DEAR DR.PAUL: Our daughter is now 21 months old. She had an allergic reaction to milk products when she was a baby. She didn’t develop any breathing problems or swelling from that incident. But if we dab milk on her cheek, it will turn red, sometimes with hives. We’ve been told most children grow out of this by the time they are two years old. When should we start to introduce milk products? Thank you.
PEDIATRICIAN DR.PAUL Answers: Cow’s milk protein allergy is the most common food allergy in young children. The cause of the allergy is the body’s reaction to the protein found in the cow’s milk. Almost all children outgrow milk allergy by the first few years of life. Of course, this varies from child to child.
The most common symptoms of cow’s milk allergy include eczema or skin rash, abdominal pain or cramps, vomiting or diarrhea and in some cases, excessive crying.
Less commonly, some children may have a very serious allergic reaction called anaphylaxis. This reaction usually occurs within minutes after eating or drinking food to which they’re allergic. The most serious symptom of an anaphylactic reaction is the swelling of the face, mouth and tongue leading to difficulty breathing. If a child ever has these symptoms, medical help should be sought immediately.
Untreated anaphylaxis can quickly become fatal. Fortunately, anaphylaxis is rare. There are two very important reasons for confirming that a child actually has a milk allergy. First, cow’s milk allergy is not the only cause of the symptoms described above. These symptoms can be caused by other conditions, which would need a different treatment.
The second reason is because of the danger of an anaphylactic reaction. It’s extremely important to know for certain if your child has a cow’s milk protein allergy because if she does, you’ll have to be very careful about making sure that all milk and milk products are removed from the diet.
How the confirmation is made depends on the individual case. The most reliable method is an allergy skin test or a blood test (RAST).
In your situation, it sounds like your daughter is still allergic (given that she gets a hive or reaction when milk touches her skin). In a sense, this is like an informal skin test. Usually, once the diagnosis is initially confirmed by an allergy test, a child is re-tested every 6 to 12 months, depending on the individual circumstances, until it becomes negative.Once the test comes up negative, cow’s milk protein can be started. In the interim, all cow’s milk protein foods (dairy products) should be avoided, including “lactose free” cow’s milk protein preparations.
Most babies who develop cow’s milk protein allergy, are bottle fed, drinking cow’s milk protein based infant formula such as Similac, Enfalac, or SMA. Breastfed children are less likely to develop food allergies of any sort which is one of the many good reasons why breastfeeding is so strongly encouraged. Occasionally though, breastfed children develop cow’s milk allergy when they react to the slight amount of cow’s milk protein that’s passed along from their mother’s diet into her breastmilk.
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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.