Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：幼儿的牛奶过敏（CMA）过度诊断似乎正在增加，并且尚未得到很好的表征。我们使用临床试验人群来描述CMA过度诊断，并确定个人水平和初级保健实践水平的风险因素。
方法：我们分析了2014-2016年在英国出生的1394名儿童的数据(BEEP试验，ISRCTN21528841)。参与者在≤2年时接受了正式的CMA诊断。CMA过度诊断有三种不同的定义：父母报告的牛奶反应；牛奶过敏症状的初级护理记录；和低过敏配方处方的初级护理记录。
结果：CMA在19名（1.4%）参与者中得到了正式诊断。CMA过度诊断很常见：16.1％的父母报告有牛奶过敏，11.3％的初级保健记录了牛奶过敏，而8.7％的患者有低过敏配方处方。在没有CMA的参与者中，归因于牛奶超敏反应的症状通常是胃肠道症状，中位年龄为49天。在没有CMA的参与者中，低过敏配方处方的中位数为10个月（四分位数范围1,16）;估计消耗的体积为中位数272升（26,448）。CMA过度诊断的危险因素是前一年的高实践低过敏配方处方和孕妇在怀孕期间的抗生素处方报告。从出生开始的独家配方喂养与低过敏配方处方的增加有关。没有证据表明处方使用儿科肾上腺素自动注射器或抗反流药物，或者焦虑等母性特征，年龄,产次和社会经济状况与CMA过度诊断相关.
结论：CMA过度诊断常见于婴儿早期。风险因素包括高初级保健实践为基础的低过敏配方处方和母亲报告的抗生素处方在怀孕期间。
方法：我们分析了2014-2016年在英国出生的1394名儿童的数据(BEEP试验，ISRCTN21528841)。参与者在≤2年时接受了正式的CMA诊断。CMA过度诊断有三种不同的定义：父母报告的牛奶反应；牛奶过敏症状的初级护理记录；和低过敏配方处方的初级护理记录。
结果：CMA在19名（1.4%）参与者中得到了正式诊断。CMA过度诊断很常见：16.1％的父母报告有牛奶过敏，11.3％的初级保健记录了牛奶过敏，而8.7％的患者有低过敏配方处方。在没有CMA的参与者中，归因于牛奶超敏反应的症状通常是胃肠道症状，中位年龄为49天。在没有CMA的参与者中，低过敏配方处方的中位数为10个月（四分位数范围1,16）;估计消耗的体积为中位数272升（26,448）。CMA过度诊断的危险因素是前一年的高实践低过敏配方处方和孕妇在怀孕期间的抗生素处方报告。从出生开始的独家配方喂养与低过敏配方处方的增加有关。没有证据表明处方使用儿科肾上腺素自动注射器或抗反流药物，或者焦虑等母性特征，年龄,产次和社会经济状况与CMA过度诊断相关.
结论：CMA过度诊断常见于婴儿早期。风险因素包括高初级保健实践为基础的低过敏配方处方和母亲报告的抗生素处方在怀孕期间。
