the Middle East and North Africa (MENA) region. In addition, we explore the role of goat milk-based formula as an alternative in infants suffering from CMI. Method: This cross-sectional survey was conducted from December 2020 to February 2021. A convenience sample of 2500 MENA-based physicians received the questionnaire, developed by a working group of pediatric experts. Results: 1868 physicians completed the questionnaire, including pediatric specialists (80.8%), training physicians (0.2%), dermatologists (0.1%), family/general physicians (12.9%), neonatologists (3.6%), neurosurgeons (0.2%), allergy nurse specialists (0.3%), pharmacists (2.1%), and public health workers (0.1%). Differentiation between CMA and CMI was recognized by the majority of respondents (80.7%), for which the majority of respondents (35.4%) identified that the elimination and challenge test was the best test to differentiate CMA from CMI, whereas 30.7% and 5.4% preferred the immunoglobulin E (IgE) test and skin prick test, respectively. In addition, 28.5% of respondents reported that there is no confirmatory test to differentiate CMA from CMI. The majority of respondents (47.3%) reported that amino acid-based formula (AAF)/ extensively hydrolyzed formula (EHF) is the cornerstone for the management of CMA. However, most respondents (33.7%) reported that lactose avoidance was best for the management of CMI. Overall, 65% of the respondents were aware of nutritionally adapted goat’s milk formula as an alternative to cow’s milk products and 37% would recommend its routine use in infants (≤2 years of age). Conclusion: The results of this survey demonstrate that the majority of physicians are aware of the underlying pathophysiology and management of CMA and CMI. However, a significant proportion of physicians do not follow the clinical guidelines concerning CMA/CMI diagnosis and management. Notably, this survey identified that goat’s milk formulas may offer a suitable alternative to AAF/EHF in infants with CMI as they contain β-casein protein which is easily digestible. In addition, goat’s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow’s milk formulas, yet further clinical trials are warranted to support the inclusion of goat’s milk formulas in clinical guidelines.
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Affiliation(s)
- Wael A. Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom 32511, Egypt;
| | - Mostafa ElHodhod
- Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
- Faculty of Medicine, October 6 University, Giza 12511, Egypt
| | | | - Fawaz AlRefaee
- Department of Pediatrics, Al Adan Hospital, Ministry of Health, Kuwait City P.O. Box 46969, Kuwait;
| | - Muath AlTuraiki
- Department of Pediatrics, King Salman Hospital, Riyadh 12769, Saudi Arabia;
| | - Samira Mousa
- Medical Department, Faculty of Veterinary Medicine, Benha University, Benha 13518, Egypt;
| | - Ali Al Mehaidib
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia;
| | - Wafaa Helmi Ayesh
- Department of Clinical Nutrition, Dubai Health Authority, Dubai P.O. Box 4545, United Arab Emirates;
| | - Ahmed N. El-Bazzar
- Department of Pediatrics, Ministry of Health Hospitals, Cairo 12613, Egypt;
| | - Joseph El Haddad
- Department of Pediatrics and Neonatology, Saint George University Hospital, Beirut 1100, Lebanon;
| | - Heba Y. El Khashab
- Department of Pediatrics, Sulaiman Al Habib Medical Group, Riyadh 12214, Saudi Arabia;
- Department of Pediatrics, Ain Shams University, Cairo 11566, Egypt
| | - Amr El Zawahry
- Pediatrics Department, King’s College Hospital London, Dubai P.O. Box 340901, United Arab Emirates;
- Department of Pediatrics, Sharjah University, Sharjah P.O. Box 27272, United Arab Emirates
| | - Mohammed Hasosah
- King Abdullah International Medical Research Center, Pediatric Gastroenterology Department, National Guard Hospital, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21482, Saudi Arabia;
| | - Sanaa Youssef Shaaban
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence:
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Vandenplas Y, Al-Hussaini B, Al-Mannaei K, Al-Sunaid A, Helmi Ayesh W, El-Degeir M, El-Kabbany N, Haddad J, Hashmi A, Kreishan F, Tawfik E. Prevention of Allergic Sensitization and Treatment of Cow's Milk Protein Allergy in Early Life: The Middle-East Step-Down Consensus. Nutrients 2019; 11:nu11071444. [PMID: 31248015 PMCID: PMC6683055 DOI: 10.3390/nu11071444] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/20/2019] [Indexed: 12/23/2022] Open
Abstract
Allergy risk has become a significant public health issue with increasing prevalence. Exclusive breastfeeding is recommended for the first six months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle-East region, putting infants at risk of developing allergic sensitization and disorders. When breastfeeding is not possible or not adequate, a partially hydrolyzed whey formula (pHF-W) has shown proven benefits of preventing allergy, mainly atopic eczema, in children with a genetic risk. Therefore, besides stimulating breastfeeding, early identification of infants at risk for developing atopic disease and replacing commonly used formula based on intact cow milk protein (CMP) with a clinically proven pHF-W formula is of paramount importance for allergy prevention. If the child is affected by cow’s milk protein allergy (CMPA), expert guidelines recommend extensively hydrolyzed formula (eHF), or an amino acid formula (AAF) in case of severe symptoms. The Middle-East region has a unique practice of utilizing pHF-W as a step-down between eHF or AAF and intact CMP, which could be of benefit. The region is very heterogeneous with different levels of clinical practice, and as allergic disorders may be seen by healthcare professionals of different specialties with different levels of expertise, there is a great variability in preventive and treatment approaches within the region itself. During a consensus meeting, a new approach was discussed and unanimously approved by all participants, introducing the use of pHF-W in the therapeutic management of CMPA. This novel approach could be of worldwide benefit.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrijne Unversiteit Brussel, 1090 Brussels, Belgium.
| | - Bakr Al-Hussaini
- Department of Paediatrics, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia.
| | - Khaled Al-Mannaei
- Department of Paediatrics, Al Salam International Hospital, Dasma 35151, Kuwait.
| | - Areej Al-Sunaid
- Department of Paediatric Gastroenterology, King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia.
| | - Wafaa Helmi Ayesh
- Clinical Nutrition Department, Dubai Health Authority, PO Box 4545 Dubai, UAE.
| | - Manal El-Degeir
- Department of Paediatrics, National Guard Hospital, Dammam 31412, Saudi Arabia.
| | - Nevine El-Kabbany
- Department of Paediatrics, Mediclinic Welcare Hospital, PO Box 31500 Dubai, UAE.
| | - Joseph Haddad
- Department of Paediatrics, Saint George Hospital University Medical Center, Balamand University, PO Box 166378 Beirut, Lebanon.
| | - Aziza Hashmi
- Department of Clinical Nutrition Services, King Abdulaziz Medical City-Jeddah, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Furat Kreishan
- Department of Paediatrics, Alhakeem Furat Clinic, Amman 11942, Jordan.
| | - Eslam Tawfik
- Department of Paediatrics, Sheikh Khalifa Medical City, PO Box 51900 Abu Dhabi, UAE.
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