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.

Recent studies have highlighted the positive impact of high sn-2 formulas on gastrointestinal (GI) tolerance. We assessed the GI tolerance, acceptability, and safety of high sn-2 infant formula among non-breastfed healthy term infants in the Gulf countries. A multicenter observational study was conducted on 227 healthy-term infants who were prescribed high sn-2 palmitate infant formula and received a minimum of two formula feedings per day for the past two weeks prior to the study’s initiation. The number of stools per day decreased significantly from a median of four (interquartile range [IQR] = 4) at baseline to 3.0 (2) stools per day at the end of follow-up (p = 0.015). The percentage of stool amount changed significantly, where 61.2% and 33.7% of the infants had an amount of 25–50% of the diaper and >50% of the diaper, respectively (p < 0.001) at the end of the follow-up. Similarly, the percentage of hard stool decreased significantly from 17.4% at baseline to 0.4% of the population at week 12 (p < 0.00). The prevalence of colic and abdominal distention declined from 21.4% and 39.9% at baseline to 2.9% and 9.4% at week 12, respectively (p < 0.05). The same decline was observed in abdominal distension and regurgitation score (p < 0.05).

Background/Objectives: International guidelines recommend a short-term milk-free elimination diet and oral food challenge (OFC), with or without specific IgE testing, for diagnosing cow’s milk allergy (CMA), with extensively hydrolysed formulas (eHF) or amino acid formulas (AAF) as first-line nutritional therapy. In some countries, par-tially hydrolysed whey formula (pHF-W) is used as a step-down, or bridge, to intact cow’s milk protein (CMP), despite limited supporting evidence. This study explored real-world diagnostic practices and experiences with pHF-W step-down use among healthcare professionals (HCPs) in China and the Middle East. Methods: An online cross-sectional survey was conducted among 600 HCPs including paediatricians, gas-troenterologists, allergists/immunologists, and dermatologists, from China, Bahrain, Kuwait, Saudi Arabia, and United Arab Emirates. IPSOS translated the 25-item ques-tionnaire into local languages, were responsible for HCP selection and implementation. Results: While 71% of respondents used a food elimination diet, OFCs were only used by 46%. The majority relied on history/physical examination (91%) and/or specific IgE testing (85%), raising concerns about misdiagnosis. While most respondents reported using eHF or AAF for first-line nutritional management, 20% used pHF-W, diverging from guideline recommendations. Seventy-seven percent of HCPs employed pHF-W as a step-down formula before intact CMP, citing improved tolerance and reduced re-currence. Over 80% of HCPs using pHF-W in this way expressed satisfaction, with 53% recommending it for 3–6 months. Conclusions: CMA diagnostic and management practices in China and the Middle East show variable adherence to international guidelines. Frequent pHF-W use highlights the need for educational interventions, better guideline dissemination, and further research to evaluate its safety and efficacy in step-down approach for CMA management.