THE MOST COMMON FOOD ALLERGY IN INFANTS (COW’S MILK ALLERGY) TAKES AROUND FOUR MONTHS TO DIAGNOSE COSTING PARENTS AND GPs TIME
Together with Allergy UK and Mead Johnson Nutrition, a new campaign has been launched called Is it Cow’s Milk Allergy, which aims to raise awareness of the symptoms of CMA and support parents with a range of tools and information which can be downloaded from www.IsItCowsMilkAllergy.co.uk
The following experts are available for interview about this campaign – Dr. Neil Shah (Paediatric Gastroenterologist at GOSH), Dr. Adam Fox (Paediatric Allergy Specialist), Dietician Sasha Watkins and also Allergy UK.
“Undiagnosed cow’s milk allergy leaves infants in distress, and puts families through unnecessary anxiety” – Allergy UK
Surveys among 300 parents1 of allergic children and 400 GPs2 find:
- A third of GPs who had diagnosed CMA in the past year estimated the incidence of CMA to be 200 times lower than the true incidence (0.01% or less2 compared to between 2% – 7.5%3)
- 31% of parents went to A&E due to their child’s CMA symptoms1
- 74% of parents said CMA takes too long to diagnose1
- Their child’s suffering left 44% of mums feeling low or depressed, and 46% of these sought medical advice1 as a result
Is It Cow’s Milk Allergy.co.uk website provides expert advice to help parents spot and understand the symptoms of CMA
[LONDON] 22nd October – A new survey1 with over 300 parents of infants diagnosed with cow’s milk allergy (CMA) reveals that it took 17 weeks to diagnose the CMA1 and involved eight visits to a healthcare professional1. This is despite the fact that, on average, their child’s symptoms started showing at six weeks old. CMA is the most common type of food allergy in young infants, affecting between 2% – 7.5% of children under one year old3.
Cow’s milk allergy: underestimated by GPs
A further survey2 conducted with 400 GPs who had diagnosed CMA within the past year indicates a disparity between their perception of CMA and that of parents: The GPs estimated CMA takes an average of nearly 8 weeks to diagnose2 – compared to the 17 weeks reported by the 300 parents surveyed1 – yet revealed an aspiration for the diagnosis period to be shortened to around 4 weeks (on average) 2.
These statistics point to a need for greater professional support and education for GPs and Health Visitors on the subject of CMA, such as education on the incidence of CMA: Of the 400 GPs who had diagnosed CMA in an infant in the past year, a third estimated the incidence to be 0.01% or less2 – far lower than the true incidence of 2% – 7.5%.
Although having an infant with CMA is often a highly stressful experience for parents, 68% of those surveyed believed that their healthcare professional, ‘Didn’t have a good level of knowledge about CMA1’ and 8 out of 10 parents did not rate their experience with GPs or Health Visitors as positive1. As acknowledged by Allergy UK, while GPs aspire to shorten the diagnosis period, they are not given adequate training on allergy and immunology
What is Cow’s Milk Allergy?
Cow’s milk allergy occurs when the immune system identifies a protein within the cow’s milk consumed as harmful, and triggers an allergic reaction. Recognising CMA can be a challenge for parents and healthcare professionals, as symptoms can vary in their severity and are diverse- including tummy pain, reluctant feeding, moderate to severe eczema, loose stools or constipation. Severe symptoms may include anaphylaxis and breathing problems.4
Symptoms of CMA are often mistaken for other common conditions such as colic and eczema caused by other conditions, they will vary from baby to baby, and can be immediate or delayed by hours or even days4 following the exposure; so it’s important to know the signs and symptoms to look out for.
In response, Mead Johnson and Allergy UK have launched the Is It Cow’s Milk Allergy? awareness campaign to help concerned parents monitor their baby and recognise the potential signs and symptoms of CMA. The website www.IsItCowsMilkAllergy.co.uk features information and a range of tools including a CMA fact sheet, symptom diary and detailed questionnaire which parents can complete and then discuss with their GP.
CMA: Who’s in Charge of Diagnosis: Primary or Secondary Care?
The UK NICE guideline on the Diagnosis and Assessment of Food Allergy in Children and Young People CG116 provides some basic guidance and support on CMA, but a new resource called the MAP guidelines5 (Milk Allergy in Primary Care) provides further clarity for GPs on if and/or when to refer infants with suspected CMA to secondary care (hospital). However, the survey with GPs2 revealed no clear consensus amongst them on this specific issue: 41% agreed with the statement, “Responsibility for diagnosis lies principally within primary care”2, but 29% disagreed. In addition, 53% said they, “Feel more comfortable involving secondary care in the diagnosis”.
On the other hand, the GP survey2 showed broad agreement on the role of Health Visitors in diagnosing CMA, with 76% agreeing that, “Health Visitors could play a much greater role in the diagnosis of CMA”2 and over half agreeing that, “Delayed diagnosis of CMA adds even more pressure to a primary care system already struggling with ever increasing demands.”2
The Costs of CMA – Time and Emotional Health
The costs of CMA are significant: 85% of the parents surveyed said their baby was in discomfort due to their unresolved symptoms1 and 31% reported having been to A&E as a result. In terms of the emotional costs, 21% reported they felt like they couldn’t bond properly with their baby and 44% of mums reported they’d felt low or depressed as a result of their baby’s CMA symptoms pre-diagnosis1, of which 46% sought advice from a healthcare professional for feelings of low mood or depression1. Not surprisingly, 51% of parents stated they couldn’t enjoy time out together as a family1 and 39% reported arguing more often1.
A Mum’s Experience
Kirstie Smith recalls her journey to diagnosis of CMA with her son, Thomas: “He was really sick, uncomfortable and in pain. It was so upsetting to see Thomas in such discomfort, and we had no idea what was wrong with him. We were going to the GP twice a week, for 7 weeks and I eventually broke down in tears in the surgery out of frustration. He became so underweight that he had to be admitted to a Special Care Unit. We finally got a diagnosis of CMA in the hospital by the dietitian and paediatrician.”
Allergy UK’s Deputy CEO, Lindsey McManus, explains, “Undiagnosed CMA leaves parents trying numerous methods to calm their child, yet in many cases, the crying and distress continue, leaving them feeling helpless, frustrated and exhausted. This puts families through unnecessary anxiety and leaves infants in distress. We want to help parents and healthcare professionals recognise potential symptoms of CMA in order to achieve the right diagnosis, and help reduce the impact of CMA on the NHS and on the lives of the patient and their family. If you’re concerned as a parent, use the support tools available such as the Is It Cow’s Milk Allergy? website and the Allergy UK helpline for further information in order to discuss your child’s symptoms with your GP.”
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1 Research conducted by Opinion Health in August 2014 amongst 300 parents with a child diagnosed with cow’s milk allergy in the past 3 years – via online survey
2 Research conducted by medeConnect in June 2014 amongst 400 GPs who had diagnosed at least one child with CMA in the past year – via online survey
3 Ludman S, Shah N and Fox A, (2013). Managing Cow’s Milk Allergy in Children. BMJ, 347:f5424. http://www.bmj.com/content/347/bmj.f5424 [Date of Access – 13.10.14]
4 Venter et al., (2013). Diagnosis and Management of Non-IgE-Mediated Cow’s Milk Allergy in Infancy – A UK Primary Care Practical Guide. Clin Transl Allergy, 3: 23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716921/ [Date of Access: 13.10.14]
5 MAP guidelines – www.ctajournal.com/content/download/figures/2045-7022-3-23-3.pdf [Date of access – 13.10.14]
6 Skripak et al., (2007) The natural history of IgE-mediated cow’s milk allergy. J Allergy Clin Immunol. Nov;120 (5):1172-7.
7 Du Toit G, Meyer R, Shah N et al. Identifying and managing cow’s milk protein allergy. Arch Dis Child Educ Pract Ed 2010;95:134-44.
8 National Institute for Health and Clinical Excellence. CG116: Food allergy in children and young people. 2011
9 Vandenplas et al., (2007) Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child 2007;92:902–908.
10 Host A: Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002, 89(6 Suppl 1):33-7.