Trends in use of specialized formula for managing cow's milk allergy in young children

Shriya Mehta; Hilary I Allen; Dianne E Campbell; Karoline Fagerli Arntsen; Melanie Rae Simpson; Robert J Boyle

doi:10.1111/cea.14180

Trends in use of specialized formula for managing cow's milk allergy in young children

Clin Exp Allergy. 2022 Jul;52(7):839-847. doi: 10.1111/cea.14180.

Authors

Shriya Mehta¹, Hilary I Allen¹, Dianne E Campbell^{2

3}, Karoline Fagerli Arntsen⁴, Melanie Rae Simpson^{4

5}, Robert J Boyle¹

Affiliations

¹ National Heart and Lung Institute, Imperial College London, London, UK.
² Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³ Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁴ Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Clinic of Laboratory Medicine, St Olav's Hospital, Trondheim, Norway.

PMID: 35643986
DOI: 10.1111/cea.14180

Abstract

Background: Excessive use of specialized formula for cow's milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialized formula products, especially amino-acid formula (AAF), have high free sugars content. We evaluated specialized formula trends in countries with public databases documenting national prescription rates.

Methods: Cross-sectional analysis of national prescription databases in the United Kingdom, Norway and Australia. Outcomes were volume and cost of specialized formula, and proportion of infants prescribed specialized formula. Expected volumes assumed 1% cow's milk allergy incidence and similar formula feeding rates between infants with and without milk allergy.

Results: Prescribed volumes of specialized formula for infants rose 2.8-fold in England from 2007 to 2018, with similar trends in other regions of the United Kingdom. Volumes rose 2.2-fold in Norway from 2009 to 2020 and 3.2-fold in Australia from 2001 to 2012. In 2020, total volumes were 9.7- to 12.6-fold greater than expected in England, 8.3- to 15.6-fold greater than expected in Norway and 3.3- to 4.5-fold greater than expected in Australia, where prescribing restrictions were introduced in 2012. In Norway, the proportion of infants prescribed specialized formula increased from 2.2% in 2009 to 6.9% in 2020, or 11.2- to 13.3-fold greater than expected. In 2020, specialized formula for infants cost US$117 (103 euro) per birth in England, US$93 (82 euro) in Norway and US$27 (23 euro) in Australia. Soya formula prescriptions exceeded expected volumes 5.5- to 6.4-fold in England in 1994 and subsequently declined, co-incident with public health concerns regarding soya formula safety. In 2020, 30%-50% of prescribed specialized formula across the three countries was AAF.

Conclusions: In England, Norway and Australia, specialized formula prescriptions increased in the early 21st century and exceeded expected levels. Unnecessary specialized formula use may make a significant contribution to free sugars consumption in young children.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Cattle
Child, Preschool
Cross-Sectional Studies
England
Female
Humans
Infant
Infant Formula
Milk Hypersensitivity* / diagnosis
Milk Hypersensitivity* / epidemiology
Milk Hypersensitivity* / etiology
Sugars

Substances

Sugars