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 1st Choice (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 |