# Discrepancy between Mexican paediatricians and ESPGHAN experts regarding cow's milk allergy

## TL;DR

Mexican pediatricians and European experts differ in their views on diagnosing and managing cow's milk allergy, especially regarding vitamin D's role.

## Contribution

The study reveals significant discrepancies between Mexican pediatricians and ESPGHAN experts on cow's milk allergy guidelines, particularly in real-world practice versus evidence-based recommendations.

## Key findings

- Mexican pediatricians rejected 19 out of 73 statements from ESPGHAN guidelines.
- The greatest disagreement was about vitamin D's role in preventing cow's milk allergy.
- Non-experts manage cow's milk allergy differently than specialists, highlighting a gap between evidence and practice.

## Abstract

Cow's milk allergy (CMA) is a common food allergy in infants. Guidelines and recommendations for the diagnosis and management of CMA are based on scientific review of the available evidence. However, real‐world situations may oblige clinicians to adapt a different attitude.

This paper evaluated the opinion of 42 Mexican paediatricians on the 73 statements presented in the recent position paper of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Voting on the statements and their interpretation were identical for both groups (online and anonymous). Both groups were unaware of the other's outcome at the moment of the voting.

While the ESPGHAN group accepted all 73 statements, the Mexican group rejected 19 statements. Two rejections were due to the mean and median being below the predefined and agreed‐upon cut‐off, and 17 were due to over 75% of participants disagreeing with the statements. The greatest discrepancy was observed regarding the role of vitamin D in preventing CMA.

While opinions on the prevalence, diagnosis and management of CMA were comparable between European paediatric gastroenterologists and Mexican general paediatricians for the majority of statements, significant differences were observed. It is essential to gather information from various regions and healthcare levels to enhance the impact of recommendations.

Cow's milk allergy (CMA) is the most prevalent food allergy during infancy.The diagnosis of CMA is debated because of the absence of specific symptoms and diagnostic tests, except for the oral food challenge which is often refused.As a consequence, there is a gap between the available evidence and the real‐world situation.

Cow's milk allergy (CMA) is the most prevalent food allergy during infancy.

The diagnosis of CMA is debated because of the absence of specific symptoms and diagnostic tests, except for the oral food challenge which is often refused.

As a consequence, there is a gap between the available evidence and the real‐world situation.

Non‐experts diagnose and manage CMA in a different way than experts.This study highlights and confirms significant differences in the diagnosis and management of CMA if ‘evidence‐based’ recommendations are compared to real‐world situations.The impact of information provided by companies on the knowledge and perception of non‐expert general paediatricians needs to be further investigated.

Non‐experts diagnose and manage CMA in a different way than experts.

This study highlights and confirms significant differences in the diagnosis and management of CMA if ‘evidence‐based’ recommendations are compared to real‐world situations.

The impact of information provided by companies on the knowledge and perception of non‐expert general paediatricians needs to be further investigated.