Madrazo JA, et al. Pediatr Gastroenterol Hepatol Nutr. 2022 May;25(3):263-275. https://doi.org/10.5223/pghn.2022.25.3.263

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.

Indrio F, et al. Pediatr Gastroenterol Hepatol Nutr. 2021 Jul;24(4):325-336. https://doi.org/10.5223/pghn.2021.24.4.325

Aims: Kuwait has one of the highest global incidences of childhood type 1 diabetes (T1D), yet little is known about the burden of coeliac disease (CD) in this population. We aimed to determine the prevalence/incidence of CD in children newly diagnosed with T1D in Kuwait and identify associated risk factors. Methods: In this prospective cohort study, all 1938 children (≤ 14 years) diagnosed with T1D in Kuwait between 2011 and 2017 were enrolled and followed for 5 years post‐diagnosis. CD development was defined by intestinal biopsy confirmation. Cox univariable regression models quantified associations between several characteristics at T1D diagnosis (age, sex, DKA, height z‐score and BMI z‐score) and incident CD risk. Results: Four baseline CD cases were excluded. Of the remaining 1934 children, 65 (3.4%) developed CD during follow‐up. The median time to CD diagnosis was 1.5 years; 40% were diagnosed within the first year. The incidence rate within the first year following T1D diagnosis was 1.35 (95% CI 0.92–1.99) per 100 person‐years and generally declined over subsequent years of follow‐up. While age at diagnosis showed no clear effect shortly after T1D diagnosis, older age was associated with progressively lower CD risk over longer follow‐up, with the risk of CD being 33% lower per one‐year increase in age at diagnosis by 5 years of follow‐up; no other baseline factors investigated were significant. Conclusion: This nationwide prospective study highlights the burden and timing of biopsy‐confirmed CD after T1D onset. CD occurred most frequently during the early years after T1D diagnosis, with a higher risk among younger children, supporting particular attention to screening in these groups.