Diagnosing Cow’s Milk Protein Allergy, how big is the gap Between Medical Best-practice and Reality?

Most of pediatricians with some interest in gastroenterology will be faced with children with proven or suspected Cow’s Milk Protein Allergy (CMPA). Just recall the last 10 children in which you suspected CMPA. Do you know in how many of them symptoms improved or disappeared after eliminating Cow’s Milk Protein (CMP)? In how many of them the diagnosis finally was confirmed? Did you test them all for sensitization against CMP and how?European societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and Allergy and Clinical Immunology (EAACI) give guidance based on the current knowledge (3-5) and suggest pathways how to reach the diagnosis of CMPA depending on age and clinical manifestation and on the management of these very different cases. However, are these guidelines known and followed? A case based survey is currently performed or already finalized among paediatricians in several European countries. Major differences between countries are disclosed which can not only be explained by the different health system of these countries. Recognition of the deficits in knowledge and implementation of the guidelines and educational programs may help to improve the care of children with CMPA and other food allergies.