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Management of cow’s milk protein allergy in primary care


The incidence of Cow's Milk Protein Allergy ( CMPA ) is increasing in the United Kingdom. However, many practitioners in primary care are unsure about its diagnosis and management. There is usually a lag period of a few months, between the first presentation of children with CMPA to their General Practitioner ( GP ), and referral to an Allergist. Enfield area comprises a middle-class, and relatively affluent population of London.


To identify the factors that influence CMPA primary care management and referral practice, in Enfield area in London.


A web-based questionnaire was completed by 46 General Practitioners in Enfield area, in January, 2010.


87% of the respondents felt that children with suspected CMPA, should be seen by an Allergist within 4 weeks from the date of referral. 54.3% of the GPs said that they referred children to a Paediatric Allergist, after a trial of extensively hydrolysed or aminoacid formula milk. The most popular milk substitutes in primary care in Enfield are Nutramigen (60.9%), Soya milk (52.2%), Neocate (47.8%) and Peptijunior (17.4%). 82.6% GPs said they prescribe Epipen (Adrenaline autoinjector) for life threatening allergic symptoms. With regards to referral to a Paediatric Dietitian, 34.8% GPs said they refer less than 25% cases of CMPA, whereas 43.5% GPs refer over 75% children with CMPA. GPs got information about management of CMPA primarily from Paediatricians (71.7%), while a significant number also accessed journals (52.2%) and the internet (50.0%).


The management of CMPA in primary care in Enfield is not consistent, and dependent upon the individual GPs. We have initiated the formulation and dissemination of a local guideline, to enable practitioners in primary care to refer children with suspected CMPA to the Allergy clinic.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Bakshi, D., Pollock, I. Management of cow’s milk protein allergy in primary care. Clin Transl Allergy 1 (Suppl 1), P40 (2011).

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