Primary care paediatricians need better clinical support to diagnose and treat cow’s milk allergy in infants

Introduction There is a discussed need for European cow’s milk allergy (CMA)/food allergy (FA) guidelines for primary care paediatricians. To understand what such a potential support should contain to be most useful for general paediatricians, the current study asked paediatric health care practitioners around Europe how they perceive and work with CMA. We used a personally targeted, web-based, survey to identify such clinical areas within the diagnosis and treatment of CMA that may require further educational support. Methods In June 2011, 735 paediatricians from Europe and surrounding countries were personally invited via email to complete a web-based survey with 21 questions about their management of CMA in infants. Two questions had responses scored on a scale from 0-5, to indicate the strength of preference in addition to a qualitative response. Results Of the 735 invited paediatricians, 326 (44%) responded from 74 countries. 88% of all responses came from Europe, Africa or Asia (the latter two mainly represented by states close to Europe). The five most frequently responding countries (n) were: Italy (32), Russia (25), Greece (20) Macedonia (14), Croatia (14). Respondents identified themselves as Primary care paediatrician (24%), Secondary care paediatrician/specialist (33%), Tertiary care paediatrician (31%), GP (2%), Other (10%). Self-reported prevalence. CMA is believed to be both under and over diagnosed. Paediatricians were thus initially asked what percentage of their patients has food allergies, either IgE-mediated or non-IgE-mediated. Average reported frequencies indicate 25% for IgE-mediated, and 22% for non-IgE-mediated food allergies (Fig 1). The total prevalence of infants presenting with food allergies was thus potentially 47%. The prevalence rates were variable, with half of the respondents only reporting a 10% prevalence for each FA type. Although 219 (66%) experienced the prevalence had increased since 2008, the numbers found in this study are very high compared to prevalence numbers found in recent clinical studies.