Thread by @LLLGB

.#RobertBoyle clinical reader in paediatric allergy at @imperialcollege is speaking now about Detecting and managing milk allergy in infants. Will look at modern problem of milk allegery overdiagnosis, promotion of overdiagnosis by current guidelines & new approach #bfconf

@imperialcollege #RoberBoyle: current prescription rates for low-allergy infant formula in England is running about 10 times what would be expected, big increase since about 2005-6. Overreporting for egg and peanut allergry on much, much lower scale. Similar 10 fold excess seen in Norway #bfconf

@imperialcollege #RobertBoyle: In a US study about 7-8% formula sold in 2019 was low allergy formula vs less than 1 % milk allergy rates. Cost for prescription formula to NHS are significant, about a quarter of the money spent on enteral nutrition #bfconf

@imperialcollege #RobertBoyle: can have damaging effects on breastfeeding women who incorrectly see their milk as toxic to their babies. Also, using low-energy formula increases free-sugar consumption when WHO & DHSC guidelines recommend they be less than 5-10% of total energy intake #bfconf

@imperialcollege #RobertBoyle industry is influencing milk allergy guidelines, which promote overdiagnosis. Symptoms often include all kinds of normall infant behaviour. This study found majority of babies have symptoms accordiing to iMap guideline (!) onlinelibrary.wiley.com/doi/abs/10.111… #bfconf

@imperialcollege #RobertBoyle: study Detection and management of milk allergy: Delphi consensus study - found that non-conflicted milk allergy guidance may prevent overdiagnosis onlinelibrary.wiley.com/doi/full/10.11… #bfconf

@imperialcollege #RobertBoyle Differences between previous guidelines and recommendations from study above 👆include making distinction between formula fed & breastfed babies, advising to cease low-allergy formula beyond 12 mos (vs no age limit or up to 2 years) #bfconf

@imperialcollege #RobertBoyle: we know fat content of breastmilk changes quite a lot based on kind of fat in diet, protein & carbohydrate less so. Allergens tend to be proteins. Elements of food get through to bm, can change colour, taste -> then infant behaviour (ex. feeding longer) #bfconf