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Overdiagnosis and industry influence: how cow’s milk protein allergy is extending the reach of infant formula manufacturers

BMJ 2018; 363 doi: (Published 05 December 2018) Cite this as: BMJ 2018;363:k5056

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  1. Chris van Tulleken, honorary senior lecturer, University College London, UK
  1. crvantulleken{at}

The condition may be helping the baby milk industry to form relationships with the paediatric profession, finds Chris van Tulleken— with potential for harm to mothers and children

Allergy to cow’s milk protein may be acting as a Trojan horse for the $50bn (£40bn; €44bn) global formula industry to forge relationships with healthcare professionals in the UK and around the world.1 Experts believe these relationships are harmful to the health of mothers and their children, creating a network of conflicted individuals and institutions that has wide ranging effects on research, policy, and guidelines. Potential overdiagnosis of the allergy can also have negative effects on breast feeding.

Between 2006 and 2016, prescriptions of specialist formula milks for infants with cow’s milk protein allergy (CMPA) increased by nearly 500% from 105 029 to over 600 000 a year,2 while NHS spending on these products increased by nearly 700% from £8.1m to over £60m annually.3 Epidemiological data give no indication of such a large increase in true prevalence45—and the extensive links between the formula industry and the research, guidelines, medical education, and public awareness efforts around CMPA have raised the question of industry driven overdiagnosis.

Nigel Rollins from the World Health Organization’s department of maternal, newborn, child, and adolescent health tells The BMJ, “It’s reasonable to question whether these [prescription and spending] increases reflect a true increase in prevalence.”

Guideline proliferation and competing interests

Clinical guidelines propose two main types of CMPA,6789 which can overlap. Immunoglobulin E (IgE) mediated reactions have rapid onset symptoms and the diagnosis can be confirmed with testing. In non-IgE mediated CMPA, symptoms are slower onset and non-specific so diagnosis can be made only with a trial of dietary exclusion followed by reintroduction.9 Many clinicians who spoke to The BMJ are concerned that these …

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