Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence

Sharayke C T A van den Hoogen, Alma C van de Pol, Yolanda Meijer, Jaap Toet, Céline van Klei, Niek J de Wit
2014 BMC Research Notes  
Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for
more » ... information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Results: Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. Conclusion: On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.
doi:10.1186/1756-0500-7-507 pmid:25106066 pmcid:PMC4266904 fatcat:imdx3pac7bdlrb7dh6rxbznxjy