{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:41:31Z","timestamp":1792395691751,"version":"4.4.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cow\u2019s milk protein allergy (CMPA) affects 2\u20136% of children, with peak prevalence in the first year of life. Despite published guidelines, significant gaps remain in awareness and practice among healthcare providers. The aim of this study was to evaluate pediatricians\u2019 knowledge and practice styles (KPS) among pediatric care providers (PCPs) working in different Arab countries regarding their diagnosis and treatment approach to CMPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a cross-sectional multinational survey in eight Arab countries including Saudi Arabia, Iraq, Lebanon, Oman, Bahrain, United Arab Emirates (UAE), Qatar, and Kuwait. The following PCPs: pediatric specialists (PSs), pediatric residents (PRs), pediatric consultants (PCs), pediatric gastroenterologists (PGs), pediatric immunologists (PIs), general physicians (GPs), and family doctors (FDs) were included in this study. The survey was anonymous, and participants provided input on the diagnosis and management of CMPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 3000 questionnaires distributed to PCPs, 2145 (response rate 72%) were completed and analyzed. The majority of the respondents were male (n = 1255; 58.5%). The majority of participants were PSs (48%). Regarding the methods to diagnose CMPA, pediatricians and non-pediatricians used clinical diagnosis (61.4%), oral elimination challenge test (27.6%), specific IgE for cow\u2019s milk (8.6%) and skin prick test (1.2%) for diagnosis of CMPA (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Furthermore, pediatricians used \u201cclinical diagnosis\u201d method to confirm CMPA significantly more than other non- pediatricians (87% vs 13%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). In terms of management of CMPA in breastfed infants, 67.8% reported that continuing breastfeeding with maternal elimination of cow\u2019s milk and dairy products was the best treatment approach, with significant differences between pediatricians and non-pediatricians (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). In terms of management of mild-moderate CMPA in formula-fed infants, hydrolyzed formula (eHF) was the most commonly prescribed (53%), while rice-based milk was the formula least often prescribed. eHF was prescribed as a first-line treatment of CMPA significantly more frequently by pediatricians than by non-pediatricians (88.9% vs 11.1%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). PCPs were more likely to comply (71.1%) with European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) clinical guidelines for CMPA. PCPs were fully agreed (68.1%) to establish unified CMPA guidelines in Arab countries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Substantial variability in pediatricians\u2019 KPS regarding CMPA across the participating Arab countries was identified. The identification of these gaps highlights the need for policymakers to develop educational materials for PCPs to increase their knowledge of CMPA. Evidence-based guidelines and standardized practice are needed in the Middle East.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjg.sjg_230_26","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:00:18Z","timestamp":1792393218000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Pediatricians\u2019 knowledge and practice styles regarding cow milk protein allergy among Arab countries"],"prefix":"10.4103","author":[{"given":"Mohammed","family":"Hasosah","sequence":"first","affiliation":[{"name":"Department of Pediatric Gastroenterology, King Abdullah Specialized Children\u2019s Hospital, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Aljiffry","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, King Abdullah Specialized Children\u2019s Hospital, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Isa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Salmaniya Medical Complex, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayder","family":"Swaij","sequence":"additional","affiliation":[{"name":"Department of Pediatric, College of Medicine, University of Duhok, Duhok, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azad","family":"Haleem","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, University of Sulaimani, Sulaimaniya, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Rozi","sequence":"additional","affiliation":[{"name":"Department of Pediatric, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Kambal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, SMC Hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Buhamrah","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology Section, Amiri Hospital, Kuwait City, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Karam","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Keserwan Medical Center, Ghazir, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Al Farsi","sequence":"additional","affiliation":[{"name":"Pediatric Allergy Immunology and Clinical Immunology, The Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"General Pediatrics and Allergy Department, The American Hospital Dubai, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatim","family":"Abdelrhman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Gastroenterology, Sidra Medicine, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy","family":"Nehme","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif","family":"El Sherif","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Alexandria University, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"R1-20261019","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1177\/0009922816664512","article-title":"Cow's milk protein allergy","volume":"55","author":"Mousan","year":"2016","journal-title":"Clin Pediatr (Phila)"},{"key":"R2-20261019","first-page":"298","article-title":"Cow's milk protein allergy: A comprehensive review of epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies","volume":"34","author":"Hao","year":"2025","journal-title":"Asia Pac J Clin Nutr"},{"key":"R3-20261019","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11882-020-0898-7","article-title":"Epidemiology and burden of food allergy","volume":"20","author":"Warren","year":"2020","journal-title":"Curr Allergy Asthma 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A real world study report","volume":"13","author":"Vandenplas","year":"2021","journal-title":"Nutrients"},{"key":"R8-20261019","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.3390\/nu11071444","article-title":"Prevention of allergic sensitization and treatment of cow's milk protein allergy in early life: The middle-east step-down consensus","volume":"11","author":"Vandenplas","year":"2019","journal-title":"Nutrients"},{"key":"R9-20261019","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s12519-021-00476-3","article-title":"Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: A modified Delphi-based study","volume":"17","author":"El-Hodhod","year":"2021","journal-title":"World J Pediatr"},{"key":"R10-20261019","first-page":"e41719","article-title":"Primary healthcare center's healthcare providers' perception and practice toward pediatric cow's milk allergy in Qassim region, Saudi Arabia","volume":"15","author":"Alghasham","year":"2023","journal-title":"Cureus"},{"key":"R11-20261019","first-page":"222","article-title":"Attitudes towards cow's milk protein allergy management by spanish gastroenterologist","volume":"89","author":"P\u00e9rez","year":"2018","journal-title":"An Pediatr (Engl Ed)"},{"key":"R12-20261019","doi-asserted-by":"crossref","first-page":"100888","DOI":"10.1016\/j.waojou.2024.100888","article-title":"World Allergy Organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guideline update-XII-Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA","volume":"17","author":"Bognanni","year":"2024","journal-title":"World Allergy Organ J"},{"key":"R13-20261019","first-page":"399","article-title":"Diagnosis and management of cow's milk protein allergy\u2014How big is the gap between ideal and reality? A quality-of-care survey in Europe","volume":"66","author":"Werkstetter","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R14-20261019","doi-asserted-by":"crossref","first-page":"263","DOI":"10.5223\/pghn.2022.25.3.263","article-title":"International cross-sectional survey among healthcare professionals on the management of cow's milk protein allergy and lactose intolerance in infants and children","volume":"25","author":"Madrazo","year":"2022","journal-title":"Pediatr Gastroenterol Hepatol Nutr"}],"container-title":["Saudi Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_230_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:00:20Z","timestamp":1792393220000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_230_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":14,"URL":"https:\/\/doi.org\/10.4103\/sjg.sjg_230_26","relation":{},"ISSN":["1319-3767","1998-4049"],"issn-type":[{"value":"1319-3767","type":"print"},{"value":"1998-4049","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"2026-05-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}