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Clin Transl Allergy. 2017 Aug 23;7:26. doi: 10.1186/s13601-017-0162-y. eCollection 2017.

Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline.

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Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado , Box B518, 13123 East 16th Avenue, Anschutz Medical Campus, Aurora, CO 80045 USA.
Children's Allergy Service, Ulster Hospital, Belfast, BT16 1RH Northern Ireland, UK.
Department Paediatrics, Imperial College, London, London, W2 1NY UK.
Gurney Surgery, Castle Partnership, 101-103 Magdalen Street, Norwich, NR3 1LN UK.
Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH UK.
Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.
Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127 China.
Royal Children's Hospital Melbourne, Murdoch Children's Research Institute, Parkville, VIC 3052 Australia.
Division of Paediatric Allergy and Asthma, Red Cross War Memorial Children's Hospital, University of Cape Town, Room 516, ICH Building, Cape Town, South Africa.
Centro de Gastroenterologica Pediatrica, Department of Paediatrics, Hospital Pequeno Principe, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Department of Paediatric Allergy, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK.
Division of Asthma, Allergy and Lung Biology, King's College, London, London, UK.
Contributed equally


Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, 'Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide' was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow's milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise.

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