Specialized infant formula prescriptions skyrocket, as researchers flag 90% are unnecessary

08 Jul 2022 --- Specialized infant formula is “excessively” prescribed for cow milk allergies; according to a study, warning this could have a long-term impact on tooth decay and obesity.

The study, published in Clinical and Experimental Allergy, found that prescriptions rose 3.2 fold in Australia from 2001 to 2012, 2.8 fold in England from 2007 to 2018 and 2.2 fold in Norway from 2009 to 2020. 

“The most surprising finding was that the volume of specialized formula prescribed was up to ten-fold greater than expected, and this is despite no evidence for an increase in milk allergy incidence in the countries studied,” Dr. Hilary Allen, researcher and Ph.D. student, Imperial College London, tells NutritionInsight.

“The main implications of our findings are that most infants prescribed specialized formula do not have a milk allergy and that nine out of ten prescriptions of specialized formula are unnecessary.”

In total, by 2020, prescriptions for specialized formula had increased 3.3-to 4.5-fold greater than expected in Australia, 9.7-to 12.6-fold greater than expected in England and 8.3-to 15.6-fold greater than expected in Norway.

Consequences of overdiagnosisOverprescription of specialized formulas may cause tooth decay and lead to childhood obesity.
Overprescribing specialized formula could have significant long-term effects, according to the study. Many specialized formulas either completely or partially replace the naturally occurring lactose in cow’s milk or breastmilk with sucrose or glucose, Allen explains.

“The long-term consequences of prescribing unnecessary specialized formula are unknown,” Allen continues. 

“Specialized formula replaces lactose with less healthy carbohydrate alternatives, called free sugars. Unnecessary specialized formula use may increase free sugar consumption in young children. It is therefore conceivable that this increased free sugar consumption may promote dental decay and obesity in children.”

The fact that these sugars promote childhood obesity creates an excessive impediment for places like the UK, which are already struggling to cope with skyrocketing childhood obesity rates. 

A high price to pay
Allen also notes the toll that overprescription places on healthcare systems. “The National Health Scheme (NHS) England spends approximately £60 million (US$72 million) annually on specialized formula used to treat milk allergy in recent years,” she says. 

Additionally, excessive use of specialized formula is a consequence of overdiagnosis of milk allergy. “This overdiagnosis of milk allergy has been associated with undermining maternal confidence in breastfeeding and impacting maternal mental health.” 

Breastfeeding has been linked to better immunity in infants, and there is growing evidence of nutritional properties that synthetic formulas are unable to duplicate, including recently discovered microbiomes that may protect infants from pollutants and toxins. 

Guidelines the culprit?
The possibility of overdiagnosis and industry involvement is not new. A recent study in England found that – even though only 1% of infants actually have milk allergies – when 1,303 infants were evaluated against the existing guidelines, “38% had multiple “mild-moderate symptoms” at three months and 74% between three and 12 months.”Prescriptions have risen ten-fold over expectations and cost the NHS £60 million (US$72 million) annually. 

“Many milk allergy guidelines are sponsored by the formula industry, and declared conflicts of interest with the formula industry are common amongst guideline authorship,” explains Allen.

The 2021 study further noted that many “normal” symptoms became labeled as “milk allergies” in many of the milk allergy guidelines. Moreover, a study published in 2021 showed that out of 125 milk allergy trials conducted since 2015, only 17 were unsupervised by formula companies. 

This has allowed specialized formula companies to both set guidelines and make unsubstantiated claims regarding their formulas for decades.

“Concerns have been raised in previous studies that milk allergy guidelines play a role in promoting overdiagnosis of milk allergy,” Allen stresses. “The formula industry has also been implicated in contributing to milk allergy overdiagnosis through sponsorship of healthcare educational events and dissemination of guidelines.” 

Allen concludes: “We have recently published independent guidance on milk allergy diagnosis and management without formula industry funding, and each author declared no conflicts of interest with the formula industry.” 

“These guidance recommendations aim to reduce milk allergy overdiagnosis with better support for breastfeeding women and advice on the limited use of specialized formula, which differs from previous largely conflicted milk allergy guidelines.”

By William Bradford Nichols