TY  - JOUR
TI  - Diagnosing cow’s milk allergy with the EATERS-X allergy-focused clinical history
AU  - Lee Qiyu, Melvin
AU  - Robertson, Isobel
AU  - O’Neill, Ann-Marie
AU  - Denton, Sally-Ann
AU  - Gandhi, Minal
AU  - Meyer, Rosan
AU  - Erlewyn-Lajeunesse, Mich
PY  - 2026
JO  - Exploration of Asthma & Allergy
VL  - 4
SP  - 1009106
DO  - 10.37349/eaa.2026.1009106
UR  - https://www.explorationpub.com/Journals/eaa/Article/1009106
AB  - Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with a prevalence of up to 7.5%. However, accurate diagnosis in primary care remains difficult due to overlapping symptoms with common infant behaviours and limited access to specialist allergy testing. Consequently, CMA is frequently over diagnosed, leading to unnecessary elimination diets, nutritional deficiencies, and increased parental anxiety. This paper introduces the EATERS-X framework, an enhanced, structured approach to obtaining an allergy-focused clinical history (AFCH) that aims to improve diagnostic precision and clinical decision-making in CMA. The tool expands upon the traditional EATERS method—comprising Environment, Allergen, Timing, Exposure, Reproducibility, and Symptoms—by incorporating an additional element, X, denoting treatment and healthcare response. Through clinical scenarios, we demonstrate how EATERS-X can be applied to distinguish between IgE-mediated, non-IgE-mediated, and mixed-type CMA, including subtypes such as food protein-induced enterocolitis syndrome (FPIES). While EATERS-X provides a practical and systematic framework for history-taking, its effectiveness is dependent on clinician training and appropriate clinical interpretation. In addition, the framework has not yet undergone formal validation against gold-standard diagnostic tests such as oral food challenges. Future prospective studies should evaluate the diagnostic reliability, inter-observer consistency, and clinical impact of EATERS-X across different healthcare settings. Integration of the EATERS-X approach in primary care aligns with current BSACI and EAACI guidelines and promotes structured, evidence-based, and patient-centred care. Future research should focus on validating the framework’s diagnostic reliability and exploring its applicability across a wider spectrum of allergic conditions.
ER  -