Lead supervisor: Dr Jaime Peters, College of Medicine and Health, University of Exeter
Dr Zhivko Zhelev, College of Medicine and Health, University of Exeter
Dr Michael Nunns, College of Medicine and Health, University of Exeter
Dr Liz Shaw, College of Medicine and Health, University of Exeter
Location: University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK
Cow’s milk protein allergy (CMPA) is the most common allergy in children, with estimated prevalence of 1% in the UK. , although evidence suggests that perceived food allergy, including cow’s milk protein allergy could be 10 times higher than diagnoses confirmed via appropriate tests (Venter 2013), with estimates of the prevalence of CMPA ranging from <1% as identified by formal testing procedures such as skin prick and blood tests to 3.5% as reported by parents.
CMPA is an immune-mediated allergic response to proteins in milk which causes unspecific symptoms of the skin, gastrointestinal tract and/or respiratory tract. These symptoms could range from mild, delayed and temporary reactions to anaphylaxis and other immediate severe reactions necessitating emergency treatment and hospital admission. In the last few years, there has been a sharp increase in the number of children prescribed specialist formula, an indication of rising rates of diagnosis. This has led to concerns regarding the appropriateness of such prescriptions, poor performance of the current diagnosis process, suspicion of misdiagnosis and over-diagnosis, and inappropriate influence by the industry. Existing guidelines recommend diagnosis is based on food challenges – eliminating and reintroducing specific food items. However, research and anecdotal evidence suggest that the reintroduction of specific food items is not often done. Therefore, there are many challenges in diagnosing CMPA, which include the effectiveness and feasibility of available diagnostic tools, as well as healthcare professionals and parents’ knowledge of the condition, available support, and marketing strategies used by the industry to promote special formula milk (including the development of CMPA awareness tools).
The aim of this PhD project is to help improve the diagnostic process by investigating the accuracy, effectiveness and cost-effectiveness of awareness tools and diagnostic tests for cow’s milk protein allergy. Given the uncertainties in the diagnostic process and that over £60m is spent every year by the NHS on specialist formula milk, this PhD will make a meaningful contribution to research, with the potential to impact on future clinical practice.
The project will involve two systematic reviews – one focussing on the development, validation and effectiveness of awareness tools intended for use by health professionals (e.g. CoMiSS), the other focussing on the accuracy, effectiveness and cost-effectiveness of diagnostic tests for cow’s milk protein allergy (e.g. skin prick tests, blood tests, open food challenges). It will also involve the development of a decision model to help identify and examine uncertainties in the evidence on the effectiveness and cost-effectiveness of using these tools/tests in the NHS.
This project would suit someone with, or hoping to gain, experience in systematic review methodology, an interest in the issue of diagnosing cow’s milk protein allergy, and in tests and diagnosis in particular. Potential candidates with an interest in health economics and decision-modelling would also be suitable.
You should have or expect to achieve at least a 2:1 Honours degree from a UK university, or equivalent in a relevant subject.
If English is not your first language you will need to meet the English language requirements and provide proof of proficiency. More information and a list of acceptable alternative tests can be found here: http://www.exeter.ac.uk/postgraduate/apply/english/