It was considered that a tool which focussed on the UK primary care setting was therefore needed, but soon it became clear that MAP was being accessed internationally, with almost 89,000 accesses to date. In healthcare environments where there is minimal specialist allergy provision, it remains important that mild-moderate non-IgE mediated CMA can be diagnosed accurately and promptly in the primary care setting where these infants are most likely to present. MAP aimed to provide simple and accessible algorithms for clinicians in primary care, detailing all the steps between initial presentation, through diagnosis and management as well as later follow up to assess for tolerance development, which is almost always seen in early childhood for those children with non IgE mediated milk allergy. This was commonly reported by patients to the authors in their own clinical practice. There was good evidence that delay in diagnosis was a common problem for patients, particularly in infants with less severe manifestations of non-IgE mediated milk allergy, and this resulted in a significant, unnecessary morbidity and anxiety. The driver for the development of primary care focussed cow’s milk allergy (CMA) guidance was the limitations of the scope of the NICE guideline, which did not include management of food allergy, nor any specific detail relating to the challenges of identifying and diagnosing milk allergy, which can present with diverse clinical symptoms, due to either an underlying IgE or a non-IgE mediated mechanism. The Milk Allergy in Primary Care guideline was first published in 2013 in this journal by five authors, four of whom had been involved in the development group of the UK National Institute for Health and Care Excellence (NICE) 2011 clinical guideline on the ‘Diagnosis and assessment of food allergy in children and young people in primary care and community settings’. We continue to welcome open and constructive engagement about how best to achieve these aims to provide evidence-based, practical guidelines for the primary care practitioner. We believe iMAP is now closer to its original aim of facilitating early and accurate diagnosis of CMA, whilst minimising, as far as possible, any concerns around overdiagnosis or a risk to breastfeeding rates. The authors address these criticisms using available evidence and, in the context of this and in consultation with patient groups, members of the General Practice Infant Feeding Network and other infant feeding healthcare leads, have collaboratively produced updated algorithms and an information leaflet to support breastfeeding. In 2018, the guidelines were criticised for 3 distinct reasons: promoting the overdiagnosis of cow’s milk allergy (CMA), negatively impacting breastfeeding and the possibility of industry influence on the guidelines. Both guidelines used existing international consensus guidelines to develop accessible algorithms accompanied by patient information leaflets. Despite its UK focus, it soon became clear that MAP was being accessed internationally and thus an updated International Milk Allergy in Primary Care (iMAP) guideline was published in 2017. MAP aimed to provide simple and accessible algorithms for UK clinicians in primary care, detailing all the steps between initial presentation, through diagnosis, management and tolerance development. The Milk Allergy in Primary (MAP) Care guideline was first published in 2013 in this journal.
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