International guidelines may lead to overdiagnosis of cow’s milk allergy in children

International guidelines designed to help doctors diagnose cow’s milk allergy could lead to overdiagnosis, according to a study conducted by the University of Bristol, published in the journal Clinical and experimental allergy today [8 December]. The study found that three-quarters of babies have two or more symptoms at some point in the first year of life, which according to the guidelines can be caused by an allergy to cow’s milk, but the condition affects only one in 100.

Allergy to cow’s milk can manifest itself with acute or delayed symptoms. Delayed symptoms are more varied and include symptoms of the gut and skin, such as blockage (milk production) and vomiting, colic, loose stools or constipation, and exacerbation of eczema. It is already known that many of these symptoms are common in infants, making delayed cow’s milk allergy difficult to diagnose.

The researchers found that one in four parents reported two or more possible “mild to moderate” symptoms each month. Symptoms were at most three months of age, when all children were fully breastfed and did not consume cow’s milk directly. At six months of age, there is no difference in the number of children with two or more symptoms between those who consume and do not consume cow’s milk. Together, these findings suggest that most of the symptoms listed in the cow’s milk allergy guidelines are common, normal, and not caused by a cow’s milk allergy.

Dr Rosie Vincent, an honorary clinical researcher at the Center for Academic Primary Care at the University of Bristol, who led the study, said: babies and encourage overdiagnosis of cow’s milk allergy. “

Senior Research Fellow and Pediatric Allergy Doctor, Dr. Michael Perkin, of the Institute for Population Health Research at St George’s University in London, added: ” cow’s milk, which is completely disproportionate to how often we know the condition is. Parents of young babies are often seen in clinics worried about the medical reason for their baby’s symptoms, such as colic, breastfeeding, or loose stools. However, our research confirms that these symptoms are extremely common. In an otherwise healthy baby, the underlying cause is unlikely. Improperly attributing these symptoms of cow’s milk allergy is not only useless, but can also cause harm by discouraging breastfeeding. “

Researchers (from the University of Bristol, St. George’s, University of London, Imperial College London, King’s College London and the St. John’s Institute of Dermatology) used data from the Inquiring About Tolerance study of 1,303 babies aged between three and twelve months. which parents were asked to record all the symptoms their child was experiencing on a monthly basis. They counted how many babies had symptoms of a cow’s milk allergy each month, as defined in the International First Aid Allergy Guide (iMAP).

Professor Matthew Reed, a general practitioner and senior co-researcher at the Center for Academic Primary Care, University of Bristol, said: “Our study is based on iMAP, but our results are likely to relate to other areas of cow’s milk allergy. Well-intentioned guidelines must be backed up by solid data to avoid the harm of overdiagnosis, which can outweigh the damage from delayed diagnoses that they seek to prevent. “

The study was funded by the International Society of Atopic Dermatitis (ISAD) and supported by the National Institutes of Health. The EAT study was funded by the UK Food Standards Agency.

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