Do Cow's Milk Allergy Guidelines Promote Overdiagnosis and Overtreatment?

Guidelines lack evidence to support recommendations to treat common infant symptoms (e.g., reflux, colic, or rash) as suspected cow's milk allergy.

Classic IgE-mediated cow's milk allergy (CMA) manifests quickly after ingestion of cow's milk protein. Non–IgE-mediated CMA has a variable presentation that may overlap with common infant symptoms (reflux, colic, or rash), potentially leading to overdiagnosis and overtreatment of CMA.

Investigators critically appraised all nine CMA clinical guidelines published in peer-reviewed journals since 2012 that specifically included recommendations about non–IgE-mediated CMA. The majority of guideline authors had financial ties to formula manufacturers. Regarding infants with mild common infant symptoms (reported to occur in 15%–20% of all infants), guideline recommendations are as follows:

Seven guidelines recommend considering CMA as a diagnosis, al…

Reviewing Author

James A. Feinstein, MD, MPH

Disclosures

Grant/Research SupportAgency for Healthcare Research and Quality

Editorial BoardsPediatrics

James A. Feinstein, MD, MPH

Disclosures

Grant/Research SupportAgency for Healthcare Research and Quality

Editorial BoardsPediatrics

Do Cow's Milk Allergy Guidelines Promote Overdiagnosis and Overtreatment?

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Reviewing Author