SpringerLink
Log in

How consistent are the key recommendations, and what is the quality of guidelines and expert consensus regarding paediatric cow’s milk protein allergy?

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The objective of this study was to assess the quality and consistency of recommendations in clinical practice guidelines (CPGs) and expert consensus on paediatric cow’s milk protein allergy (CMPA) to serve as a foundation for future revisions and enhancements of clinical guidelines and consensus documents. We conducted a comprehensive literature search across several databases, including the Chinese Biomedical Literature Database (CBM), PubMed, Embase, Web of Science, UpToDate, ClinicalKey, DynaMed Plus and BMJ Best Practice. We spanned the search period from the inception of each database through October 1, 2023. We integrated subject headings (MeSH/Emtree) and keywords into the search strategy, used the search methodologies of existing literature and developed it in collaboration with a librarian. Two trained researchers independently conducted the literature screening and data extraction. We evaluated methodological quality and recommendations by using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and AGREE-Recommendations for Excellence (AGREE-REX) tools. Moreover, we compared and summarized key recommendations from high-quality CPGs. Our study included 27 CPGs and expert consensus documents on CMPA. Only four CPGs (14.8%) achieved a high-quality AGREE II rating. The four high-quality CPGs consistently provided recommendations for CMPA. The highest scoring domains for AGREE II were ‘scope and purpose’ (77 ± 12%) and ‘clarity of presentation’ (75 ± 22%). The lowest scoring domains were ‘stakeholder involvement’ (49 ± 21%), ‘rigor of development’ (34 ± 20%) and ‘applicability’ (12 ± 20%). Evaluation with AGREE-REX generally demonstrated low scores across its domains.

   Conclusion: Recommendations within high-quality CPGs for the paediatric CMPA showed fundamental consistency. Nevertheless, the methodology and recommendation content of CPGs and the expert consensus exhibited low quality, thus indicating a substantial scope for enhancement. Guideline developers should rigorously follow the AGREE II and AGREE-REX standards in creating CPGs or expert consensuses to guarantee their clinical efficacy in managing paediatric CMPA.

What is Known:

• The quality of clinical practice guidelines and expert consensus on paediatric cow's milk protein allergy (CMPA) remains uncertain.

• There is a lack of clarity regarding the consistency of crucial recommendations for CMPA management.

What is New:

• Improving the methodological quality of guidelines and consensus on CMPA requires greater emphasis on stakeholder engagement, rigorous development processes, and practical applicability.

• The recommendations from four high-quality guidelines align. However, addressing clinical applicability, integrating values and preferences, and ensuring actionable implementation are critical to improving the quality of all guidelines.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

AGREE II:

The Appraisal of Guidelines for Research & Evaluation II

AGREE-REX:

The AGREE-Recommendation for Excellence

CPG:

Clinical practice guidelines

CMPA:

Cow’s milk protein allergy

CBM:

China Biomedical Literature Database

GRADE:

The Grading of Recommendations Assessment, Development, and Evaluation

ICC:

Intraclass correlation coefficient

IgE:

Immunoglobulin E

OFC:

Oral food challenge

OIT:

Oral immunotherapy

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

SPT:

Skin prick test

SIGN:

Scottish Intercollegiate Guidelines Network

WAO:

World Allergy Organization

References

  1. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E (2011) Clinical practice guidelines we can trust. National Academies Press (US) 2011, Washington (DC)

  2. Ruszczyński M, Horvath A, Dziechciarz P, Szajewska H (2016) Cow’s milk allergy guidelines: a quality appraisal with the AGREE II instrument. Clin Exp Allergy: Journal of the British Society for Allergy and Clinical Immunology 46:1236–1241. https://doi.org/10.1111/cea.12784

    Article  Google Scholar 

  3. Zheng Q, Gao Y, **ong L, Huang H, Li J, OuYang G, Saimire W, Yang J, Zhang Y, Wang X, Luo X (2022) Chinese herbal medicine and COVID-19: quality evaluation of clinical guidelines and expert consensus and analysis of key recommendations. Acupuncture and Herbal Medicine 2:152–161. https://doi.org/10.1097/hm9.0000000000000043

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dans AL, Dans LF (2010) Appraising a tool for guideline appraisal the AGREE II instrument. J Clin Epidemiol 63:1281–1282. https://doi.org/10.1016/j.jclinepi.2010.06.005

    Article  PubMed  Google Scholar 

  5. Luo X, Liu Y, Ren M, Zhang X, Janne E, Lv M, Wang Q, Song Y, Mathew JL, Ahn HS, Lee MS, Chen Y (2021) Consistency of recommendations and methodological quality of guidelines for the diagnosis and treatment of COVID-19. J Evid Based Med 14:40–55. https://doi.org/10.1111/jebm.12419

    Article  PubMed  PubMed Central  Google Scholar 

  6. Norris SL, Louis H, Sawin VI, Porgo TV, Lau YHA, Wang Q, Ferri M (2019) An evaluation of WHO emergency guidelines for Zika virus disease. J Evid Based Med 12:218–224. https://doi.org/10.1111/jebm.12347

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yin Leung AS, Tham EH, Samuel M, Munblit D, Chu DK, Dahdah L, Yamamoto-Hanada K, Trikamjee T, Warad V, van Niekerk A, Martinez S, Ellis A, Bielory L, Cuadros G, van Bever H, Wallace D, Tang M, Sublett J, Wong GWK (2022) Quality and consistency of clinical practice guidelines on the prevention of food allergy and atopic dermatitis: systematic review protocol. World Allergy Organ J https://doi.org/10.1016/j.waojou.2022.100679

    Article  PubMed  PubMed Central  Google Scholar 

  8. AGREE-REX Research Team (2019) The Appraisal of Guidelines Research & Evaluation-Recommendation EXcellence AGREE-REX. https://www.agreetrust.org/wp-content/uploads/2019/04/AGREE-REX-2019.pdf.  Accessed 10 Apr 2022

  9. Toca MC, Morais MB, Vázquez-Frias R, Becker-Cuevas DJ, Boggio-Marzet CG, Delgado-Carbajal L, Higuera-Carrillo MM, Ladino L, Marchisone S, Messere GC, Ortiz GJ, Ortiz-Paranza LR, Ortiz-Piedrahita C, Riveros-López JP, Sosa PC, Villalobos-Palencia NC (2022) Consensus on the diagnosis and treatment of cow’s milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Revista de gastroenterologia de Mexico (English) 87:235–250. https://doi.org/10.1016/j.rgmxen.2022.01.002

    Article  CAS  PubMed  Google Scholar 

  10. Meyer R, Venter C, Bognanni A, Szajewska H, Shamir R, Nowak-Wegrzyn A, Fiocchi A, Vandenplas Y (2023) World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update - VII - milk elimination and reintroduction in the diagnostic process of cow’s milk allergy. World Allergy Organ J. https://doi.org/10.1016/j.waojou.2023.100785

    Article  PubMed  PubMed Central  Google Scholar 

  11. Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, Clark AT (2014) BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy : Journal of the British Society for Allergy and Clinical Immunology 44:642–672. https://doi.org/10.1111/cea.12302

    Article  CAS  Google Scholar 

  12. Matthai J, Sathiasekharan M, Poddar U, Sibal A, Srivastava A, Waikar Y, Malik R, Ray G, Geetha S, Yachha SK (2020) Guidelines on diagnosis and management of cow’s milk protein allergy. Indian Pediatr 57:723–729

    Article  PubMed  Google Scholar 

  13. Guler N, Cokugras FC, Sapan N, Selimoglu A, Turktas I, Cokugras H, Aydogan M, Beser OF (2020) Diagnosis and management of cow’s milk protein allergy in Turkey: region-specific recommendations by an expert-panel. Allergologia et Immunopathologia 48:202–210. https://doi.org/10.1016/j.aller.2019.05.004

    Article  CAS  PubMed  Google Scholar 

  14. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol 63:1308–1311. https://doi.org/10.1016/j.jclinepi.2010.07.001

    Article  PubMed  Google Scholar 

  15. Brozek JL, Firmino RT, Bognanni A, Arasi S, Ansotegui I, Assa’ad AH, Bahna SL, Canani RB, Bozzola M, Chu DK et al (2022) World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update - XIV - recommendations on CMA immunotherapy. World Allergy Organ J. https://doi.org/10.1016/j.waojou.2022.100646

    Article  PubMed  PubMed Central  Google Scholar 

  16. Muraro A, de Silva D, Halken S, Worm M, Khaleva E, Arasi S, Dunn-Galvin A, Nwaru BI, De Jong NW, Rodríguez Del Río P et al (2022) Managing food allergy: GA(2)LEN guideline 2022. World Allergy Organ J. https://doi.org/10.1016/j.waojou.2022.100687

    Article  PubMed  PubMed Central  Google Scholar 

  17. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, Dutoit G, Eigenmann P (2014) EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 69:1008–1025. https://doi.org/10.1111/all.12429

    Article  CAS  PubMed  Google Scholar 

  18. Alonso-Lebrero E, Bento L, Martorell-Aragonés A, Ribeiro L (2018) Iberian consensus on cow’s milk allergy: the CIBAL Study. Allergologia et immunopathologia 46:517–532. https://doi.org/10.1016/j.aller.2017.10.003

    Article  CAS  PubMed  Google Scholar 

  19. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH et al (2010) Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 126:S1–58. https://doi.org/10.1016/j.jaci.2010.10.007

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chen T, Hong L, Wang H, Shao J, Yang F, Wang Y, Liu G, Xu X, Sheng X, Xu C (2022) Guidelines for diagnosis and nutritional intervention of mild to moderate non-IgE mediated cow’s milk protein allergy in Chinese infants. Chin J Appl Clin Pediatr 37:241–250. https://doi.org/10.3760/cma.j.cn101070-20220106-00016

    Article  CAS  Google Scholar 

  21. El-Hodhod MA, El-Shabrawi MHF, AlBadi A, Hussein A, Almehaidib A, Nasrallah B, AlBassam EM, El Feghali H, Isa HM, Al Saraf K, Sokhn M, Adeli M, Al-Sawi NMM, Hage P, Al-Hammadi S (2021) Consensus statement on the epidemiology, diagnosis, prevention, and management of cow’s milk protein allergy in the Middle East: a modified Delphi-based study. World journal of pediatrics : WJP 17:576–589. https://doi.org/10.1007/s12519-021-00476-3

    Article  PubMed  Google Scholar 

  22. Kemp AS, Hill DJ, Allen KJ, Anderson K, Davidson GP, Day AS, Heine RG, Peake JE, Prescott SL, Shugg AW, Sinn JK (2008) Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust 188:109–112. https://doi.org/10.5694/j.1326-5377.2008.tb01534.x

    Article  PubMed  Google Scholar 

  23. Ribes-Koninckx C, Amil-Dias J, Espin B, Molina M, Segarra O, Diaz-Martin JJ (2023) The use of amino acid formulas in pediatric patients with allergy to cow’s milk proteins: recommendations from a group of experts. Front Pediatr. https://doi.org/10.3389/fped.2023.1110380

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vandenplas Y, Al-Hussaini B, Al-Mannaei K, Al-Sunaid A, Ayesh WH, El-Degeir M, El-Kabbany N, Haddad J, Hashmi A, Kreishan F, Tawfik E (2019) Prevention of allergic sensitization and treatment of cow’s milk protein allergy in early life: the middle-east step-down consensus. Nutrients. https://doi.org/10.3390/nu11071444

    Article  PubMed  PubMed Central  Google Scholar 

  25. Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, Prescott SL, Shugg A, Sinn JK, Heine RG (2009) Management of cow’s milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health 45:481–486. https://doi.org/10.1111/j.1440-1754.2009.01546.x

    Article  PubMed  Google Scholar 

  26. Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P, Ewgpag (2010) Cow’s milk protein allergy in children: a practical guide. Ital J Pediatr. https://doi.org/10.1186/1824-7288-36-5

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dupont C, Chouraqui JP, de Boissieu D, Bocquet A, Bresson JL, Briend A, Darmaun D, Frelut ML, Ghisolfi J, Girardet JP, Goulet O, Hankard R, Rieu D, Vidailhet M, Turck D (2012) Dietary treatment of cows’ milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics. Br J Nutr 107:325–338. https://doi.org/10.1017/s0007114511004831

    Article  CAS  PubMed  Google Scholar 

  28. Espín Jaime B, Díaz Martín JJ, Blesa Baviera LC, Claver Monzón Á, Hernández Hernández A, García Burriel JI, Mérida MJG, Pinto Fernández C, Coronel Rodríguez C, Román Riechmann E, Ribes Koninckx C (2019) Non-IgE-mediated cow’s milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP). Anales de pediatria 90:193.e191–193. https://doi.org/10.1016/j.anpedi.2018.11.007

    Article  Google Scholar 

  29. Kansu A, Yuce A, Dalgic B, Sekerel BE, Cullu-Cokugras F, Cokugras H (2016) Consensus statement on diagnosis, treatment and follow-up of cow’s milk protein allergy among infants and children in Turkey. Turk J Pediatr 58:1–11. https://doi.org/10.24953/turkjped.2016.01.001

    Article  PubMed  Google Scholar 

  30. Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, Mearin ML, Papadopoulou A, Ruemmele FM, Staiano A, Schäppi MG, Vandenplas Y (2012) Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr 55:221–229. https://doi.org/10.1097/MPG.0b013e31825c9482

    Article  CAS  PubMed  Google Scholar 

  31. Vandenplas Y, Abuabat A, Al-Hammadi S, Aly GS, Miqdady MS, Shaaban SY, Torbey PH (2014) Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow’s Milk Protein Allergy. Pediat Gastroenterol Hepatol Nutr 17:61–73. https://doi.org/10.5223/pghn.2014.17.2.61

    Article  Google Scholar 

  32. Venter C, Brown T, Shah N, Walsh J, Fox AT (2013) Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy - a UK primary care practical guide. Clin Transl Allergy. https://doi.org/10.1186/2045-7022-3-23

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fleischer DM, Chan ES, Venter C, Spergel JM, Abrams EM, Stukus D, Groetch M, Shaker M, Greenhawt M (2021) A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. J Allergy Clin Immunol Pract 9:22–43.e24. https://doi.org/10.1016/j.jaip.2020.11.002

    Article  CAS  PubMed  Google Scholar 

  34. Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT et al (2014) Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 134:1016–1025.e1043. https://doi.org/10.1016/j.jaci.2014.05.013

    Article  PubMed  Google Scholar 

  35. ASACI (2022) Guide for milk substitutes in cow’s milk allergy

  36. Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R (2014) Food allergy: a practice parameter update-2014. J Allergy Clin Immunol. https://doi.org/10.1016/j.jaci.2014.05.013

    Article  PubMed  PubMed Central  Google Scholar 

  37. Solà I, Carrasco JM, Díaz Del Campo P, Gracia J, Orrego C, Martínez F, Kotzeva A, Guillamón I, Calderón E, de Gaminde I, Louro A, Rotaeche R, Salcedo F, Velázquez P, Alonso-Coello P (2014) Attitudes and perceptions about clinical guidelines: a qualitative study with Spanish physicians. PloS one. https://doi.org/10.1371/journal.pone.0086065

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yao-long C, Ke-hu Y, **-hui T, Qaseem A (2016) Development of evidence-based practice guidelines: international experience and Chinese practice. Journal of Lanzhou University Medical Sciences 42:29–35. https://doi.org/10.13885/j.issn.1000-2812.2016.01.006

    Article  Google Scholar 

  39. El Hajj MS, Jaam M, Sheikh Ali SAS, Saleh R, Awaisu A, Paravattil B, Wilby KJ (2021) Critical appraisal of tobacco dependence treatment guidelines. Int J Clin Pharm 43:85–100. https://doi.org/10.1007/s11096-020-01110-4

    Article  PubMed  Google Scholar 

  40. García LM, Sanabria AJ, Alvarez EG, Trujillo-Martín MM, Etxeandia-Ikobaltzeta I, Kotzeva A, Rigau D, Louro-González A, Barajas-Nava L, Del Campo PD, Estrada MD, Solà I, Gracia J, Salcedo-Fernandez F, Lawson J, Haynes RB, Alonso-Coello P (2014) The validity of recommendations from clinical guidelines: a survival analysis. CMAJ : Canadian Medical Association Journal = Journal de l’Association medicale canadienne 186:1211–1219. https://doi.org/10.1503/cmaj.140547

    Article  Google Scholar 

  41. Hill JE, Stephani AM, Sapple P, Clegg AJ (2020) The effectiveness of continuous quality improvement for develo** professional practice and improving health care outcomes: a systematic review. Implementation Science. https://doi.org/10.1186/s13012-020-0975-2

    Article  PubMed  PubMed Central  Google Scholar 

  42. Horbar JD, Carpenter JH, Buzas J, Soll RF, Suresh G, Bracken MB, Leviton LC, Plsek PE, Sinclair JC (2004) Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial. BMJ (Clinical research ed). https://doi.org/10.1136/bmj.329.7473.1004

    Article  PubMed  Google Scholar 

  43. Innvaer S, Vist G, Trommald M, Oxman A (2002) Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 7:239–244. https://doi.org/10.1258/135581902320432778

    Article  PubMed  Google Scholar 

  44. Langlois EV, Becerril Montekio V, Young T, Song K, Alcalde-Rabanal J, Tran N (2016) Enhancing evidence informed policymaking in complex health systems: lessons from multisite collaborative approaches. Health Res Policy Syst. https://doi.org/10.1186/s12961-016-0089-0

    Article  PubMed  PubMed Central  Google Scholar 

  45. Francke AL, Smit MC, de Veer AJ, Mistiaen P (2008) Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. https://doi.org/10.1186/1472-6947-8-38

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tricco AC, Zarin W, Rios P, Nincic V, Khan PA, Ghassemi M, Diaz S, Pham B, Straus SE, Langlois EV (2018) Engaging policy-makers, health system managers, and policy analysts in the knowledge synthesis process: a sco** review. Implementation science. https://doi.org/10.1186/s13012-018-0717-x

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sun Y, Gao Y, Chen J, Sun H, Cai YT, Ge L, Li YN, Zhang J, Tian JH (2019) Evidence map** of recommendations on diagnosis and therapeutic strategies for diabetes foot: an international review of 22 guidelines. Metab Clin Exp. https://doi.org/10.1016/j.metabol.2019.153956

    Article  PubMed  Google Scholar 

  48. D’Auria E, Venter C (2020) Precision medicine in cow’s milk allergy. Curr Opin Allergy Clin Immunol 20:233–241. https://doi.org/10.1097/aci.0000000000000640

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We extend our deepest gratitude to the dedicated individuals who developed the guidelines, the insightful reviewers for their invaluable feedback, our research team for their unwavering support and collaboration throughout this study, and express our sincere appreciation for the support provided by the Natural Science Foundation of Gansu Province. This work was supported by the Natural Science Foundation of Gansu Province (21JR11RA178).

Author information

Author notes

  1. Tengfei Li and Qingyong Zheng contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China

    Tengfei Li, Yiyi Li, Yongjia Zhou & Bowa Zhang

  2. Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

    Tengfei Li, Qingyong Zheng, Mingyue Zhang, Caihua Xu & **hui Tian

  3. First Clinical College of Medicine, Lanzhou University, Lanzhou, China

    Zewei Wang

  4. Department of Gastroenterology, Gansu Province Maternity and Child Health Hospital (Gansu Province Central Hospital), Lanzhou, China

    Li Zhou

Authors
  1. Tengfei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qingyong Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mingyue Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yiyi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yongjia Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caihua Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bowa Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zewei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. **hui Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Li Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Tengfei Li and **hui Tian conceived the manuscript. Tengfei Li and Qingyong Zheng drafted the manuscript. Mingyue Zhang, Yiyi Li, and Yongjia Zhou filtered the articles. Mingyue Zhang, Yiyi Li, Yongjia Zhou, Caihua Xu, Bowa Zhang, and Zeiwei Wang analysed the data and constructed the graphs. **hui Tian and Li Zhou provided a critical version of the manuscript. All authors contributed to the revision of the manuscript and approved the final manuscript.

Corresponding authors

Correspondence to **hui Tian or Li Zhou.

Ethics declarations

Ethics approval

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 146 KB)

Supplementary file2 (TIF 517 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, T., Zheng, Q., Zhang, M. et al. How consistent are the key recommendations, and what is the quality of guidelines and expert consensus regarding paediatric cow’s milk protein allergy?. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05622-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00431-024-05622-3

Keywords

Search

Navigation