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Guidelines change the diagnostic process of cow milk food allergy: problem-based learning

Assa’ad, Amal; Fiocchi, Alessandro

Current Opinion in Allergy and Clinical Immunology: October 2012 - Volume 12 - Issue 5 - p 564–569
doi: 10.1097/ACI.0b013e328357cae6
Special Commentaries

Purpose of review The accurate diagnosis of food allergy and its management has been the subject of two published guidelines, the National Institute of Health Sponsored Expert Panel Guidelines and the World Allergy Organization guidelines: Diagnosis and Rationale for Action Against Cow Milk Allergy. Both guidelines have drawn attention to the unique aspects of different food allergens. They have highlighted the possible overdiagnosis and underdiagnosis of food allergy. The purpose of this review is to demonstrate the utility and application of the two published guidelines in a real-life scenario that the pediatrician or allergy/immunology specialist may be faced with.

Recent findings This review is divided into two sections: the first section is problem-based learning, presenting a clinical scenario of a child suspected of cow milk allergy (CMA) and followed over time. At each step, the guidelines are consulted and referenced. The second section reviews recent research that demonstrates that CMA has a high prevalence, and that testing methodologies can be improved on.

Summary Clinicians taking the approach outlined by the guidelines will be able to confirm or refute a diagnosis of CMA, all the while minimizing unnecessary tests and procedures.

aDivision of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

bDepartment of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy

Correspondence to Amal Assa’ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. Tel: +1 513 636 6771; fax: +1 513 636 4615; e-mail: amal.assa’

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