Table 1 Guidance on formula choice
Clinical presentation | DRACMA 1stChoice (Fiocchi et al[2]) | ESPGHAN 1stChoice (Koletzko et al[7]) | USA 1st Choice (Boyce et al[10], Bahtia et al[22] American Academy of Pediatrics[25]) | AUSTRALIAN Consensus Panel 1stChoice (Allen et al[11]) |
|---|---|---|---|---|
Anaphylaxis | AAF | AAF | No recommendation | AAF |
Acute urticaria or angioedema | eHF | No specific mention but eHF in general as 1st line treatment for CMA apart from specific indications for AAF | No recommendation | eHF if < 6 months |
Soya if > 6 months | ||||
Atopic eczema/dermatitis | eHF | No specific mention but eHF in general as 1st line treatment | No recommendation | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Immediate gastrointestinal allergy | eHF | No specific mention but eHF in general as 1st line treatment | No recommendation | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Allergic eosinophilic oesophagitis | AAF | AAF (as well as other eosinophilic disorders of the gut) | AAF/hypoallergenic formula (NIAID) | AAF |
Gastroesophageal reflux disease (GORD) | eHF | No specific mention but eHF in general as 1st line treatment | No recommendation | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Cow’s milk protein-induced enteropathy | eHF | (Severe enteropathy complicated by faltering growth and hypoprotenemia) AAF | eHF/AAF | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 if also presenting with faltering growth | ||||
Food protein-induced enterocolitis syndrome (FPIES) | eHF | AAF | Hypoallergenic formula (NIAID) eHF/AAF | eHF |
CM protein-induced gastroenteritis and proctocolitis | eHF | No specific mention but eHF in general as 1st line treatment | Gastro-enteritis: | |
eHF if < 6 months | ||||
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Proctitis: eHF | ||||
Severe irritability (colic) | eHF | No specific mention but eHF in general as 1st line treatment | Hypoallergenic formula | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Constipation/Diarrhoea | eHF | No specific mention but eHF in general as 1st line treatment | No recommendation | eHF if < 6 months |
Soya if > 6 months | ||||
eHF if >6 months if also presenting with faltering growth | ||||
Milk-induced chronic pulmonary disease (Heiner’s syndrome) | AAF | No recommendation | No recommendation | No recommendation |
Faltering growth | No recommendation | AAF (particularly presenting with enterocolitis complicated by hypoprotenemia and anaemia) | No recommendation | See with other conditions – but defaults to eHF |
Breast fed infants – not responding on maternal milk avoidance | No recommendation | AAF | “alternative formulas” eHF/AAF | No recommendation |
Multiple food allergies | No recommendation | eHF/AAF | No recommendation | No recommendation |
Severe atopic eczema/dermatitis | No recommendation | AAF (particularly if presenting with faltering growth complicated by hypoprotenemia and anaemia) | No recommendation | No recommendation |