Nutrients 2021, 13, 3429. https://doi.org/10.3390/nu13103429 www.mdpi.com/journal/nutrients Concept Paper Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow’s Milk Allergy in the Middle East, North Africa, and Pakistan Region Yvan Vandenplas 1, *, Christophe Dupont 2,3,4 , Wajeeh Al-Dekhail 5 , Hani A. Al Hashmi 6 , Ahmed Fouad Khalil 7 , Mostafa Abdel-Aziz El-Hodhod 8,9 , Khaled Husain 10 and Avantika Singh 11 1 Vrije Unversiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, 1090 Brussels, Belgium 2 Pediatric Gastroenterology Department, Paris-Descartes University, 75006 Paris, France; christophe.dupont@wanadoo.fr 3 Pediatric Gastroenterology Department, APHP Necker-Enfants Malades Hospital, 750015 Paris, France 4 Marcel Sembat Clinic, 92100 Boulogne, France 5 Section of Gastroenterology, Pediatrics Department, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; wdekhail@kfshrc.edu.sa 6 Section of Allergy and Clinical Immunology, Pediatrics Department, King Abdulaziz Hospital, Jeddah 22421, Saudi Arabia; aboabdullahha777@gmail.com 7 Pediatric Gastroenterology and Nutrition Department, Alexandria University, Alexandria 21544, Egypt; fouad_ped@yahoo.com 8 Pediatric Gastroenterology and Endoscopy Department, Faculty of Medicine, Ain Shams University, Cairo 11535, Egypt; mostafaelhodhod@yahoo.com 9 Dean of Faculty of Medicine, October 6 University, Giza 12511, Egypt 10 Pediatric Gastroenterology, Hepatology and Nutrition Department, Dar AlShifa Hospital, Kuwait City 13034, Kuwait; khusain12@yahoo.com 11 Pediatric Gastroenterology Department, Mediclinic Airport Road, Abu Dhabi 48481, United Arab Emirates; Avantika.Singh@mediclinic.ae * Correspondence: yvan.vandenplas@uzbrussel.be; Tel.: +32-2477-5780 Abstract: Cow’s milk allergy (CMA) is the most common food allergy in early childhood, and its prevalence continues to rise. Exclusive breastfeeding is recommended for infants in the first 6 months of life, but this recommendation is poorly adhered to in many parts of the world, including the Middle East, North Africa, and Pakistan (MENAP) region. If the infant is affected by CMA, current guidelines recommend extensively hydrolyzed formulas (eHFs) or amino acid-based for- mulas (AAFs) in the case of severe symptoms, and hydrolyzed rice formulas (HRFs) where availa- ble. In recent years, HRFs have been proposed as a plant-based alternative to cow’s milk protein- based eHFs, and updates to current guidelines have been recommended. In 2014, a consensus state- ment and guidelines were published for the Middle East region on the prevention, diagnosis, and management of CMA. As new advances have been made in the extensively hydrolyzed hypoaller- genic infant formula space, along with updated scientific evidence, a workshop of experts from the MENAP region focused on HRF was convened in 2021. This publication summarizes the insights from this meeting. During the consensus part of the meeting, a new approach was discussed and approved by all participants, and agreement was reached that HRF can be recommended as a first- line alternative to cow’s milk-based eHF in the dietary management of CMA. Keywords: cow’s milk allergy; hydrolyzed protein; infant allergy; infant feeding; Middle East; rice 1. Introduction Allergy risk has become a significant public health issue with rising prevalence, and despite past, current, and ongoing research, the reasons are not fully understood [1–3]. In infants, exclusive breastfeeding is recommended for the first 6 months of life, but this Citation: Vandenplas, Y.; Dupont, C.; Al-Dekhail, W.; Al Hashmi, H.A.; Khalil, A.F.; El-Hodhod, M.A.-A.; Husain, K.; Singh, A. Exploring the Advantages of a Hydrolyzed Rice Formula in the Dietary Management of Infants with Cow’s Milk Allergy in the Middle East, North Africa, and Pakistan Region. Nutrients 2021, 13, 3429. https://doi.org/10.3390/ nu13103429 Academic Editor: Nadja Haiden Received: 10 September 2021 Accepted: 27 September 2021 Published: 28 September 2021 Publisher’s Note: MDPI stays neu- tral with regard to jurisdictional claims in published maps and institu- tional affiliations. Copyright: © 2021 by the authors. Li- censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and con- ditions of the Creative Commons At- tribution (CC BY) license (http://crea- tivecommons.org/licenses/by/4.0/).