Allen Hilary I, Wing Olivia, Milkova Dara, Jackson Emilia, Li Karen, Bradshaw Lucy E, Wyatt Laura, Haines Rachel, Santer Miriam, Murphy Andrew W, Brown Sara J, Kelleher Maeve, Perkin Michael R, Jay Nicola, Smith Timothy D H, Moriarty Frank, Montgomery Alan A, Williams Hywel C, Boyle Robert J
National Heart and Lung Institute, Imperial College London, London, UK.
Centre of Evidence Based Dermatology, Lifespan and Population Health, University of Nottingham, Nottingham, UK.
Allergy. 2025 Jan;80(1):148-160. doi: 10.1111/all.16203. Epub 2024 Jun 20.
Cow's milk allergy (CMA) overdiagnosis in young children appears to be increasing and has not been well characterised. We used a clinical trial population to characterise CMA overdiagnosis and identify individual-level and primary care practice-level risk factors.
We analysed data from 1394 children born in England in 2014-2016 (BEEP trial, ISRCTN21528841). Participants underwent formal CMA diagnosis at ≤2 years. CMA overdiagnosis was defined in three separate ways: parent-reported milk reaction; primary care record of milk hypersensitivity symptoms; and primary care record of low-allergy formula prescription.
CMA was formally diagnosed in 19 (1.4%) participants. CMA overdiagnosis was common: 16.1% had parent-reported cow's milk hypersensitivity, 11.3% primary care recorded milk hypersensitivity and 8.7% had low-allergy formula prescription. Symptoms attributed to cow's milk hypersensitivity in participants without CMA were commonly gastrointestinal and reported from a median age of 49 days. Low-allergy formula prescriptions in participants without CMA lasted a median of 10 months (interquartile range 1, 16); the estimated volume consumed was a median of 272 litres (26, 448). Risk factors for CMA overdiagnosis were high practice-based low-allergy formula prescribing in the previous year and maternal report of antibiotic prescription during pregnancy. Exclusive formula feeding from birth was associated with increased low-allergy formula prescription. There was no evidence that practice prescribing of paediatric adrenaline auto-injectors or anti-reflux medications, or maternal features such as anxiety, age, parity and socioeconomic status were associated with CMA overdiagnosis.
CMA overdiagnosis is common in early infancy. Risk factors include high primary care practice-based low-allergy formula prescribing and maternal report of antibiotic prescription during pregnancy.
幼儿牛奶蛋白过敏（CMA）的过度诊断现象似乎在增加，且尚未得到充分描述。我们利用一个临床试验人群来描述CMA过度诊断的情况，并确定个体层面和基层医疗实践层面的风险因素。
我们分析了2014年至2016年在英格兰出生的1394名儿童的数据（BEEP试验，ISRCTN21528841）。参与者在2岁及以下时接受了正式的CMA诊断。CMA过度诊断通过三种不同方式定义：家长报告的牛奶反应；基层医疗记录中的牛奶过敏症状；以及基层医疗记录中的低敏配方奶粉处方。
19名（1.4%）参与者被正式诊断为CMA。CMA过度诊断很常见：16.1%的家长报告有牛奶过敏，11.3%的基层医疗记录中有牛奶过敏，8.7%有低敏配方奶粉处方。无CMA的参与者中归因于牛奶过敏的症状通常为胃肠道症状，中位报告年龄为49天。无CMA的参与者中低敏配方奶粉处方的持续时间中位数为10个月（四分位间距1，16）；估计摄入量中位数为272升（26，448）。CMA过度诊断的风险因素包括上一年基层医疗实践中低敏配方奶粉的高处方率以及母亲报告孕期使用抗生素。出生后纯配方奶喂养与低敏配方奶粉处方增加有关。没有证据表明基层医疗实践中开具儿科肾上腺素自动注射器或抗反流药物，或母亲的特征如焦虑、年龄、产次和社会经济地位与CMA过度诊断有关。
CMA过度诊断在婴儿早期很常见。风险因素包括基层医疗实践中低敏配方奶粉的高处方率以及母亲报告孕期使用抗生素。
