Statistics

 array:25 [
  "pii" => "S2341287918300127"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2018.01.003"
  "estado" => "S300"
  "fechaPublicacion" => "2018-10-01"
  "aid" => "2352"
  "copyright" => "Asociación Española de Pediatría"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "An Pediatr (Barc). 2018;89:222-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2442
    "formatos" => array:3 [
      "EPUB" => 189
      "HTML" => 1720
      "PDF" => 533
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S169540331730471X"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2017.10.015"
      "estado" => "S300"
      "fechaPublicacion" => "2018-10-01"
      "aid" => "2352"
      "copyright" => "Asociación Española de Pediatría"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "An Pediatr (Barc). 2018;89:222-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 7621
        "formatos" => array:3 [
          "EPUB" => 198
          "HTML" => 5615
          "PDF" => 1808
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Manejo de la alergia a prote&#237;na de leche de vaca por los gastroenter&#243;logos espa&#241;oles"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "222"
            "paginaFinal" => "229"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Attitudes towards cow&#39;s milk protein allergy management by spanish gastroenterologist"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alicia Isabel Pascual P&#233;rez, Alejandra M&#233;ndez S&#225;nchez, &#211;scar Segarra Cant&#243;n, Beatriz Espin Jaime, Santiago Jim&#233;nez Trevi&#241;o, Carlos Bouso&#241;o Garc&#237;a, Juan Jos&#233; D&#237;az Mart&#237;n"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "Alicia Isabel"
                "apellidos" => "Pascual P&#233;rez"
              ]
              1 => array:2 [
                "nombre" => "Alejandra"
                "apellidos" => "M&#233;ndez S&#225;nchez"
              ]
              2 => array:2 [
                "nombre" => "&#211;scar"
                "apellidos" => "Segarra Cant&#243;n"
              ]
              3 => array:2 [
                "nombre" => "Beatriz"
                "apellidos" => "Espin Jaime"
              ]
              4 => array:2 [
                "nombre" => "Santiago"
                "apellidos" => "Jim&#233;nez Trevi&#241;o"
              ]
              5 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Bouso&#241;o Garc&#237;a"
              ]
              6 => array:2 [
                "nombre" => "Juan Jos&#233;"
                "apellidos" => "D&#237;az Mart&#237;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287918300127"
          "doi" => "10.1016/j.anpede.2018.01.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918300127?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331730471X?idApp=UINPBA00005H"
      "url" => "/16954033/0000008900000004/v1_201810020620/S169540331730471X/v1_201810020620/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2341287918301510"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2017.12.007"
    "estado" => "S300"
    "fechaPublicacion" => "2018-10-01"
    "aid" => "2349"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2018;89:230-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2092
      "formatos" => array:3 [
        "EPUB" => 149
        "HTML" => 1219
        "PDF" => 724
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "230"
          "paginaFinal" => "237"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Adaptaci&#243;n y estudio de propiedades m&#233;tricas de un cuestionario de valoraci&#243;n del sue&#241;o para lactantes y preescolares"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pia Cassanello, Ana D&#237;ez-Izquierdo, Nuria Gorina, Nuria Matilla-Santander, Jose M&#46; Mart&#237;nez-Sanchez, Albert Balaguer"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Pia"
              "apellidos" => "Cassanello"
            ]
            1 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "D&#237;ez-Izquierdo"
            ]
            2 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Gorina"
            ]
            3 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Matilla-Santander"
            ]
            4 => array:2 [
              "nombre" => "Jose M&#46;"
              "apellidos" => "Mart&#237;nez-Sanchez"
            ]
            5 => array:2 [
              "nombre" => "Albert"
              "apellidos" => "Balaguer"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S169540331730468X"
        "doi" => "10.1016/j.anpedi.2017.12.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331730468X?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301510?idApp=UINPBA00005H"
    "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301510/v1_201810020628/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2341287918301480"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2017.11.010"
    "estado" => "S300"
    "fechaPublicacion" => "2018-10-01"
    "aid" => "2330"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2018;89:211-21"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6657
      "formatos" => array:3 [
        "EPUB" => 155
        "HTML" => 5928
        "PDF" => 574
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Care of the newborn with perinatal asphyxia candidate for therapeutic hypothermia during the first six hours of life in Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "211"
          "paginaFinal" => "221"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Asistencia en Espa&#241;a del reci&#233;n nacido con asfixia perinatal candidato a hipotermia terap&#233;utica durante las primeras seis horas de vida"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1357
              "Ancho" => 2503
              "Tamanyo" => 212404
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Quality of care in tertiary care hospitals that offered therapeutic hypothermia by unit level of care&#46; &#40;a&#41; Includes items 5&#8211;10&#44; and combined items 1&#8211;2 and 3&#8211;4&#46; &#40;b&#41; Includes items 12&#8211;14&#44; 17&#44; 21&#44; 22&#46; &#40;c&#41; Includes items 20&#44; 25&#44; 27&#8211;30&#44; and combined items 24a&#8211;24b&#44; 26a&#8211;26d and 26b&#8211;26c&#46; Total<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;a&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;b&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;c&#41;&#46; The data for the items regarding &#8220;Delivery&#8221;&#44; &#8220;6<span class="elsevierStyleHsp" style=""></span>h life&#8221; and &#8220;Delivery-6<span class="elsevierStyleHsp" style=""></span>h life&#8221; include the answers of all 89 hospitals&#46; The data for items regarding &#8220;Professionals&#8221; and for the &#8220;Total&#8221; questionnaire include the responses of the 53 hospitals that offered TH that participated in the survey &#40;4 level IIIA&#44; 34 level IIIB and 15 level IIIC&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => "Juan Arnaez, Alfredo Garcia-Alix, Sara Calvo, Sim&#243;n Lubi&#225;n-L&#243;pez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Arnaez"
            ]
            1 => array:2 [
              "nombre" => "Alfredo"
              "apellidos" => "Garcia-Alix"
            ]
            2 => array:2 [
              "nombre" => "Sara"
              "apellidos" => "Calvo"
            ]
            3 => array:2 [
              "nombre" => "Sim&#243;n"
              "apellidos" => "Lubi&#225;n-L&#243;pez"
            ]
            4 => array:1 [
              "colaborador" => "Grupo de Trabajo ESP-EHI"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => ""
          "autores" => array:1 [
            0 => array:1 [
              "colaborador" => "ESP-EHI Working Group&#46; Neonatal units of tertiary hospitals in Spain"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403317304496"
        "doi" => "10.1016/j.anpedi.2017.11.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317304496?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301480?idApp=UINPBA00005H"
    "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918301480/v1_201810020628/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Attitudes towards cow&#39;s milk protein allergy management by Spanish gastroenterologist"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "222"
        "paginaFinal" => "229"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alicia Isabel Pascual P&#233;rez, Alejandra M&#233;ndez S&#225;nchez, &#211;scar Segarra Cant&#243;n, Beatriz Espin Jaime, Santiago Jim&#233;nez Trevi&#241;o, Carlos Bouso&#241;o Garc&#237;a, Juan Jos&#233; D&#237;az Mart&#237;n"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Alicia Isabel"
            "apellidos" => "Pascual P&#233;rez"
            "email" => array:1 [
              0 => "Aliciapascual13&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Alejandra"
            "apellidos" => "M&#233;ndez S&#225;nchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "&#211;scar"
            "apellidos" => "Segarra Cant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Beatriz"
            "apellidos" => "Espin Jaime"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Santiago"
            "apellidos" => "Jim&#233;nez Trevi&#241;o"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Carlos"
            "apellidos" => "Bouso&#241;o Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Juan Jos&#233;"
            "apellidos" => "D&#237;az Mart&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "&#193;rea de Gesti&#243;n Cl&#237;nica de Pediatr&#237;a&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Secci&#243;n de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica&#44; Hospital Universitario Vall d&#8217;Hebr&#243;n&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Unidad de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica&#44; Hospital Universitario Virgen del Roc&#237;o&#44; Sevilla&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Unidad de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica&#44; &#193;rea de Gesti&#243;n Cl&#237;nica de Pediatr&#237;a&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Manejo de la alergia a prote&#237;na de leche de vaca por los gastroenter&#243;logos espa&#241;oles"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Food allergy is an increasing health care concern&#46; Food allergy is defined as an adverse health effect secondary to a specific immune response that occurs reproducibly following exposure to a given food&#46; The immune reaction may be IgE mediated&#44; non-IgE mediated&#44; or mixed&#46; Cow&#39;s-milk protein is the leading cause of food allergy in infants and young children&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Without an appropriate diagnostic workup&#44; there is a high risk of both over- and underdiagnosis and therefore&#44; over and undertreatment&#46; This could affect dramatically to children&#39;s quality of life&#46; Moreover&#44; milk avoidance&#44; when it is not necessary&#44; may disturb child&#39;s nutritional status or growth development&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although cow&#39;s milk protein allergy &#40;CMPA&#41; is a prevalent condition&#44; its management is quite different depending on the attending physician&#46; Several guidelines<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#8211;7</span></a> from different organizations have been recently published in highly read journals&#44; trying to unify the management of this condition among pediatric practitioners involved&#44; including primary care pediatricians&#44; pediatric gastroenterologists and pediatric allergologists&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to analyze the variability in CMPA management by different pediatric gastroenterologist divisions in Spain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A fifty-item questionnaire &#40;<a class="elsevierStyleCrossRef" href="#sec0045">Appendix A</a>&#41; was composed and sent through the Spanish Society for Pediatric Gastroenterology&#44; Hepatology and Nutrition &#40;SEGHNP&#41; e-mail list&#44; where the vast majority of pediatric gastroenterologists in Spain are included&#46; This Society has a total of 321 members&#44; among which 121 of them are full members&#46; The questionnaire comprised open and closed items in a Likert&#39;s scale from 0 to 5&#44; including questions about CMPA diagnosis&#44; treatment and prognosis&#46; The items score were grouped as follows&#58; 0&#8211;1 &#8220;disagree&#8221;&#59; 2&#8211;3 &#8220;undefined&#8221;&#59; 4&#8211;5 &#8220;agree&#8221;&#46; The questionnaire was sent January 15th 2016 and the study was closed on January 31st&#46; Data were anonymously included in a database and then analyzed with SPSS 20&#46;0&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Seventy-three questionnaires were received back&#46; 56&#46;9&#37; of the respondents were SEGHNP full members&#46; The median time of professional experience of the participants&#44; was 16 years&#44; ranging from 5 to 43 years&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Only 3 of the items reached more than 90&#37; of concordance among the survey respondents&#46; In other words&#44; for those 3 items more than 90&#37; of the survey respondents agreed with the same answer&#46; In 11 items&#44; the median score fell into the undefined category &#40;2&#8211;3 points&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">More than 90&#37; of the survey respondents disagreed with the statement that a negative specific IgE test&#44; ruled out CMPA&#46; On the contrary&#44; a 90&#37; agreement was observed with the two following items&#58; after a positive oral challenge&#44; it is mandatory to avoid CMP during&#44; at least&#44; 6 months and by 2 years of age&#44; 80&#37; of CMPA infants will develop tolerance to CMP&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A huge variability was observed regarding answers to the open label questions so those data are not shown in the results&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnosis</span><p id="par0045" class="elsevierStylePara elsevierViewall">According to diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; 25&#37; of the participants answered that symptoms relief after CMP removal was enough to diagnose CMPA&#46; Forty-three percent of the respondents considered that Oral Challenge &#40;OC&#41; should be performed always in a hospital setting but when they were specifically asked about mild non-IgE mediated CMPA cases&#44; 83&#46;5&#37; agreed with the possibility of reintroducing milk at home&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Related to the diagnostic workup&#44; 46&#46;5&#37; recognized routine use of the patch test and 50&#37; always performed both prick test and blood sampling for specific IgE antibodies&#46; OC was mandatory to diagnose CMPA for 36&#37; of the respondents&#46; Moreover&#44; 12&#37; considered that it could never be avoided&#46; OC protocols were almost different in every unit and were performed equally by pediatric allergologists and gastroenterologists&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Treatment</span><p id="par0055" class="elsevierStylePara elsevierViewall">According to treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; 11&#37; thought that soy formula was an appropriate treatment for children under 6 months of age&#44; and 5&#46;5&#37; believed that milk from other mammals was a suitable alternative option&#46; A majority of the respondents &#40;67&#46;1&#37;&#41; did not consider a milk free diet in their protocols in children older than 3 years&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">When they were asked about their formula of choice&#44; a 69&#46;9 percent indicated extensively hydrolyzed casein formulas as their first option&#46; Extensively hydrolyzed whey formulas were the second option for 50&#46;7&#37;&#46; The third choice was amino acid based formulas for 39&#46;7&#37;&#46; As a fourth option 46&#46;6&#37; chose hydrolyzed rice formula&#46; Soy formulas were chosen as the last option in 43&#46;8&#37; of the cases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although 79&#46;4&#37; had desensitization protocols in their divisions&#44; nearly all units followed a different protocol&#46; Sixty three percent had protocols for IgE mediated CMPA and 16&#46;4&#37; for both IgE and non IgE mediated CMPA&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Prognosis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Related to prognosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; 8&#46;2&#37; of the respondents did not consider CMP exposition as a possible death hazard at any age&#46; Twenty four percent of the respondents were not sure if non-IgE mediated CMPA infants developed tolerance before or after IgE mediated ones&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">European Society of Pediatric Gastroenterology&#44; Hepatology and Nutrition &#40;ESPGHAN&#41; guidelines were the most widely used&#44; with a 64&#37; of the respondents following those guidelines&#46; All the respondents were aware of the existence of published guidelines&#44; but 23&#37; of them considered that their knowledge on CMPA was outdated and scarce&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Although CMPA is a very prevalent condition which pediatric gastroenterologists have been treating for decades&#44; there is still huge variability on its management&#46; Without an appropriate diagnostic workup&#44; including food challenge procedures&#44; there is a high risk of both over- and under-diagnosis&#46; In consequence&#44; we are under risk of over- and under-treatment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We have observed a huge variability among pediatric gastroenterologists in Spain regarding CMPA diagnosis and management&#46; Not surprisingly&#44; the vast majority of the pediatric gastroenterologists in Spain&#44; were aware of the existence of clinical practice guidelines on the problem&#44; and most of them acknowledged to follow the ESPGHAN guidelines&#44; published in 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Nevertheless&#44; significant differences in clinical practice were found compared to the ESPGHAN recommendations both in diagnosis and treatment&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">ESPGHAN guidelines indicate clearly when and when not to perform an OC in patients suspected to have CMPA&#46; All cases of non IgE mediated CMPA&#44; with the exception of Food Protein Induced Enterocolitis Syndrome &#40;FPIES&#41; should undergo an OC to be adequately diagnosed&#46; In IgE mediated cases&#44; with a clear reaction close to the moment of milk ingestion and with a positive specific IgE testing to CMP&#44; the OC could be avoided&#46; In our survey&#44; 36&#37; participants considered OC to be mandatory always&#46; One in each four pediatric gastroenterologists considered symptom resolution on CMP exclusion diet was enough to diagnose CMPA&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A high percentage of respondents considered that exposition to milk could be performed at home in non severe&#44; non IgE mediated CMPA patients&#44; a scenario considered in the ESPGHAN guidelines&#46; When asked to describe the protocol used for milk reintroduction at home&#44; there were almost no coincidences&#44; being nearly one different protocol per unit in the whole country&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nearly half of the participants reported regular use of patch tests in their offices for the diagnosis of CMPA&#44; a slightly higher percentage than reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> However&#44; 76&#37; of the respondents thought that non IgE mediated CMPA diagnosis should not be made exclusively based on its results&#46; In current ESPGHAN guidelines&#44; these tests are not recommended&#46; The patch test is difficult to read and subjective&#46; Moreover&#44; there are difficulties on its standardization and application of antigen&#46; In any case&#44; recent studies indicate that they are reliable and safe but its use cannot substitute oral challenge in most of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Only 11&#37; of the respondents considered soy formula to be an adequate option for infants below six months of age&#46; ESPGHAN discourages soy formula consumption in this age group because of its phytates and isoflavones content&#46; Not surprisingly&#44; only 5&#46;5&#37; considered milk from other mammals as a suitable option in the treatment of CMPA infants&#46; This option should always be avoided<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> because cow&#44; goat and sheep milks evidence 87&#8211;98&#37; identity of amino acids and immunological cross reactivity is a real issue&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In children older than 3 years of age&#44; a diet with no dairy content is considered to be a safe option for treatment if CMPA persists beyond that age&#44; given that calcium and vitamin D are adequately supplied in the child&#39;s diet&#46; In our survey&#44; close to 70&#37; of the respondents did not consider this as a safe option&#46; In the Spanish National Health System&#44; dietitians are scarce&#46; Those pediatric gastroenterologists&#44; with no help from experienced pediatric dietitians&#44; could feel insecure to recommend this diet to children under these circumstances&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Although most of the CMPA infants will outgrow their allergy before the age of three&#44; a significant proportion of children will continue to be allergic to cow&#39;s milk&#44; being this percentage higher for those with an IgE mediated allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> Four out of 10 of the respondents were not sure if this statement was true&#46; In the last years&#44; oral desensitization protocols &#40;OTI&#41; have been developed for these IgE patients and are widely used&#44; even when several concerns have been raised regarding the possibility of developing eosinophilic esophagitis during the treatment&#46; In our study&#44; almost 90&#37; of the respondents have access to these protocols in their practices&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">There are several reports indicating that accidental exposure to cow&#39;s milk has been responsible of deaths&#44; and all CMPA children with an anaphylactic reaction or at risk of developing one and their parents should be instructed in the use of epinephrine injectors for that cause&#46; Close to 10 percent of the responders to our survey&#44; did not recognize accidental exposure to milk as a hazardous risk at any age&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Finally&#44; one out of four pediatric gastroenterologists in Spain&#44; considered that their knowledge on CMPA was outdated and scarce&#44; even when almost all of them were aware of the existence of practice guidelines&#46; Continued medical education systems are not always capable of maintaining practitioners updated&#46; Several initiatives have been conducted in order to enhance medical knowledge on food allergy management&#46; Yu et al&#46;&#44; carried out a study that developed and piloted a food allergy educational resource with very good results&#46; Self-paced online training modules were selected by their survey respondent as one of the most preferred learning methods&#46; Based upon this&#44; the educational material comprised a slide set and written material as well as a self-injectable epinephrine demonstration&#46; Significant improvement in knowledge and confident was observed after completed pre-and post-knowledge test&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Another brief educational tool&#44; is the Food Allergy Comprehension Tool &#40;FACT&#41; that is a rapid way to address known knowledge gaps among pediatricians and to identify areas in need of further intervention&#46; It was designed to integrate with the current food allergy guidelines&#46; It includes a pre- and post-evaluation&#44; allergy case studies and several case-related questions with detailed explanations&#46; Significant improvements in knowledge and confidence were observed&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">We have found surveys regarding CMPA management focused on primary care physicians&#46; The goal of a survey carried by Gupta and coworkers&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> was to characterize food allergy knowledge&#44; attitudes&#44; and beliefs among primary care physicians and family physicians in the United States&#46; Participants answered 61&#37; of knowledge based items correctly&#46; The overall score was significantly higher for pediatricians &#40;62&#37;&#41; than for family physicians &#40;54&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A Spanish study<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> found low awareness of existing guidelines for CMA among general pediatricians&#44; pediatric nutritionists and allergologists&#46; 39&#37; of their survey respondent from 52 countries were unaware of CMA management guidelines&#46; They also found a potential over-diagnosis among general pediatricians in Europe due to variable diagnostic practices&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first survey conducted among pediatric gastroenterologists on this topic&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The strengths of our study were that in Spain&#44; nearly all non-IgE mediated and many IgE mediated CMPA patients are managed by pediatric gastroenterologists&#44; and the vast majority of them were reached through the mailing list&#46; Twenty-three percent of the Spanish pediatric gastroenterologists answered the survey with a high percentage of full members&#44; and data were collected and analyzed in a short period of time&#44; avoiding communication among participants&#46; The median time of professional experience was over 15 years&#44; and more than half of the respondents were full members&#44; indicating that participants in the study are experienced professionals with a high degree of specialization&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The main limitation of the study is a possible selection bias in the participants&#46; Data were anonymously included in a database&#44; but we can assume that respondents were those more confident in their answers or with a greater interest in CMPA&#44; so we could reasonably expect to get better results in this group&#46; It may well be that the final results may underestimate the real magnitude of the problem&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; although CMPA is a prevalent condition that pediatric gastroenterologists have been treating for decades&#44; we have found huge variability on its management&#46; There are multiple opportunities for improvement in CMPA diagnostic workup and management among pediatric gastroenterologist in the future&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1089593"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1033007"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1089592"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1033006"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Diagnosis"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Treatment"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Prognosis"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflict of interest"
        ]
        9 => array:2 [
          "identificador" => "xack370101"
          "titulo" => "Acknowledgements"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-09-01"
    "fechaAceptado" => "2017-10-16"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1033007"
          "palabras" => array:3 [
            0 => "Food allergy"
            1 => "Allergy"
            2 => "Cow&#39;s milk protein allergy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1033006"
          "palabras" => array:3 [
            0 => "Alergia alimentaria"
            1 => "Alergia"
            2 => "Alergia a prote&#237;nas de leche de vaca"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Food allergy is an increasing health problem in the developed world&#46; Cow&#39;s milk protein is the main cause of food allergy in infants&#46; Without an appropriate diagnostic workup&#44; there is a high risk of both over- and underdiagnosis and therefore&#44; over and undertreatment&#46; The objective of our study was to analyze the variability in cow&#39;s milk protein allergy &#40;CMPA&#41; management by pediatric gastroenterologists in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 50 item questionnaire&#44; including open and closed items in a Likert&#39;s scale from 0 to 5&#44; was drafted and distributed through the Spanish Society for Pediatric Gastroenterology&#44; Hepatology and Nutrition &#40;SEGHNP&#41; e-mail list&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Seventy-three questionnaires were received back out of 321&#46; Only 3 of the items achieved concordance greater than 90&#37;&#46; Thirty-three percent considered oral challenge to be necessary for the diagnosis of CMPA under any circumstance&#46; Twenty-five percent considered that symptom improvement after cow&#39;s milk removal was enough for the diagnosis&#46; Oral challenge was performed at home by 83&#46;5&#37; in non-IgE mediated cases&#46; Extensively hydrolyzed casein formulas were the treatment of choice for 69&#46;9&#37;&#46; Soy formulas were the last option&#46; Almost all respondents were aware of the existence of clinical guidelines on CMPA&#44; being European Society of Pediatric Gastroenterology&#44; Hepatology and Nutrition guidelines the most followed &#40;64&#46;4&#37;&#41;&#46; Twenty-three percent considered that their knowledge about allergy was inadequate&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Although CMPA is a prevalent condition that pediatric gastroenterologists have been treating for decades&#44; we found a huge variability on its management&#46; There is potential for improvement in this field among pediatric gastroenterologist in the future&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La alergia alimentaria es un problema creciente&#44; siendo la prote&#237;na de leche de vaca la principal causa en ni&#241;os&#46; Sin un proceso diagn&#243;stico adecuado&#44; existe un elevado riesgo de sobrediagn&#243;stico e infradiagn&#243;stico y&#44; por lo tanto&#44; de sobretratamiento e infratratamiento&#46; El objetivo de nuestro estudio fue analizar la variabilidad en el manejo de la alergia a prote&#237;na de leche de vaca &#40;APLV&#41; por los gastroenter&#243;logos pedi&#225;tricos espa&#241;oles&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se envi&#243; un cuestionario de 50 preguntas a trav&#233;s de la lista de email de la Sociedad Espa&#241;ola de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;tricas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Recibimos 73 cuestionarios de los 321 enviados&#46; Solo 3 de las respuestas lograron m&#225;s del 90&#37; de acuerdo&#46; El 33&#37; considera que la provocaci&#243;n oral es necesaria para el diagn&#243;stico de APLV siempre&#46; El 25&#37; considera que la mejor&#237;a cl&#237;nica tras la retirada de las prote&#237;nas de leche de vaca es suficiente para el diagn&#243;stico&#46; La provocaci&#243;n oral es realizada en domicilio por el 83&#44;5&#37; de los encuestados en APLV no IgE mediada&#46; Los hidrolizados extensos de case&#237;na son el tratamiento de elecci&#243;n &#40;69&#44;9&#37;&#41;&#46; Las f&#243;rmulas de soja&#44; la &#250;ltima opci&#243;n&#46; Casi todos los encuestados conoc&#237;an la existencia de gu&#237;as de manejo de APLV&#44; siendo las de la Sociedad Europea de Gastroenterolog&#237;a&#44; Hepatolog&#237;a y Nutrici&#243;n Pedi&#225;trica las m&#225;s utilizadas &#40;64&#44;4&#37;&#41;&#46; El 23&#37; considera que su conocimiento sobre alergia es inadecuado&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Aunque la APLV es una patolog&#237;a prevalente que los gastroenter&#243;logos pedi&#225;tricos llevan d&#233;cadas tratando&#44; hemos encontrado una gran variabilidad en su manejo&#46; Existe posibilidad de mejora en este campo en el futuro&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez AI&#44; S&#225;nchez AM&#44; Cant&#243;n &#211;S&#44; Jaime BE&#44; Trevi&#241;o SJ&#44; Garc&#237;a CB&#44; et al&#46; Manejo de la alergia a prote&#237;na de leche de vaca por los gastroenter&#243;logos espa&#241;oles&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;89&#58;222&#8211;229&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">We presented these results in the Spanish Congress of Pediatric Gastroenterology&#44; Hepatology and Nutrition in Gij&#243;n&#44; May 2016 and in the World Congress of Pediatric Gastroenterology&#44; Hepatology and Nutrition in Montreal&#44; October 2016&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The following questionnaire is anonymous&#46; It comprises 50 open and Likert&#39;s scale questions&#46; It requires 15<span class="elsevierStyleHsp" style=""></span>min approximately to be completed&#46;</span></p> <p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Thank you in advance for your cooperation&#46;</span></p> <p id="par0185" class="elsevierStylePara elsevierViewall">Identity data<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Gender&#58;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Age&#58;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Type of member &#40;full members&#47;associate members&#41;&#58;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Years of experience &#40;fellowship included&#41;&#58;</p></li></ul></p> <p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Diagnosis</span></p> <p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Please note your agreement with the following statements &#40;from 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no agreement at all to 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete agreement&#41;</span></span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Cow&#39;s milk protein allergy &#40;CMPA&#41; diagnosis is based mainly on the positivity of any specific IgE test&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0225" class="elsevierStylePara elsevierViewall">If specific IgE determination in blood is negative&#44; any kind of CMPA could be ruled out&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">If casein specific IgE levels are positive&#44; oral food challenge &#40;OFC&#41; should not be performed independent on their level in blood</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">OFC could be avoided under certain circumstances&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0240" class="elsevierStylePara elsevierViewall">OFC is mandatory for CMPA diagnosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Symptoms improvement after milk&#39;s withdrawal is enough most of the times to establish CMPA diagnosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">11&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Non IgE mediated CMPA diagnosis is based mainly on the positivity of a patch test&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">12&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">To evaluate efficacy in a diagnostic elimination diet&#44; milk&#39;s withdrawal should be maintained for at least a month&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">13&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">OFC cannot be avoided under any circumstance&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">14&#46;</span><p id="par0265" class="elsevierStylePara elsevierViewall">After a positive OFC&#44; infants must be on a milk-free diet for at least 6 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">15&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">After a positive OFC&#44; any subsequent challenge should be delayed after the age of 12 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">16&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Oral food challenge must always be performed in a hospital setting</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">17&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">In a patient presenting with perioral rash after repeated exposition to cow&#39;s milk proteins&#44; in which symptoms improve after cow&#39;s milk withdrawal&#44; if specific IgE tests are negative&#44; a diagnosis of non IgE CMPA could be made&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">18&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">In patients with negative specific IgE in which CMPA is still suspected&#44; and the determination of a specific IgG to CMP is positive&#44; it is mandatory to remove milk from the infants&#8217; diet&#46;</p></li></ul></p> <p id="par0290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">The following questions are meant to be answered freely&#58;</span><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">19&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">In a patient with a suspected CMPA&#46; In which circumstance you won&#8217;t carry out an IgE blood sample&#47;prick test&#63;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">20&#46;</span><p id="par0300" class="elsevierStylePara elsevierViewall">If you have a patient with a suspected IgE mediated CMPA&#44; Which test will you ask for&#58; prick test&#44; IgE specific blood sample or both&#63;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">21&#46;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Are patch tests carried out at your Hospital&#63;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">22&#46;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Who performs oral challenges at your Hospital&#63; Gastroenterologist or allergologist&#63;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">23&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Describe the protocol followed to do it&#58;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">24&#46;</span><p id="par0320" class="elsevierStylePara elsevierViewall">In patients older than 24 months of age with persistent IgE mediated CMPA symptoms without a story of anaphylaxis&#46; Would you determine specific IgE prior to the exposure&#63;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">25&#46;</span><p id="par0325" class="elsevierStylePara elsevierViewall">In the previous situation&#46; Would you carry out an oral food challenge if specific IgE turns out positive&#63; Yes&#44; always&#47;no&#44; never&#47;sometimes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">26&#46;</span><p id="par0330" class="elsevierStylePara elsevierViewall">If your answer was &#8220;sometimes&#8221; please specify when&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">27&#46;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Do you carry out CMP oral challenges at home&#63;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">28&#46;</span><p id="par0340" class="elsevierStylePara elsevierViewall">If your answer is yes&#44; please note when&#58;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">29&#46;</span><p id="par0345" class="elsevierStylePara elsevierViewall">If your answer is yes&#44; please explain how do you perform the exposition&#46;</p></li></ul></p> <p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Treatment</span></p> <p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Note your agreement with the following statements &#40;from 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no agreement at all to 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete agreement&#41;</span></span><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">30&#46;</span><p id="par0360" class="elsevierStylePara elsevierViewall">25&#37; of infants will need an amino acid based formula because they will not tolerate treatment with extensively hydrolyzed formulas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">31&#46;</span><p id="par0365" class="elsevierStylePara elsevierViewall">Soy formula is not a suitable option for children younger than 6 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">32&#46;</span><p id="par0370" class="elsevierStylePara elsevierViewall">Desensitization protocols are effective in a significant percentage despite the causative mechanism of CMPA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">33&#46;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Sheep or goat milks are suitable and secure options for those children older than a year that refuse to eat another kind of formula&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">34&#46;</span><p id="par0380" class="elsevierStylePara elsevierViewall">Parents of children with IgE mediated CMPA should be trained in adrenaline self-injector device&#39;s use&#46;</p></li><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">35&#46;</span><p id="par0385" class="elsevierStylePara elsevierViewall">Extensively hydrolyzed casein formula is the treatment of choice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">36&#46;</span><p id="par0390" class="elsevierStylePara elsevierViewall">In children older than 3 years&#44; dairy-free diet could be a suitable option&#46;</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">37&#46;</span><p id="par0395" class="elsevierStylePara elsevierViewall">There are no evidences indicating that some probiotics could induce accelerated tolerance development in CMPA infants</p></li></ul></p> <p id="par0400" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">The following questions are meant to be answered freely&#58;</span><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">38&#46;</span><p id="par0405" class="elsevierStylePara elsevierViewall">Do you carry out desensitization protocols at your hospital&#63;</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">39&#46;</span><p id="par0410" class="elsevierStylePara elsevierViewall">Which kind of protocol do you carry out&#63; &#40;standard&#47;accelerated&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">40&#46;</span><p id="par0415" class="elsevierStylePara elsevierViewall">At what age&#63;</p></li><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">41&#46;</span><p id="par0420" class="elsevierStylePara elsevierViewall">Do you carry out the protocol in patients with IgE mediated CMPA&#44; non IgE mediated CMPA or both&#63;</p></li><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">42&#46;</span><p id="par0425" class="elsevierStylePara elsevierViewall">Please&#44; order the following formulas according to your prescription frequency &#40;from more frequent to less frequent prescription&#41;&#58; elemental formula&#44; extensively hydrolyzed seroprotein formulas&#44; extensively hydrolyzed casein formulas&#44; hydrolyzed rice formulas&#44; soy formula&#46;</p></li></ul></p> <p id="par0430" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Prognosis</span></p> <p id="par0435" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Please note your agreement with the following statements &#40;from 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no agreement at all to 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total agreement&#41;</span><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0215"><span class="elsevierStyleLabel">43&#46;</span><p id="par0440" class="elsevierStylePara elsevierViewall">Infants with IgE mediated CMPA will develop tolerance before non IgE mediated ones</p></li><li class="elsevierStyleListItem" id="lsti0220"><span class="elsevierStyleLabel">44&#46;</span><p id="par0445" class="elsevierStylePara elsevierViewall">By 2 years of age&#44; 80&#37; of CMPA infants will develop tolerance to CMP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0225"><span class="elsevierStyleLabel">45&#46;</span><p id="par0450" class="elsevierStylePara elsevierViewall">CMP unnoticed exposure could be a death hazard at any age&#46;</p></li><li class="elsevierStyleListItem" id="lsti0230"><span class="elsevierStyleLabel">46&#46;</span><p id="par0455" class="elsevierStylePara elsevierViewall">CMPA persistence is not related with casein specific IgE levels&#46;</p></li><li class="elsevierStyleListItem" id="lsti0235"><span class="elsevierStyleLabel">47&#46;</span><p id="par0460" class="elsevierStylePara elsevierViewall">Those children who develop CMPA while receiving breast feeding have a greater risk of achieving delayed tolerance &#40;&#62;12 months&#41; than those who develop CMPA while receiving formula&#46;</p></li></ul></p> <p id="par0465" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">The following questions are meant to be answered freely&#58;</span><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0240"><span class="elsevierStyleLabel">48&#46;</span><p id="par0470" class="elsevierStylePara elsevierViewall">Do you know about the existence of CMPA clinical practice guidelines&#63;</p></li><li class="elsevierStyleListItem" id="lsti0245"><span class="elsevierStyleLabel">49&#46;</span><p id="par0475" class="elsevierStylePara elsevierViewall">If your answer is yes&#44; please note which one is the one you follow in your daily practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0250"><span class="elsevierStyleLabel">50&#46;</span><p id="par0480" class="elsevierStylePara elsevierViewall">Do you think that your knowledge about CMA is appropriate&#63; &#40;0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>nothing appropriate&#44; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>completely appropriate&#41;&#46;</p></li></ul></p> <p id="par0485" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Thank you for your cooperation</span></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Variability and attitudes towards Cow&#39;s Milk Protein Allergy Management by Pediatric Gastroenterologists in Spain"
            "identificador" => "sec0045"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The questionnaire comprised open and closed items in a Likert&#39;s scale from 0 to 5&#44; including questions about CMPA diagnosis&#44; treatment and prognosis&#46; The items score were grouped as follows&#58; 0&#8211;1 &#8220;disagree&#8221;&#59; 2&#8211;3 &#8220;undefined&#8221;&#59; 4&#8211;5 &#8220;agree&#8221;&#46; The following table summarizes the answers &#40;expressed in percentage&#41; related to diagnosis of CMPA &#40;Questions 5 to 18&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46; Cow&#39;s milk protein allergy &#40;CMPA&#41; diagnosis is based mainly on the positivity of any specific IgE test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&#46; If specific IgE determination in blood is negative&#44; any kind of CMPA could be ruled out&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&#46; If casein specific IgE levels are positive&#44; oral food challenge &#40;OFC&#41; should not be performed independent on their level in blood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#46; OFC could be avoided under certain circumstances&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#46; OFC is mandatory for CMPA diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#46; Symptoms improvement after milk&#39;s withdrawal is enough most of the times to establish CMPA diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46; Non IgE mediated CMPA diagnosis is based mainly on the positivity of a patch test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#46; To evaluate efficacy in a diagnostic elimination diet&#44; milk&#39;s withdrawal should be maintained for at least a month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&#46; OFC cannot be avoided under any circumstance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#46; After a positive OFC&#44; infants must be on a milk-free diet for at least 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#46; After a positive OFC&#44; any subsequent challenge should be delayed after the age of 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#46; Oral food challenge must always be performed in a hospital setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46; In a patient presenting with perioral rash after every exposition to cow&#39;s milk proteins&#44; in which symptoms improve after cow&#39;s milk withdrawal&#44; if specific IgE test are negative&#44; a diagnosis of non IgE CMPA could be made&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&#46; In patients with negative specific IgE in which CMPA is still suspected&#44; and the determination of a specific IgG to CMP is positive&#44; it&#39;s mandatory to remove milk from the infants&#8217; diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862793.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagnosis&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The questionnaire comprised open and closed items in a Likert&#39;s scale from 0 to 5&#44; including questions about CMPA diagnosis&#44; treatment and prognosis&#46; The items score were grouped as follows&#58; 0&#8211;1 &#8220;disagree&#8221;&#59; 2&#8211;3 &#8220;undefined&#8221;&#59; 4&#8211;5 &#8220;agree&#8221;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The following table summarizes the answers &#40;expressed in percentage&#41; related to treatment of CMPA &#40;Questions 30 to 37&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30&#46; 25&#37; of infants will need amino acid based formula because they will not tolerate treatment with extensively hydrolyzed formulas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">31&#46; Soy formula is not a suitable option for children younger than 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">32&#46; Desensitization protocols are effective in a significant percentage despite causative mechanism of CMPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">33&#46; Sheep or goat&#39;s milk are suitable and secure options for those children older than a year that refuses to eat another kind of formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">34&#46; Parents of children with IgE mediated CMPA should be trained in adrenaline self-injector device&#39;s use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">35&#46; Extensively hydrolyzed casein formula is the treatment of choice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">36&#46; In children older than 3 years&#44; dairy-free diet could be a suitable option&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">37&#46; There are no evidences indicating that some probiotics could induce accelerated tolerance development in CMPA infants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862795.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Treatment&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The questionnaire comprised open and closed items in a Likert&#39;s scale from 0 to 5&#44; including questions about CMPA diagnosis&#44; treatment and prognosis&#46; The items score were grouped as follows&#58; 0&#8211;1 &#8220;disagree&#8221;&#59; 2&#8211;3 &#8220;undefined&#8221;&#59; 4&#8211;5 &#8220;agree&#8221;&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The following table summarizes the answers &#40;expressed in percentage&#41; related to prognosis of CMPA &#40;Questions 43 to 47&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">43&#46; Infants with IgE mediated CMPA will develop tolerance before non IgE mediated ones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">44&#46; By 2 years of age&#44; 80&#37; of CMPA infants will develop tolerance to CMP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">45&#46; CMP unnoticed exposure could be a dead hazard at any age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">46&#46; CMPA persistence is not related with casein specific IgE levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">47&#46; Those children who develop CMPA while receiving breastfeeding have a greater risk of achieving delayed tolerance &#40;&#62;12 months&#41; than those who develop CMPA while receiving formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862794.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Prognosis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic approach and management of cow&#39;s-milk protein allergy in infants and children&#58; ESPGHAN GI Committee practical guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Koletzko"
                            1 => "B&#46; Niggemann"
                            2 => "A&#46; Arato"
                            3 => "J&#46;A&#46; Dias"
                            4 => "R&#46; Heuschkel"
                            5 => "S&#46; Husby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0b013e31825c9482"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "221"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22569527"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of past food avoidance due to allergic symptoms on the growth of children at school age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Mukaida"
                            1 => "T&#46; Kusunoki"
                            2 => "T&#46; Morimoto"
                            3 => "T&#46; Yasumi"
                            4 => "R&#46; Nishikomori"
                            5 => "T&#46; Heike"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2332/allergolint.10-OA-0188"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergol Int"
                        "fecha" => "2010"
                        "volumen" => "59"
                        "paginaInicial" => "369"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20864793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Children who avoid drinking cow milk have low dietary calcium and poor bone health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;E&#46; Black"
                            1 => "S&#46;M&#46; Williams"
                            2 => "I&#46;E&#46; Jones"
                            3 => "A&#46; Goulding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ajcn/76.3.675"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2002"
                        "volumen" => "76"
                        "paginaInicial" => "675"
                        "paginaFinal" => "680"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12198017"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "World Allergy Organization &#40;WAO&#41; diagnosis and rationale for action against cow&#39;s milk allergy &#40;DRACMA&#41; guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Fiocchi"
                            1 => "J&#46; Brozek"
                            2 => "H&#46; Sch&#252;nemann"
                            3 => "S&#46;L&#46; Bahna"
                            4 => "A&#46; von Berg"
                            5 => "K&#46; Beyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "World Allergy Organ J"
                        "fecha" => "2010"
                        "volumen" => "21"
                        "paginaInicial" => "1"
                        "paginaFinal" => "125"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the diagnosis and management of cow&#39;s milk protein allergy in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Vandenplas"
                            1 => "M&#46; Brueton"
                            2 => "C&#46; Dupont"
                            3 => "D&#46; Hill"
                            4 => "E&#46; Isolauri"
                            5 => "S&#46; Koletzko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/adc.2006.110999"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2007"
                        "volumen" => "92"
                        "paginaInicial" => "902"
                        "paginaFinal" => "908"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17895338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a latinoamericana para el diagn&#243;stico y tratamiento de alergia a las prote&#237;nas de la leche de vaca &#40;GL-APLV&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Montijo-Barrios"
                            1 => "M&#46;V&#46; L&#243;pez-Ugalde"
                            2 => "J&#46; Ram&#237;rez-Mayans"
                            3 => "M&#46;S&#46; Anaya-Fl&#243;rez"
                            4 => "J&#46;L&#46; Arredondo-Garc&#237;a"
                            5 => "I&#46; Azevedo-Tenorio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Invest Clin"
                        "fecha" => "2014"
                        "volumen" => "66"
                        "paginaInicial" => "9"
                        "paginaFinal" => "72"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cow&#39;s milk protein allergy in children&#58; a practical guide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Caffarelli"
                            1 => "F&#46; Baldi"
                            2 => "B&#46; Bendandi"
                            3 => "L&#46; Calzone"
                            4 => "M&#46; Marani"
                            5 => "P&#46; Pasquinelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1824-7288-36-5"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ital J Pediatr"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20205781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Position document&#58; IgE-mediated cow&#39;s milk allergy&#46; Food allergy committee of SEICAP &#40;Spanish Society of Pediatric Allergy&#44; Asthma and Clinical Immunology&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Martorell-Aragon&#233;s"
                            1 => "L&#46; Echevarr&#237;a-Zudaire"
                            2 => "E&#46; Alonso-Lebrero"
                            3 => "J&#46; Bon&#233;-Calvo"
                            4 => "M&#46;D&#46; Mart&#237;n-Mu&#241;oz"
                            5 => "S&#46; Nevot-Falc&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Allergol Immunopathol"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "507"
                        "paginaFinal" => "526"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Boonyaviwat"
                            1 => "P&#46; Pacharn"
                            2 => "O&#46; Jirapongsananuruk"
                            3 => "P&#46; Vichyanond"
                            4 => "N&#46; Visitsunthorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.12382"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "737"
                        "paginaFinal" => "741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25817700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of elimination diets on growth and nutritional status in children with multiple food allergies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Berry"
                            1 => "J&#46; Adams"
                            2 => "H&#46; Voutilainen"
                            3 => "P&#46;J&#46; Feustel"
                            4 => "J&#46; Celestin"
                            5 => "K&#46;M&#46; J&#228;rvinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.12348"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "133"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25640977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The natural history of milk allergy in an observational cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;A&#46; Wood"
                            1 => "S&#46;H&#46; Sicherer"
                            2 => "B&#46;P&#46; Vickery"
                            3 => "S&#46;M&#46; Jones"
                            4 => "A&#46;H&#46; Liu"
                            5 => "D&#46;M&#46; Fleischer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2012.10.060"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2013"
                        "volumen" => "131"
                        "paginaInicial" => "805"
                        "paginaFinal" => "812"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23273958"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral and sublingual immunotherapy&#58; potential causes for eosinophilic gastrointestinal disorders&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Babaie"
                            1 => "M&#46; Mesdaghi"
                            2 => "M&#46; Nishino"
                            3 => "M&#46; Mansouri"
                            4 => "M&#46; Ebisawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000457796"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Arch Allergy Immunol"
                        "fecha" => "2017"
                        "volumen" => "172"
                        "paginaInicial" => "89"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28226319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Further fatalities caused by anaphylactic reactions to food&#44; 2001&#8211;2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Bock"
                            1 => "A&#46; Munoz-Furlong"
                            2 => "H&#46;A&#46; Sampson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2006.12.622"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2007"
                        "volumen" => "119"
                        "paginaInicial" => "1016"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17306354"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Further fatal allergic reactions to food in the United Kingdom&#44; 1999&#8211;2006"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;S&#46; Pumphrey"
                            1 => "M&#46;H&#46; Gowland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2007.01.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2007"
                        "volumen" => "119"
                        "paginaInicial" => "1018"
                        "paginaFinal" => "1019"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17349682"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of a food allergy education resource for primary care physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;E&#46; Yu"
                            1 => "A&#46; Kumar"
                            2 => "C&#46; Bruhn"
                            3 => "S&#46;S&#46; Teuber"
                            4 => "S&#46;H&#46; Sicherer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6920-8-45"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Educ"
                        "fecha" => "2008"
                        "volumen" => "8"
                        "paginaInicial" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18826650"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A brief intervention to improve food allergy knowledge among US pediatricians&#58; lessons learned"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;E&#46; Springston"
                            1 => "C&#46;H&#46; Lau"
                            2 => "P&#46; Patel"
                            3 => "M&#46;R&#46; Warrier"
                            4 => "M&#46;W&#46; Sohn"
                            5 => "J&#46; Pongracic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-3038.2012.01331.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "642"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22831457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Food allergy knowledge&#44; attitudes&#44; and beliefs of primary care physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;S&#46; Gupta"
                            1 => "E&#46;E&#46; Springston"
                            2 => "J&#46;S&#46; Kim"
                            3 => "B&#46; Smith"
                            4 => "J&#46;A&#46; Pongracic"
                            5 => "X&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "126"
                        "paginaFinal" => "132"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "22-22"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of an EPA advisory group discussion on the management of cow&#39;s milk allergy in infants by paediatricians in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Moya"
                            1 => "S&#46; Dreborg"
                            2 => "R&#46;G&#46; Heine"
                            3 => "M&#46; Pettoello-Mantovani"
                            4 => "E&#46;M&#46; Varga"
                            5 => "H&#46;C&#46; Cokugras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Acta Pediatr Esp"
                        "fecha" => "2011"
                        "volumen" => "100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack370101"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Thank you to all the participants in our survey&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008900000004/v1_201810020628/S2341287918300127/v1_201810020628/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008900000004/v1_201810020628/S2341287918300127/v1_201810020628/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918300127?idApp=UINPBA00005H"
]