Identifying possible cow's milk protein allergy in children < 2 years.
Research type
Research Study
Full title
Can a parental pre-completed allergy-focused history questionnaire aid in the identification of children with possible cow's milk protein allergy in primary care?
IRAS ID
207339
Contact name
Rosan Meyer
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
1 years, 1 months, 0 days
Research summary
This is a pilot study that aims to establish whether a parent-completed questionnaire of symptoms will help general practitioners (GPs) identify possible cow's milk protein allergy (CMPA) in children.
CMPA is the most common food allergy in children in the UK. Research on the diagnosis of CMPA in primary care has shown that this condition is poorly understood by GPs, and that parents with affected children are unhappy with its current management in primary care.
Diagnosis of CMPA by GPs in primary care is suboptimal, with significant under diagnosis, incorrect diagnosis and delays in diagnosis. Furthermore, GPs have expressed dissatisfaction with their ability to identify children with possible CMPA, and feel they require more support with this. Knowledge of the difficulties faced in diagnosing CMPA in primary care prompted the development of a symptom-based questionnaire, with the help of focus groups involving parents and health professionals. This questionnaire is intended to be completed by parents of children with possible symptoms of CMPA identified by their GP or health visitor, and covers the symptoms the child is experiencing. Parents will bring this completed questionnaire to the GP appointment for further assessment of their child. The questionnaire is intended to be used as a diagnostic aid by GPs to help them identify children with possible CMPA. The use of this questionnaire has not so far been tested in primary care.
This study aims to assess the use of this parental pre-completed CMPA questionnaire in children aged between 0-2 years in 2 GP practices in Bristol over the period of one year. It aims to obtain preliminary data on whether this questionnaire may improve GPs current practice of identifying children with suspected CMPA. Qualitative analysis of parents’ and GPs’ views of the value and effectiveness of this questionnaire will also be conducted through interviews.
Lay Summary of study results:
Introduction
The difficulties of identifying children with possible cow’s milk protein allergy in primary care are well recognised, with research showing it is poorly understood by general practitioners, and that parents feel there is a lack of understanding of it in primary care.
This study aims to establish whether a parental pre-completed questionnaire of symptoms associated with cow’s milk protein allergy is useful for parents, and aids general practitioners in the identification of children < 2 years of age with possible cow’s milk protein allergy.Methods
This study recruited 15 general practitioners and 30 parents of children with possible symptoms of cow’s milk protein allergy from 3 general practices in Bristol, England. Parents brought a pre-completed symptom questionnaire to their child’s consultation for review by the doctor. Following this, semi-structured qualitative interviews were employed to elicit the views of both general practitioners and parents about the usefulness of the questionnaire in clinical practice, and when assessing children with possible cow’s milk protein allergy. Interviews were audio-recorded, transcribed verbatim and analysed using the constant comparative method to identify key themes.Results
General practitioners overall favoured the questionnaire and reported that it was beneficial to their assessment in various ways; by saving time during the consultation, reducing time taken to initiate treatment or refer to secondary care, potentially reducing mis-diagnosis and delays in diagnosis, and having a positive impact on the doctor-patient relationship. However, doctors expressed concern that the questionnaire may inadvertently lead parents to believe their child had cow’s milk protein allergy. Parents reported a positive impact on the consultation by helping them express their concerns and ideas more clearly to the doctor, encouraging engagement with their child’s management, and assisting the doctor with the assessment of their child. The majority of general practitioners and parents (93% and 90% respectively) would consider using this questionnaire in the future.Conclusion
This symptom questionnaire may be of use as a potential diagnostic aid for general practitioners in the assessment of children < 2 years with possible cow’s milk protein allergy.REC name
London - Surrey Borders Research Ethics Committee
REC reference
16/LO/2087
Date of REC Opinion
3 Jan 2017
REC opinion
Further Information Favourable Opinion