“…Of the 28 OFCs performed n = 6 were negative. A total of n = 22 tests were inconclusive when checked for adherence with the current guideline [ 3 ], or adherence was unclear due to inadequate reporting. Of the 22 inconclusive results six were interpreted as positive by the clinician involved.…”
Section: Resultsmentioning
confidence: 99%
“…Reasons for OFCs not being in adherence with guideline recommendations were (a) the suspicion of CMA not being substantial enough to warrant OFC [ 3 ], (b) not all test phases were (completely) performed, and (c) appearance or disappearance of complaints in the several phases of OFC was not documented. In summary, none of the infants had a positive DBPCFC or OFC entirely reported as performed according the guideline (Figure 2 ) [ 3 ]. Figure 2 Flow chart: Infants which followed a diet and/or open food challenge.…”
Section: Resultsmentioning
confidence: 99%
“…According to the current guideline "Food Hypersensitivity" an OFC is correctly conducted when the following phases have been conducted: (a) symptoms are assessed at start of elimination and at start and end of the provocation phase (b) the test was continued for at least one week in case of mild symptoms during provocation (red stains around the mouth, crying or mild eczema) (c) the test was interpreted as positive only when original symptoms returned after provocation and again disappeared after re-elimination. For each OFC the recorded procedures for each phase were assessed to evaluate whether guideline recommendations had been followed [ 3 ]. Finally, dietary measures were recorded (types of milk formulas prescribed).…”
Section: Methodsmentioning
confidence: 99%
“…In primary care in the Netherlands the recommended diagnostic work-up for children with suspected CMA at the time of our study was an open food challenge (OFC), before starting long term diet. The consecutive steps of an OFC are described in detail in the current guideline "Food Hypersensitivity" issued by the Dutch College of General Practitioners (2010) [ 3 ]: elimination phase, provocation phase, and re-elimination of cow’s milk. When symptoms disappear after elimination, appear again after provocation, and subsequently disappear again after re-elimination a positive diagnosis of CMA is established.…”
Section: Introductionmentioning
confidence: 99%
“…An (unjustified) CMA diagnosis may have major impact both medically (somatisation, dietary deficiencies, growth delay etc.) [ 3 , 4 , 7 ] and economically (1500–2500 Euros per suspected patient in the first year after initial presentation [ 8 , 9 ]). In the Dutch primary health care system management of suspected CMA is a shared responsibility by the GP and the preventive child healthcare (PCH).…”
BackgroundCow’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.MethodsA 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.ResultsOf 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.ConclusionOn 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.
“…Of the 28 OFCs performed n = 6 were negative. A total of n = 22 tests were inconclusive when checked for adherence with the current guideline [ 3 ], or adherence was unclear due to inadequate reporting. Of the 22 inconclusive results six were interpreted as positive by the clinician involved.…”
Section: Resultsmentioning
confidence: 99%
“…Reasons for OFCs not being in adherence with guideline recommendations were (a) the suspicion of CMA not being substantial enough to warrant OFC [ 3 ], (b) not all test phases were (completely) performed, and (c) appearance or disappearance of complaints in the several phases of OFC was not documented. In summary, none of the infants had a positive DBPCFC or OFC entirely reported as performed according the guideline (Figure 2 ) [ 3 ]. Figure 2 Flow chart: Infants which followed a diet and/or open food challenge.…”
Section: Resultsmentioning
confidence: 99%
“…According to the current guideline "Food Hypersensitivity" an OFC is correctly conducted when the following phases have been conducted: (a) symptoms are assessed at start of elimination and at start and end of the provocation phase (b) the test was continued for at least one week in case of mild symptoms during provocation (red stains around the mouth, crying or mild eczema) (c) the test was interpreted as positive only when original symptoms returned after provocation and again disappeared after re-elimination. For each OFC the recorded procedures for each phase were assessed to evaluate whether guideline recommendations had been followed [ 3 ]. Finally, dietary measures were recorded (types of milk formulas prescribed).…”
Section: Methodsmentioning
confidence: 99%
“…In primary care in the Netherlands the recommended diagnostic work-up for children with suspected CMA at the time of our study was an open food challenge (OFC), before starting long term diet. The consecutive steps of an OFC are described in detail in the current guideline "Food Hypersensitivity" issued by the Dutch College of General Practitioners (2010) [ 3 ]: elimination phase, provocation phase, and re-elimination of cow’s milk. When symptoms disappear after elimination, appear again after provocation, and subsequently disappear again after re-elimination a positive diagnosis of CMA is established.…”
Section: Introductionmentioning
confidence: 99%
“…An (unjustified) CMA diagnosis may have major impact both medically (somatisation, dietary deficiencies, growth delay etc.) [ 3 , 4 , 7 ] and economically (1500–2500 Euros per suspected patient in the first year after initial presentation [ 8 , 9 ]). In the Dutch primary health care system management of suspected CMA is a shared responsibility by the GP and the preventive child healthcare (PCH).…”
BackgroundCow’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.MethodsA 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.ResultsOf 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.ConclusionOn 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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
