title: Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional 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.
  
  
  CONCLUSIONS
  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.
authors.forename: Sharayke C T A
authors.initials: SC
authors.lastname: van den Hoogen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room Str 6,131 Postbus 85500, 3508 Utrecht, GA, The Netherlands. A.C.vandePol-5@umcutrecht.nl.
authors.forename: Alma C
authors.initials: AC
authors.lastname: van de Pol
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Meijer
authors.forename: Jaap
authors.initials: J
authors.lastname: Toet
authors.forename: Céline
authors.initials: C
authors.lastname: van Klei
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
mesh_terms: D000818:Animals; D002417:Cattle; D058006:General Practice; D006801:Humans; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000178:diet therapy; D009426:Netherlands; D010349:Patient Compliance; D012189:Retrospective Studies
references.citation: JAMA. 2010 May 12;303(18):1848-56
references.pmid: 20460624
references.citation: Ned Tijdschr Geneeskd. 2013;157(38):A6311
references.pmid: 24050447
references.citation: J Med Econ. 2010;13(2):273-83
references.pmid: 20469979
references.citation: Scand J Prim Health Care. 1986 Feb;4(1):43-50
references.pmid: 3961309
references.citation: Eur J Pediatr. 2009 Aug;168(8):891-6
references.pmid: 19271238
references.citation: Pediatr Allergy Immunol. 2010 Jul;21 Suppl 21:1-125
references.pmid: 20618740
references.citation: J Med Econ. 2010 Mar;13(1):119-28
references.pmid: 20092426
references.citation: J Allergy Clin Immunol. 2006 May;117(5):1118-24
references.pmid: 16675341