Cow's Milk Protein Allergy (CMPA) typically presents in the first year of life and most infants develop a tolerance to cow's milk proteins after about six months or at around 9-12 months of age. The estimated population prevalence varies between 1.8% and 7.5% of infants although it is believed that it is often overdiagnosed. National figures suggest that the Tees Valley region has one of the highest CMPA prescribing rates. This project aimed analyse and address this variation.
In this project, a team of practice-based pharmacists have carried out 964 in-depth reviews of infants' CMPA milk prescriptions and, where appropriate, provided parents with support to rechallenge or reintroduce cow's milk or plant-based milk into the baby's diet, in line with local guidance.
The project identified that CMPA specialist milk formula is being initiated by a range of healthcare professionals from different provider organisations, including GPs, dietitians, health visitors and paediatricians. Consequently, there appeared to be a lack of clarity as to who is responsible for patient follow-up and deprescribing, as well as prescribers' training needs on CMPA prescribing and where to access supporting materials such as the 'Milk Allergy in Primary Care' (MAP) Milk Ladder. A significant proportion of infants were started first line on an amino-acid formula (AAF) which should be reserved for those who are not responding to extensively hydrolysed formula (EHF). In addition, only 18% of babies were rechallenged with cow's milk products after around 4 weeks to confirm the CMPA diagnosis. Delays in weaning infants off CMPA milk formula was reflected in that 64% of infants on CMPA milk formula were older than 12 months. The findings also highlighted the importance of good parent/carer counselling on what CMPA is and how and how long the specialist formula should be used.
