Medical Technology

Infant Milk Allergy Guidelines Promote Overdiagnosis, Study Says

According to the authors of a study published online this week in Clinical and Experimental Allergy international guidelines were developed to aid non-specialists to diagnose cow’s milk allergy (CMA). This leads doctors to overdiagnose CMA symptoms in infants and causes them to be unable diagnose it.

Rosie Vincent, MBChB is the primary author. She is a professor of Population Health Sciences at University of Bristol in Bristol. The study revealed that non-immunoglobulin-mediated symptoms of milk allergy are common in a baby’s first 12 months. Examples include colic, vomiting, diarrhea and more frequent loose stool colic, irritability, and loose stool.

The results are based on a secondary analysis of data from 1303 infants in the study EAT, a population-based, controlled, randomized trial in the UK that examined whether introducing allergenic foods into an infant’s diet reduced the risk of developing an allergy to that food.

It’s more than just reflux. Children who are happy spit up, and there’s no need to be done since they will eventually grow out of it. Heather Cassell, MD, University of Arizona College of Medicine

As a sign of how prevalent the symptoms listed in the guidelines (published in 2017 and in 2019) are observed in all infants, nearly three-quarters (74 percent) of participants reported at least two mild-to-moderate symptoms, and 9 percent reported at least two severe symptoms in at least one month between 3 and 12 months of age. There was no data available for infants younger than.

However, the frequency of non-IgE-mediated CMA is believed to be less than 1% in infants in European countries, the study states.

25 percent of families reported two or more non IgE CMA mild symptoms While 1.4 percent reported severe symptoms every month between the age of 3 and 12 months.

“These symptoms were highest at 38%, with at minimum two mild to moderate symptoms and 4.3 percent with at minimum two severe symptoms at 3 months, when participants did not consume cow’s milk,” Vincent said.

Researchers note that at 6 months there was no significant difference in the number of children with at least two of the symptoms between those consuming and non-consumers of milk from cows.

Consequences of misdiagnosis

She added that overdiagnosing milk allergies could result in additional expenses, tests that are not needed, or fewer breastfeeding.

Protein from cow’s milk is typically present in standard infant formula or in milk-based foods.

The authors point out that breastmilk has tiny amounts of lactoglobulin but they are not sufficient to cause reactions in more than 99 percent of infants with IgE-mediated cow’s milk allergy.

A misdiagnosis is likely to cause an increase in prescriptions of unneeded specialized products, which will lead to an increase in costs for patients and healthcare systems, and the use of allergy tests that are not validated, Vincent said.

Vincent said that even the suggestion of cow’s milk protein producing symptoms by way of breast milk could make mothers to not breastfeed.

The authors also pointed out that formula makers and marketing consultants backed three of the nine CMA guidelines recently examined by them. 81% of guideline authors have reported conflicts of interest with formula companies.

Heather Cassell, MD ,a pediatric allergy and immunology specialist with Banner Health and a clinical associate professor of pediatrics at the University of Arizona College of Medicine in Tucson She informed Medscape Medical News the conflicts of interest in milk allergy research and guidelines have been a persistent issue.

She said that formula has always been affordable to those who can afford it. This was 100% promoted by formula companies.”

“We have formula companies that send us samples to help encourage pediatricians to use the formula earlier if they’re concerned about a milk protein allergy,” Cassell said.

Concerning the overdiagnosis of allergy to milk, she suggested that the reintroduction of cow’s dairy later could improve the diagnosis and determine whether the child no more reacts. She points out, however, that only 21 percent of parents have reintroduced cow milk in the study.

Cassell said that the goal should be a little less than 100 percent, with the exception of babies with severe symptoms. “You don’t want to hinder the baby from advancing with their diet.”

She said families and providers need to look at several context clues before settling on a label for milk allergies.

It’s not about baby vomiting up, it’s about reflux. Happy babies spit up and there’s nothing that has to be done because they’ll eventually get rid of it,” Cassell stressed.

She suggested that significant irritation with blood in the stool could cause more concerns. “I believe the emphasis should be placed on re-trying the food another time,” she suggested.

Vincent pointed out that there isn’t a simple or quick test to detect non-IgE-mediated cow’s milk allergy.

She said that further study is required to determine what symptoms are more likely to point towards an illness.

Although the researchers used iMAP guidelines to conduct their research, they wrote that their findings could be applied to other CMA guidelines since they listed similar signs and symptoms.

The International Society of Atopic Dermatitis has funded the study. Vincent reports that he received a three-month research fellowship from Pfizer and support from the NIHR School for Primary Care Research Financial disclosures for the other authors are available in the full text. Cassell writes about the University of Arizona School of Medicine as a trial site to test a patch to detect milk protein allergy in infants.

Clin Exp Allergy. Published online on December 7, 2021. Abstract

Marcia Frellick, a Chicago-based freelance journalist is Marcia Frellick. She was previously a journalist at, Science News, Chicago Tribune, and Chicago Sun-Times. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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