Cow’s Milk Protein Allergy: ETAPA Survey on Pediatric Management and Tolerance Acquisition

<b>Background:</b> Cow's milk protein allergy (CMPA) is among the most common pediatric food allergies. Understanding tolerance acquisition and diagnostic approaches is critical for optimizing care, particularly in Spain, where regional differences may impact management. This study analyzed real-world practices for determining CMPA oral tolerance acquisition by Spanish pediatricians. <b>Methods:</b> A questionnaire was distributed to healthcare providers in primary and hospital pediatric settings across various Spanish provinces. The survey addressed demographic profiles, diagnostic approaches, tolerance acquisition, and dietary modifications. <b>Results:</b> Among the 269 health professionals included (mean age 48.3 ± 11.0 years, 62.3% women), most worked in primary care (55.4%), 20.4% in public hospitals, and 17.8% in private practice. Overall, 35.5% routinely referred CMPA cases to specialists. Specific IgE testing (27.9%) and elimination diets (41.3%) were the main diagnostic tools. Diagnostic dairy-exclusion duration varied, mainly in non-IgE cases. Hospital-based diagnostic oral food challenges (OFC) were preferred for suspected IgE-mediated cases (95.7%), while home-based protocols were used for non-IgE suspected cases (80.7%). Guideline adherence for home-based OFC varied by specialty. Tolerance acquisition was evaluated annually by 67.7% of participants, with a mean success rate of 80%. Therapeutic dairy-exclusion duration varied, with 64.7% excluding CMP for 6-12 months. Minimum age for CMP reintroduction was considered dependent on phenotype and severity, with 12 months of age mentioned most frequently (17.1%). <b>Conclusions:</b> Despite general alignment with international guidelines, relevant variability exists in CMPA management in Spain. Harmonizing diagnostic and therapeutic practices across specialties and care levels may help standardize care and improve patient outcomes.