Supplementary Material for: Practice of the Treatment of Milk Allergy in the UK: A National Audit

Background: The management of cow's milk allergy (CMA) includes initial dairy exclusion with suitable dietary substitution, diagnostic challenges where indicated, and supervised re-introduction as the condition resolves. Information on clinician practice is limited. We audited the current practice of clinicians in the UK to evaluate adherence to international guidelines. Methods: An online questionnaire was sent to all clinicians whose practice included children identified on the national allergy society website. One hundred and sixty questionnaires were sent and 116 (73%) responded. Results: Skin prick tests were more commonly used than serum-specific IgE as diagnostic tests. Respective proportions selecting amino acid formulas (AAF) or extensively hydrolysed formulas (EHF) in severe versus mild/moderate presentations were 78 and 40% versus 20 and 88%; soya formula was the first choice in 8.6 and 24%. The criteria for selection of AAF as the first choice were predominantly severe IgE-mediated and non-IgE-mediated reactions, failure to thrive and if infants refused EHF. Oral challenges might be used to diagnose CMA in 69%, whereas nearly 90% performed challenges to assess tolerance. Most of these were open challenges, more commonly with fresh milk (90%) than baked milk (60%). Home baked milk challenges were frequently considered (70%), although only after consideration of the clinical scenario. Practice did not vary with experience. Conclusions: Current practice amongst UK clinicians of the management of CMA is broadly in line with current guidance, particularly the positioning of hypoallergenic milks as substitute milk choices. A notable deviation was the use of home baked milk challenges or re-introduction.背景：牛乳过敏（Cow's Milk Allergy, CMA）的管理方案涵盖初始牛乳回避联合适宜膳食替代、必要时开展诊断难点排查，以及在病情缓解时实施医护监督下的再引入疗法。目前关于临床医师诊疗实践的相关信息较为有限。本研究对英国临床医师的当前诊疗实践开展审计，以评估其对国际指南的依从性。 方法：向英国国家过敏学会官网公示的接诊牛乳过敏患儿的所有临床医师发放在线问卷。本次共发放问卷160份，回收有效应答116份，应答率为73%。 结果：诊断检测中，皮肤点刺试验（Skin prick test）的使用率高于血清特异性IgE（serum-specific IgE）检测。针对重症与轻中度病例，分别选用氨基酸配方（amino acid formulas, AAF）或深度水解配方（extensively hydrolysed formulas, EHF）的比例依次为78%、40%与20%、88%；大豆配方作为首选替代乳的比例分别为8.6%与24%。临床医师将氨基酸配方作为首选方案的判定标准主要包括严重IgE介导与非IgE介导的过敏反应、生长发育迟缓，以及婴儿无法耐受深度水解配方。69%的医师可能采用口服激发试验诊断CMA，近90%的医师会通过激发试验评估患儿的耐受情况。其中多数为开放式激发试验，使用鲜牛乳的比例（90%）高于烘焙牛乳（60%）。家庭烘焙牛乳激发试验常被纳入考量（70%），但仅在综合评估临床场景后才会实施。医师的诊疗实践未随从业经验产生显著差异。 结论：当前英国临床医师针对CMA的管理实践整体符合现行指南要求，尤其是低致敏性牛乳作为替代乳的推荐使用原则。但存在一处显著偏差：即采用家庭烘焙牛乳激发试验或再引入疗法。