Milk allergy guidelines for infants in England promote over-diagnosis: A cross-sectional survey

Diagnosis of cow’s milk allergy (CMA) in infants is based on reproducible symptoms and absence of symptoms on elimination of cow’s milk protein.1,2 Previous research has raised concerns that CMA guidelines published by national or international organisations could be driving CMA overdiagnosis.1 Personal testimonies by mothers suggest that a diagnosis of suspected CMA may reduce breastfeeding confidence, especially when maternal dietary restrictions are advised,2 and the potential for this to lead to cessation of breastfeeding has been suggested by earlier comments by experts in the fields of breastfeeding and CMA.2,3 Dietary restrictions are not likely to be needed for most breastfed infants with CMA, since quantities of cow’s milk protein transferred to the infant via breastmilk are much smaller than thresholds of reactivity in children with CMA.