National Heart and Lung Institute, Imperial College London, London, UK.
NIHR Clinical Research Network, North West Coast Primary Care Team, Liverpool, UK.
Clin Exp Allergy. 2024 Nov;54(11):909-918. doi: 10.1111/cea.14570. Epub 2024 Sep 27.
Cow's milk allergy (CMA) overdiagnosis appears to be increasing and is associated with excessive low-allergy formula prescription. We evaluated recent trends and regional variation in low-allergy formula prescribing for CMA in England, and assessed potential risk factors for higher prescribing rates.
Data on national and regional prescribing of low-allergy formulas were extracted from England's electronic prescription database using R. Region-level factors were evaluated for potential associations with regional low-allergy formula prescription rates using multivariate linear regression. Analysis of national prescribing trends covered 2007-2023, analysis of regional variation and region-level factors examined 2017-2019, prior to a re-organisation of the regional healthcare structure in England.
Low-allergy formula prescribing increased from 6.1 to 23.3 L per birth nationally, between 2007 and 2023. Regional prescribing rate varied from 0.8 to 47.6 L per birth in 2017-2019. We found significant associations between regional low-allergy formula prescribing rate and regional prescribing rates for milk feed thickeners Gaviscon Infant and Carobel Instant (β = 0.10, p < 0.01), and for other anti-reflux medications used in young children (β = 0.89 p < 0.01). Inconsistent associations were seen with prescribing junior adrenaline auto-injectors and oral antibiotics. A model including these four variables accounted for 37% of regional variation in low-allergy formula prescribing rate. Region-level socio-economic deprivation, CMA guideline recommendations and paediatric allergy service provision were not associated with low-allergy formula prescribing.
Low-allergy formula prescribing in England is increasing, varies significantly by region and is consistently associated with prescribing rates for milk feed thickeners and other anti-reflux medication for young children. Community prescribing behaviours may be important determinants of CMA overdiagnosis.
牛奶过敏（CMA）的过度诊断似乎正在增加，并与过度开具低敏配方奶粉有关。我们评估了英国 CMA 低敏配方奶粉开具的最新趋势和地区差异，并评估了更高开具率的潜在危险因素。
使用 R 从英国电子处方数据库中提取全国和地区低敏配方奶粉的处方数据。使用多元线性回归评估区域水平因素与区域低敏配方奶粉处方率的潜在关联。全国处方趋势分析涵盖 2007-2023 年，区域差异和区域水平因素分析涵盖 2017-2019 年，在此之前，英国的区域医疗保健结构进行了重组。
2007 年至 2023 年间，全国低敏配方奶粉的处方量从 6.1 升至 23.3L/出生。2017-2019 年间，各地区的处方率从 0.8 至 47.6L/出生不等。我们发现，2017-2019 年，区域低敏配方奶粉处方率与区域牛奶饲料增稠剂 Gaviscon Infant 和 Carobel Instant 的处方率（β=0.10，p<0.01）以及用于幼儿的其他抗反流药物的处方率（β=0.89，p<0.01）之间存在显著关联。与初级肾上腺素自动注射器和口服抗生素的处方存在不一致的关联。包括这四个变量的模型可以解释低敏配方奶粉处方率的 37%的区域差异。区域水平的社会经济剥夺、CMA 指南建议和儿科过敏服务提供与低敏配方奶粉的处方无关。
英国低敏配方奶粉的处方量不断增加，地区差异显著，且始终与牛奶饲料增稠剂和用于幼儿的其他抗反流药物的处方率相关。社区处方行为可能是 CMA 过度诊断的重要决定因素。
