1025 Monitoring the impact of cow's milk allergy on children and their families with the FLIP questionnaire – a 6 month follow-up study

Sunday, 7 December 2014: 18:30 - 18:50
Exhibition Hall-Poster Area (Sul America)

Andrea Mikkelsen, PhD, Registered Dietician , Department of Public Health and Community Medicin/Public Health Epidemiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

Kirsten Mehlig, PhD , Department of Public Health and Community Medicine/Public Health Epidemiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Magnus P. Borres, MD, PhD , Department of Pediatrics, Thermofisher Scientific, Uppsala and Sahlgrenska Academy, Gothenburg, Sweden

Lena Oxelmark, PhD, Registered Nurse , Institute of Health and Care Sciences, and Departement of Neurobiology, Care Sciences and Society, Division of Nursing, Sahlgrenska Academy and Karolinska Institute Stockholm, Gothenburg and Stockholm, Sweden

Cecilia Björkelund, MD, PhD , Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, Gothenburg, Sweden

Lauren Lissner, PhD, Registered Dietician , Department of Public Health and Community Medicin/Public Health Epidemiology, Sahlgrenska Acadamy, Gothenbrug, Sweden


Cow’s milk allergy (CMA) in children typically changes over time and many develop tolerance. However, challenges in daily life may remain. We sought to measure change in impairment in affected families following the progression of CMA using a new Food hypersensitivity famiLy ImPact questionnaire (FLIP).  


Families of children with CMA, exclusively or in combination with other food allergy (FA), who participated in the validation of the FLIP, were re-approached six months later for follow-up. Change in impairment over time was assessed by paired sample t-test between both occasions in the FLIP’s total and subscales’ scores. The analysis was stratified by the progression of CMA, i.e. outgrown versus persistent CMA at follow-up. Mixed models were used to compare FLIP trajectories by progression status.


Perceived impairment in families with children who had outgrown CMA (n = 20) decreased as measured by the FLIP’s total score (p = 0.0005) and for two subscales; Health and Emotions (p = 0.0005) and Everyday Life (p = 0.0005).  However, no significant improvements were registered in the Nutrition subscale. The impairment in the group with persistent CMA (n = 57) was unchanged at follow-up except for an increased impact on the Everyday Life subscale (p = 0.001). In the final analysis comparing the groups outgrown versus persistent CMA, longitudinal changes were clearly different for the scores in the FLIP and the subscales Health and Emotions and Everyday Life and suggestively different for the Nutrition subscale.


Families still affected at follow-up experienced sustained impact in daily life. Despite development of tolerance, no-longer affected families revealed sustained impact on nutritional concerns. We can confirm that impairment caused by CMA changes over time following its progression. Follow-ups should be offered even after outgrown CMA to encourage progression to unrestricted diet, preventing eating disorders and impaired growth.