University of Exeter funding: Medical Studies - PhD

Improving the diagnosis of cow’s milk protein allergy in children. Self funded Medical Studies PhD. Ref: 3507

About the Research Project


Lead supervisor: Dr Jaime Peters, College of Medicine and Health, University of Exeter

Additional supervisors:
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

Project description:

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.

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Entry requirements

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. Click here for more information and a list of acceptable alternative tests.

How to apply

To apply, please use the 'Apply Now' button above.

You will need to upload the following documents to the application form. Please note our preferred format is PDF, each file named with your surname and the name of the document, eg. “Smith – CV.pdf”, “Smith – Cover Letter.pdf”, “Smith – Transcript.pdf”:

Letter of application outlining your academic interests, prior research experience. You should also indicate your reasons for wishing to undertake the project.
Transcript(s) giving full details of subjects studied and grades/marks obtained. This should be an interim transcript if you are still studying.
Two references (see Reference information section below)
If you are not a national of a majority English-speaking country you will need to submit evidence of your current proficiency in English.  For further details of the University’s English language requirements please see

Reference information

If possible, please upload your references to the online application form. If your referees would prefer to send their reference directly to the University, please ask them to send these via email to

References should be in the form of a letter. Referees must email their references to us from their institutional email accounts. We cannot accept references from personal/private email accounts, unless it is a scanned document on institutional headed paper and signed by the referee.

All application documents must be submitted in English. Certified translated copies of academic qualifications must also be provided.

The closing date for applications is midnight (GMT) on 16 September 2019


Application deadline:16th September 2019
Value:This project is self funded
Duration of award:Not applicable
Contact: PGR Enquiries