Randomized Controlled Trial

. 2022 Jan;52(1):82-93.

doi: 10.1111/cea.14060. Epub 2021 Dec 7.

Frequency of guideline-defined cow's milk allergy symptoms in infants: Secondary analysis of EAT trial data

Rosie Vincent^{1

2}, Stephanie J MacNeill³, Tom Marrs^{4

5}, Joanna Craven⁶, Kirsty Logan⁷, Carsten Flohr⁸, Gideon Lack^{9

10

11}, Suzana Radulovic^{4

5}, Michael R Perkin¹², Matthew J Ridd^{1

13}

Affiliations

¹ Population Health Sciences, University of Bristol, Bristol, UK.
² Dermatology, Bristol Royal Infirmary, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK.
³ Department of Medical Statistics, Bristol Trials Centre, University of Bristol, Bristol, UK.
⁴ Department of Paediatric Allergy, Children's Allergies, Evelina London, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
⁵ Department of Paediatric Allergy, Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁶ King's College London, London, UK.
⁷ Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK.
⁸ Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
⁹ Department of Paediatric Allergy, King's College London, London, UK.
¹⁰ Children's Allergy Clinical Academic Group, KHP Institute of Women and Children's Health at Evelina London, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
¹¹ Paediatric Allergy Group, Department of Women and Children's Health, Peter Gorer Department of Immunobiology, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, St Thomas' Hospital, London, UK.
¹² Population Health Research Institute, St George's, University of London, London, UK.
¹³ Department of Primary Health Care, Population Health Sciences, University of Bristol, Bristol, UK.

PMID: 34877731
DOI: 10.1111/cea.14060

Randomized Controlled Trial

Frequency of guideline-defined cow's milk allergy symptoms in infants: Secondary analysis of EAT trial data

Rosie Vincent et al. Clin Exp Allergy. 2022 Jan.

. 2022 Jan;52(1):82-93.

doi: 10.1111/cea.14060. Epub 2021 Dec 7.

Authors

Affiliations

¹ Population Health Sciences, University of Bristol, Bristol, UK.
² Dermatology, Bristol Royal Infirmary, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK.
³ Department of Medical Statistics, Bristol Trials Centre, University of Bristol, Bristol, UK.
⁴ Department of Paediatric Allergy, Children's Allergies, Evelina London, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
⁵ Department of Paediatric Allergy, Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁶ King's College London, London, UK.
⁷ Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK.
⁸ Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
⁹ Department of Paediatric Allergy, King's College London, London, UK.
¹⁰ Children's Allergy Clinical Academic Group, KHP Institute of Women and Children's Health at Evelina London, Guy's & St. Thomas' NHS Foundation Trust, London, UK.
¹¹ Paediatric Allergy Group, Department of Women and Children's Health, Peter Gorer Department of Immunobiology, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, St Thomas' Hospital, London, UK.
¹² Population Health Research Institute, St George's, University of London, London, UK.
¹³ Department of Primary Health Care, Population Health Sciences, University of Bristol, Bristol, UK.

PMID: 34877731
DOI: 10.1111/cea.14060

Abstract

Background: Non-IgE-mediated Cow's Milk Allergy (CMA) has a prevalence of less than 1% in children. Guidelines developed to help non-specialists diagnose CMA may lead to misattribution of normal symptoms and contribute to overdiagnosis of CMA. We sought to establish the frequency of symptoms during infancy associated with non-IgE-mediated CMA, using the international Milk Allergy in Primary Care (iMAP) guideline as representative of CMA guidelines more generally.

Method: Secondary analysis of the Enquiring About Tolerance (EAT) randomized controlled trial (ISRCTN 14254740; 1303 exclusively breastfed 3-month-old healthy infants). Key outcomes were ≥2 iMAP symptoms associated with 'mild-moderate' and 'severe' non-IgE-mediated CMA.

Results: Whilst breastfeeding and parental atopy rates were higher than the general population, participants were otherwise similar to the population of England and Wales. Two or more non-IgE CMA symptoms were reported by 25% families for mild-moderate and 1.4% for severe symptoms each month between ages 3 and 12 months, peaking at 38% with ≥2 mild-moderate and 4.3% ≥2 severe symptoms at three months, when participants were not directly consuming cow's milk. 74% of participants reported ≥2 mild-moderate symptoms and 9% ≥2 severe symptoms in at least one month during this period. At six months there was no evidence of difference in the proportion of children with ≥2 symptoms between those consuming (29.5% mild-moderate, 1.8% severe) and not consuming cow's milk (35.3% mild-moderate, 2.2% severe). Mean monthly reporting of ≥2 symptoms was also no different between those with (15.8% mild-moderate, 1.1% severe) or without eczema at baseline (16.7% mild-moderate, 1.3% severe).

Conclusions: Guideline-defined symptoms of non-IgE-mediated CMA are very common in infants. Guidelines may promote milk allergy overdiagnosis by labelling normal infant symptoms as possible milk allergy.

Keywords: atopic dermatitis; clinical immunology; epidemiology; food allergy; pediatrics.

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Comment in

In response to Frequency of guideline-defined cow's milk allergy symptoms in infants: Secondary analysis of EAT trial data by Vincent et al.
Martin VM, Marget M, Yuan Q, Shreffler WG. Martin VM, et al. Clin Exp Allergy. 2022 Apr;52(4):581-582. doi: 10.1111/cea.14090. Epub 2022 Mar 30. Clin Exp Allergy. 2022. PMID: 34981585 Free PMC article. No abstract available.

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Frequency of guideline-defined cow's milk allergy symptoms in infants: Secondary analysis of EAT trial data

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Frequency of guideline-defined cow's milk allergy symptoms in infants: Secondary analysis of EAT trial data

Authors

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Comment in

References

REFERENCES

Publication types

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Associated data

Grants and funding

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Full Text Sources