Time Trends, Regional Variation and Associations of Low-Allergy Formula Prescribing in England

IF 6.3 2区医学 Q1 ALLERGY Clinical and Experimental Allergy Pub Date : 2024-09-27 DOI:10.1111/cea.14570

Karen H. T. Li, Olivia Wing, Hilary I. Allen, Timothy D. H. Smith, Frank Moriarty, Robert J. Boyle

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Abstract

Background

Cow's milk allergy (CMA) overdiagnosis appears to be increasing and is associated with excessive low-allergy formula prescription. We evaluated recent trends and regional variation in low-allergy formula prescribing for CMA in England, and assessed potential risk factors for higher prescribing rates.

Methods

Data on national and regional prescribing of low-allergy formulas were extracted from England's electronic prescription database using R. Region-level factors were evaluated for potential associations with regional low-allergy formula prescription rates using multivariate linear regression. Analysis of national prescribing trends covered 2007–2023, analysis of regional variation and region-level factors examined 2017–2019, prior to a re-organisation of the regional healthcare structure in England.

Results

Low-allergy formula prescribing increased from 6.1 to 23.3 L per birth nationally, between 2007 and 2023. Regional prescribing rate varied from 0.8 to 47.6 L per birth in 2017–2019. We found significant associations between regional low-allergy formula prescribing rate and regional prescribing rates for milk feed thickeners Gaviscon Infant and Carobel Instant (β = 0.10, p < 0.01), and for other anti-reflux medications used in young children (β = 0.89 p < 0.01). Inconsistent associations were seen with prescribing junior adrenaline auto-injectors and oral antibiotics. A model including these four variables accounted for 37% of regional variation in low-allergy formula prescribing rate. Region-level socio-economic deprivation, CMA guideline recommendations and paediatric allergy service provision were not associated with low-allergy formula prescribing.

Conclusions

Low-allergy formula prescribing in England is increasing, varies significantly by region and is consistently associated with prescribing rates for milk feed thickeners and other anti-reflux medication for young children. Community prescribing behaviours may be important determinants of CMA overdiagnosis.

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英格兰低过敏配方奶粉处方的时间趋势、地区差异和关联。

背景：牛奶过敏（CMA）的过度诊断率似乎正在上升，这与过多的低敏配方奶粉处方有关。我们评估了英格兰针对 CMA 的低敏配方奶粉处方的最新趋势和地区差异，并评估了处方率较高的潜在风险因素：使用多变量线性回归法评估了地区级因素与地区低过敏配方奶粉处方率的潜在关联。对2007-2023年全国处方趋势进行了分析，对2017-2019年（英格兰地区医疗结构重组之前）的地区差异和地区级因素进行了分析：2007年至2023年间，全国低过敏配方奶粉处方量从每胎6.1升增至23.3升。2017-2019 年，地区处方率从每名新生儿 0.8 升到 47.6 升不等。我们发现，地区低过敏配方奶粉处方率与奶粉增稠剂佳维乐婴儿配方奶粉和卡乐宝速溶配方奶粉的地区处方率之间存在明显关联（β = 0.10，p 结论：地区低过敏配方奶粉处方率与奶粉增稠剂佳维乐婴儿配方奶粉和卡乐宝速溶配方奶粉的地区处方率之间存在明显关联：英格兰的低过敏配方奶粉处方量在不断增加，各地区的差异很大，而且与幼儿奶粉增稠剂和其他抗反流药物的处方率始终相关。社区处方行为可能是 CMA 过度诊断的重要决定因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Allergy 医学-过敏

CiteScore

10.40

自引率

9.80%

发文量

189

审稿时长

3-8 weeks

期刊介绍： Clinical & Experimental Allergy strikes an excellent balance between clinical and scientific articles and carries regular reviews and editorials written by leading authorities in their field. In response to the increasing number of quality submissions, since 1996 the journals size has increased by over 30%. Clinical & Experimental Allergy is essential reading for allergy practitioners and research scientists with an interest in allergic diseases and mechanisms. Truly international in appeal, Clinical & Experimental Allergy publishes clinical and experimental observations in disease in all fields of medicine in which allergic hypersensitivity plays a part.