Guidelines may promote over-diagnosis of cow's milk allergy in infants,
study finds

Date:
December 8, 2021
Source:
University of Bristol
Summary:
International guidelines developed to help doctors diagnose
cow's milk allergy may lead to over-diagnosis, according to new
research. The study found that three-quarters of infants have
two or more symptoms at some point in the first year of life
which guidelines say may be caused by cow's milk allergy, yet the
condition only affects one in 100.



FULL STORY ========================================================================== International guidelines developed to help doctors diagnose cow's milk
allergy may lead to over-diagnosis, according to University of Bristol-led research published in the journal Clinical and Experimental Allergy today
[8 December].

The study found that three-quarters of infants have two or more symptoms
at some point in the first year of life which guidelines say may be
caused by cow's milk allergy, yet the condition only affects one in 100.


========================================================================== Cow's milk allergy can present with either acute or delayed
symptoms. Delayed symptoms are more varied and include gut and skin
symptoms, such as posseting (bringing up milk) and vomiting, colic, loose stools or constipation, and flaring of eczema. Many of these symptoms
are already known to be common in infants, making delayed cow's milk
allergy difficult to diagnose.

Researchers found that one in four parents reported two or more possible
"mild to moderate" symptoms every month. Symptoms were most numerous
at three months of age, when all children were fully breastfed and
not directly consuming cow's milk. At six months of age, there was no difference in the number of children with two or more symptoms between
those consuming and not consuming cow's milk.

Together, these findings suggest that the majority of symptoms listed
in cow's milk allergy guidelines are common, normal and not caused by
cow's milk allergy.

Dr Rosie Vincent, Honorary Clinical Research Fellow at the Centre for
Academic Primary Care, University of Bristol who led the research,
said: "Guidelines, designed to help the non-specialist to diagnose
cow's milk allergy in infants may unintentionally medicalise normal
infant symptoms and promote over- diagnosis of cow's milk allergy."
Senior co-researcher and children's allergy doctor, Dr Michael Perkin,
from the Population Health Research Institute at St George's, University
of London, added: "Our findings come against a background of rising prescription rates for specialist formula for children with cow's milk
allergy, which is completely out of proportion to how common we know
the condition is. Parents of young infants are often seen in clinics,
worried about a medical cause for their infant's symptoms such as colic, bringing up milk or loose stools. However, our research confirms that
these symptoms are extremely common. In an otherwise healthy infant,
an underlying cause is unlikely. Incorrectly attributing these symptoms
to cow's milk allergy is not only unhelpful, but it may also cause harm
by discouraging breastfeeding." The researchers (from the University
of Bristol, St George's, University of London, Imperial College London,
King's College London, and St John's Institute of Dermatology), used
data from the Enquiring About Tolerance study of 1,303 infants aged
between three and twelve months, in which parents were asked to record
any symptoms their child experienced on a monthly basis. They counted
how many infants had cow's milk allergy symptoms each month, as defined
in the international Milk Allergy in Primary Care (iMAP) guideline.

Professor Matthew Ridd, a GP and senior co-researcher at the Centre for Academic Primary Care, University of Bristol, said: "Our study was based
on iMAP but our results are likely to apply to other cow's milk allergy guidelines. Well-meaning guidelines need to be supported by robust data
to avoid the harms from over-diagnosis, which may be greater than the
damage of delayed diagnoses that they seek to prevent." The research
was funded by the International Society of Atopic Dermatitis (ISAD)
and supported by the National Institute for Health Research. The EAT
study was funded by the UK Food Standards Agency.

========================================================================== Story Source: Materials provided by University_of_Bristol. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Rosie Vincent, Stephanie J. MacNeill, Tom Marrs, Joanna Craven,
Kirsty
Logan, Carsten Flohr, Gideon Lack, Suzana Radulovic, Michael
R. Perkin, Matthew J. Ridd. Frequency of guideline‐defined
cow's milk allergy symptoms in infants: Secondary analysis of
EAT trial data. Clinical & Experimental Allergy, 2021; DOI:
10.1111/cea.14060 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211208090134.htm

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