The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

Abstract

Introduction Cow's milk allergy (CMA) is common in infants and children. Clinical presentations may vary, with a range of symptoms affecting the gastrointestinal (GI), skin and respiratory systems. Whilst the primary focus of research to date has been on the management of these symptoms, studies investigating the broader clinical burden of CMA are limited. Methods We performed a retrospective matched cohort study examining clinical data, including allergic symptoms and infections, extracted from case records within The Health Improvement Network database. A total of 6998 children (54% male) were included in the study, including 3499 with CMA (mean age at diagnosis 4.04 months) and 3499 matched controls without CMA, observed for a mean period of 4.2 years. Results GI, skin and respiratory symptoms affected significantly more children with CMA (p < .001), which recurred more often (p < .001), compared with children without CMA. More children with CMA had symptoms affecting multiple systems (p < .001). CMA was associated with a greater probability of these symptoms requiring hypoallergenic formula (HAF) prescription persisting over time (log‐rank test p < .0001, unadjusted hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.76–0.85, p < .001), with a longer median duration of symptoms and HAF prescription compared with the duration of symptoms in those without CMA (3.48 vs. 2.96 years). GI, skin, respiratory and ear infections affected significantly more children with CMA than those without, increasing by 74% (p < .001), 20% (p < .001), 9% (p < .001), and 30% (p < .001) respectively. These infections also recurred more often among children with CMA, increasing by 62% for GI infections, 37% for skin and respiratory infections, and 44% for ear infections (p < .001). Conclusions This real‐world study provides evidence to suggest that CMA presents a significant clinical burden to children, which has implications for the healthcare system. Further research is warranted to understand the health economic impact of this, and the phenotypes, factors and management approaches which may affect clinical outcomes.

The health economic impact of cow's milk allergy in childhood: A retrospective cohort study

“…Given the multitude of GI, skin and respiratory symptoms which are common in CMA, it is not surprising that the prescription rates of these medications are increased. This supports the notion of a greater clinical burden of CMA, including a recent publication, of significantly increased GI, skin and respiratory symptom rates observed among children with CMA compared to those without 30 …”

“…This supports the notion of a greater clinical burden of CMA, including a recent publication, of significantly increased GI, skin and respiratory symptom rates observed among children with CMA compared to those without. 30 …”

“… 14 Recently, significantly higher rates of GI, skin, ear and respiratory infections have been documented among children with CMA, compared to those without, increasing by 62%, 37%, 44% and 37% respectively. 30 …”

“…29 In the absence of data relating to reason for hospital admission, these costs were presented as a mean of the range of paediatric admissions costs for the most common type of infection (respiratory) documented among the cohort, reported elsewhere. 30 Unit costs for each healthcare resource were extrapolated to the respective healthcare usage rates, presented per person-year and per 5-person-years, to give an indication of CMA-associated healthcare costs over 1 year, and 5 years, of early life.…”

Pilot Study of the Applicability, Usability, and Accuracy of the Nutricate© Online Application, a New Dietary Intake Assessment Tool for Managing Infant Cow’s Milk Allergy

“…Cow’s milk allergy management has an economic impact that generates an increase in health costs due to the duplication in medical consultation between the PCP, the hospital [ 12 ], and the other health services, such as specialized nutrition [ 13 ]. Several studies have highlighted the clinical [ 14 ], population-level [ 15 ], and economic burden of cow’s milk allergy [ 11 ]. Indeed, medical consultations in a hospital setting are time-consuming for both healthcare professionals and parents.…”