Cow's milk allergy guidelines: a quality appraisal with the AGREE II instrument

Background The appropriate diagnosis and management of cow's milk allergy (CMA) is challenging. Objective To systematically review the quality of the existing guidelines on CMA. Methods The Cochrane Library, MEDLINE, and EMBASE databases were searched from 2010 to November 2015. The methodological rigour, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results Of the 15 included guidelines, two, both developed by recognized scientific organizations, achieved the highest score (100%). Eight others were considered to be of high quality (i.e., overall quality scores > 60%). The quality scores for each domain varied. Of all the domains, clarity and presentation had the highest mean score, and applicability had the lowest mean score. The scores (mean +/- SD) for individual domains were as follows: domain 1 (score and purpose) 62 +/- 36%; domain 2 (stakeholder involvement) 56 +/- 33%; domain 3 (rigor of development) 55 +/- 38%; domain 4 (clarity of presentation) 71 +/- 29%; domain 5 (applicability) 44 +/- 33%; and domain 6 (editorial independence) 60 +/- 36%. One guideline had the maximum possible score of 100% for all AGREE II domains. Conclusion and Clinical Relevance A number of guidelines on CMA are available; however, their quality varies. Overall, the guidelines developed by recognized professional/scientific organizations were of the highest quality. These guidelines should be recommended for use. Still, the methodological quality of CMA guidelines may be improved.