{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:37:44Z","timestamp":1790980664690,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Cow\u2019s milk allergy (CMA) and cow\u2019s milk intolerance (CMI) are the major cow\u2019s 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\u2019s milk formula as an alternative to cow\u2019s milk products and 37% would recommend its routine use in infants (\u22642 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\u2019s milk formulas may offer a suitable alternative to AAF\/EHF in infants with CMI as they contain \u03b2-casein protein which is easily digestible. In addition, goat\u2019s milk formulas contain higher levels of oligosaccharides and medium-chained fatty acids compared with standard cow\u2019s milk formulas, yet further clinical trials are warranted to support the inclusion of goat\u2019s milk formulas in clinical guidelines.<\/jats:p>","DOI":"10.3390\/nu14051067","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T09:24:53Z","timestamp":1646299493000},"page":"1067","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Survey to Identify the Current Management of Cow\u2019s Milk Disorders and the Role of Goat Milk-Based Formulas in the Middle East and North Africa Region"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6145-0572","authenticated-orcid":false,"given":"Wael A.","family":"Bahbah","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom 32511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0966-5466","authenticated-orcid":false,"given":"Mostafa","family":"ElHodhod","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt"},{"name":"Faculty of Medicine, October 6 University, Giza 12511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Salah","sequence":"additional","affiliation":[{"name":"Egyptian Academy of Pediatrics, Cairo 11311, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7980-1518","authenticated-orcid":false,"given":"Fawaz","family":"AlRefaee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Al Adan Hospital, Ministry of Health, Kuwait City P.O. Box 46969, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muath","family":"AlTuraiki","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Salman Hospital, Riyadh 12769, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4001-4568","authenticated-orcid":false,"given":"Samira","family":"Mousa","sequence":"additional","affiliation":[{"name":"Medical Department, Faculty of Veterinary Medicine, Benha University, Benha 13518, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Al Mehaidib","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaa Helmi","family":"Ayesh","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Dubai Health Authority, Dubai P.O. Box 4545, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-7876","authenticated-orcid":false,"given":"Ahmed N.","family":"El-Bazzar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ministry of Health Hospitals, Cairo 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"El Haddad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Saint George University Hospital, Beirut 1100, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba Y.","family":"El Khashab","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sulaiman Al Habib Medical Group, Riyadh 12214, Saudi Arabia"},{"name":"Department of Pediatrics, Ain Shams University, Cairo 11566, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"El Zawahry","sequence":"additional","affiliation":[{"name":"Pediatrics Department, King\u2019s College Hospital London, Dubai P.O. Box 340901, United Arab Emirates"},{"name":"Department of Pediatrics, Sharjah University, Sharjah P.O. Box 27272, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8434-2109","authenticated-orcid":false,"given":"Mohammed","family":"Hasosah","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center, Pediatric Gastroenterology Department, National Guard Hospital, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21482, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanaa Youssef","family":"Shaaban","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1862-8651","authenticated-orcid":false,"given":"Yvan","family":"Vandenplas","sequence":"additional","affiliation":[{"name":"KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/09637486.2021.1921705","article-title":"Gastric protein digestion of goat and cow milk infant formula and human milk under simulated infant conditions","volume":"73","author":"He","year":"2021","journal-title":"Int. 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