A165 Improving management of cow's milk protein allergy at patterdale lodge GP practice

Published Date: 01st October 2026

Publication Authors: Kalathil. SL

Background
This Quality Improvement Project aimed to review and improve the prescription of specialist infant formula for children with Cow's Milk Protein Allergy (CMPA) according to the PanMersey CMPA guidelines. The PanMersey guidelines advise follow-up at 6 and 12 months as well as the initiation of milk ladder after 12 months.

Methods
A review was conducted on 37 patients in November 2024-13 with active prescriptions and 24 previously prescribed formula. Only patients prescribed specialist infant formula after the release of the PanMersey guidelines in July 2021 were included. For both groups, we examined the appropriateness of the prescribed formula, follow-up review times and dietician referrals. Following implementation of quality improvement strategies, the 13 patients with active prescriptions in November 2024 were reviewed to assess whether appropriate follow-up had occurred in July 2025.

Results
Among active prescriptions in November 2024, 85% had review within 2-4weeks. All received age-appropriate formula and had dietitian review. Among previously prescribed patients, 80% had review within 2-4weeks. Age-appropriate formula was prescribed in 92%. Dietitian referral occurred in 87%. Follow-up occurred in 75% at 6 months and 50% at 12 months. Following intervention, follow-up improved to 80% at 6 months and 70% at 12 months. Among three new prescriptions, all had timely review and appropriate prescribing, with 66% dietitian review.

Conclusion
Specialist milk represents a large portion of GP practice expenses with each tin costing up to 30. Therefore, follow-up to review needs is important. In addition, families need guidance and support in initiating milk ladder. The quality improvement strategies to improve follow-up included: i. a poster simplifying PanMersey CMPA guidelines to improve accessibility and ii. an IT alert that flags patients aged above 1 on specialist milk to prompt clinicians to arrange follow-up. These interventions successfully improved follow-up rates especially at 12 months.

Kalathil, SL; Kondottil, MAV. (2026). A165 Improving management of cow's milk protein allergy at patterdale lodge GP practice. Clinical and Experimental Allergy. 56(10), p.1344. [Online]. Available at: https://dx.doi.org/10.1111/cea.70420 [Accessed 30 October 2026]