{Reference Type}: Journal Article
{Title}: Prevalence and risk factors for milk allergy overdiagnosis in the BEEP trial cohort.
{Author}: Allen HI;Wing O;Milkova D;Jackson E;Li K;Bradshaw LE;Wyatt L;Haines R;Santer M;Murphy AW;Brown SJ;Kelleher M;Perkin MR;Jay N;Smith TDH;Moriarty F;Montgomery AA;Williams HC;Boyle RJ;
{Journal}: Allergy
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 20
{Factor}: 14.71
{DOI}: 10.1111/all.16203
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.