Thread by @DoctorChrisVT, "When working with infants and their mothers, we need to be careful [...]

Chris van Tulleken 🏳️‍🌈

DoctorChrisVT

"When working with infants and their mothers, we need to be careful not to blindly diagnose every mewling and puking infant with #CowsMilkAllergy"
New paper by @DrMunblit et al in @JAMAPediatrics
Significant for mothers and children around the world. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2764081

Assessment of Evidence About Common Infant Symptoms and Cow’s Milk Allergy

This Special Communication provides an overview of cow’s milk allergy guideline recommendations and discusses whether they might promote cow’s milk allergy overdiagnosis or undermine breastfeeding.

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2764081

This group are extremely vulnerable to influence by industry and this paper provides data that explain clearly how mothers, their babies and their doctors are all exploited. It's very readable so I’ll share some quotes:

"Can Maternal Ingestion of Cow’s Milk Trigger Symptoms in Breastfed Infants With cows milk allergy (CMA)?" The authors look at all the available data on how much cows milk protein ends up in maternal breast milk if the mother consumes dairy.

“The probability an infant with CMA whose mother has consumed 200 to 700 mL of cow’s milk will ingest sufficient cow’s milk protein via a large breastfeed to trigger an allergic reaction is low.”

“Just 3 of 174 women (1.7%) who provided more than 600 breastmilk samples for analysis had at least 1 sample with sufficient BLG level to trigger an allergic reaction in the most sensitive 1% of infants with CMA.”

“These data suggest that for more than 99% of infants with proven CMA, breast- milk from a cow’s milk–consuming woman contains insufficient BLG to trigger an allergic reaction.”

“When industry is closely involved in education, guideline development, and dissemination, we should not be wholly surprised that trends in diagnosis and treatment favor use of their products."

"Formula manufacturers may gain from promoting increased CMA diagnosis by influencing practitioners and parents to use a specialized formula in place of a cheaper formula and by potentially undermining women’s confidence in breastfeeding."

"We need to dissociate the development and dissemination of CMA guidelines from the industries that might profit from them." Authors are from @StGeorgesUni @uwanews @UniMelbscicomm @UniofNottingham @ImperialMed

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