Guidelines may facilitate overdiagnosis of infant milk allergies

International milk allergies in primary care guidelines may promote overdiagnosis by labeling normal infant symptoms as potentially milk allergies. Clinical and allergies..

“We investigated the frequency of symptoms associated with milk allergy in children without IgE, which is related to the guidelines,” the author said. Rosie Vincent, MBChB, A clinical fellow in dermatology at the Royal Hospital of Bristol told Healio.

“This study was facilitated by increasing the diagnosis of non-IgE-mediated milk allergies and increasing the prescription of infant formula, despite a true prevalence of about 1%,” the university said. Vincent, who is also an Honorary Clinical Research Fellow, said. Bristol.

Researchers performed a secondary analysis of the data from Inquiries about Tolerance (EAT) researchWe investigated whether early introduction of allergic foods into the diet of babies reduces the risk of developing allergies to those foods.

The 1,303 healthy infants in the cohort were fully breastfed until at least 3 months of age. Researchers randomly assigned them to the Standard Deployment Group (SIG) or the Early Deployment Group (EIG).

Infants in the EIG group were introduced to six allergic foods, including milk, along with breastfeeding. Infants in the SIG Group were completely breastfed until about 6 months of age.

Researchers saw babies on clinic visits at 3 and 12 months. Parents also answered monthly questionnaires about the baby’s general health and intake of allergic foods until the baby was 12 months old.

The questionnaire asked parents if their baby had any side effects on food, such as eczema, respiratory problems, or gastrointestinal problems since the 3-month assessment or since the previous questionnaire.

According to the International Milk Allergy (iMAP) Guidelines for Primary Care, among the mild to moderate symptoms of milk allergy not mediated by IgE, colic, reflux, food refusal or aversion, diarrhea, constipation, pruritus, rash, atopic dermatitis. Is identified. Symptoms of severe allergies include diarrhea, vomiting, abdominal pain, blood and mucus in the stool, and severe atopic dermatitis.

“The main finding in this study is how common the symptoms mentioned in the iMAP guidance on non-IgE-mediated milk allergies are,” said Vincent.

Specifically, 25% of families reported two or more mild to moderate non-IgE milk allergic symptoms each month between 3 and 12 months, and 1.4% reported severe symptoms. .. Researchers say these numbers peaked at 3 months of age (mild to moderate, 38%, severe, 4.2%) when the baby was not yet consuming milk.

By 12 months of age, 73.6% of babies experienced multiple mild to moderate symptoms and 9.3% experienced multiple severe symptoms in at least one month.

Monthly average reports of milk-related symptoms ranged from 0.2% for bloody stools to 45.8% for vomiting and peaked at 3 months in 78.1% for infants, with an average monthly report of 2.2% for 3-12 months. Reached.

Colic, vomiting, and abdominal discomfort were most common at 3 months of age and decreased with age, but food reversal and disgust increased in the first 12 months. Diarrhea and constipation also increased in infancy, but skin symptoms were more stable.

Few participants reached the threshold for severe symptoms of Milk allergy, Abdominal pain reaches the highest rate of 13.1% in 3 months. The most severe symptoms were reported to have a prevalence of 1% to 2% per month.

However, only 0.6% (n = 7 of 1,166) of EAT participants, including 0.7% (n = 4 of 597) and 0.5% (n = 4 of 597) of the SIG Group, go through IgE by age 3. I was finally diagnosed with a milk allergy. EIG group n = 569 3).

“These findings suggest that the majority of children with these symptoms do not have a milk allergy,” Vincent said.

At 6 months, researchers found that between children consuming and not consuming milk (29.5% vs. 35.3%), or with and without eczema at baseline (15.8). We observed that there was no difference in the proportion of children with two or more mild to moderate symptoms. % Vs. 16.7%). This lack of difference persisted when researchers examined infants with two or more severe symptoms (milk consumption vs. no consumption, 2.2% vs. 1.1%; eczema, 1.1% vs. 1.3%).

Researchers warn that robust data needs to support guidelines to prevent the harm of overdiagnosis beyond the oversight and delay of milk allergy diagnosis aimed at prevention.

“Physicians should use this evidence as a reference. The frequency of these symptoms is found in the representative group of normal and healthy babies. Physicians also medicalize the symptoms of normal babies. Such guidelines need to be carefully interpreted to avoid.

Researchers should also not over-interpret mild, transient, or isolated symptoms and consider diagnosis if the symptoms are multiple, significant, persistent, or refractory. I said there is. Researchers should continue to encourage parents to understand the normality of common infant symptoms.

“It’s important not to plant seeds of suspected milk allergies unless you have a good reason. Doctors take IgE without considering whether the baby may be experiencing normal infantile symptoms. You need to be careful not to use the guidelines for non-mediated milk allergies, “says Vincent.

Research in this area should continue, Vincent added.

“In the absence of a simple diagnostic test for non-IgE milk allergies, further research is needed to identify which combination of symptoms is specific and sensitive to the condition,” she said.

For more information:

Rosie Vincent, MBChB, Can be reached with [email protected] Or on Twitter @ RosieVince.