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Ask the Doc: Could it be Milk Allergies?

An Upper Marlboro allergist answers readers' questions about allergies.

Q: Neither of my boys have diagnosed allergies, but they will not drink cows milk. They say they do not like the taste. Could this be their body's way of telling me they have an allergy? - Jenni, Riverdale Park, MD

A: Dear Jenni,

Thanks for your question.  I initially trained as a pediatrician, so I have definitely seen my fair share of little one's who either refuse to drink cow's milk or just "don't like" drinking it!  It's a common complaint, so don't worry.  Let me try to help by giving you some background information about cow's milk allergy first.  

Cow's milk allergy is present in about 1-3 percent of the population, with about 2.5 percent being in infants.  While we used to believe that the the majority would outgrew their allergy by five years of age, more recent data by the American Academy of Allergy, Asthma and Immunology suggests that is true for only about one-third of those initially allergic.  The remaining majority will generally outgrow it anytime between 5 years and their teenage years.  

It's also important to understand the difference between a true cow's milk allergy and cow's milk intolerance.   A food allergy, or hypersensitivity, is an abnormal reaction to the food -- in this case, cow's milk protein -- that is mediated by the immune system.  It generally involves the skin, gastrointestinal tract, respiratory tract, or multiple organ systems, leading to symptoms such as eczema, hives, flushing, swelling of any part of the body, stomach cramps, vomiting, diarrhea or bloody stool, coughing, and/or trouble breathing.  Systemic anaphylaxis to cow's milk is life-threatening and entails more than one of these system being involved, including low blood pressure and/or loss of consciousness.  If your child has ever had any of these symptoms to cow's milk, you'll need to see an allergist to get diagnosed and be prescribed an epinephrine injector in case of a future life-threatening reaction.  

Moooving on...cow's milk intolerance, on the other hand, is not immune-mediated, and is generally related to issues with digestion or metabolism.  It is overall a benign condition, even though its symptoms can look like some of those related to a true allergy.  These symptoms are generally limited to the gastrointestinal tract, such as abdominal cramping, diarrhea and in more severe cases, possibly weight loss or failure to gain weight. One of the most common milk intolerances is caused by a deficiency of the enzyme lactase, which breaks down lactose, the sugar found in milk.  Therefore, it is difficult to digest the lactose, leading to the gastrointestinal problems mentioned, but not related to an immune-mediated allergy.  

If your boys don't have any of the symptoms above, it's unlikely to be an allergy or even an intolerance to cow's milk.  I don't know how old they are, but in general, when you switch an infant over to cow's milk at age one (based on the American Academy of Pediatrics guidelines), you may have to help your child acquire a taste for the milk.  Breast milk and formula both have a slightly different consistency than straight cow's milk, and are generally sweeter.  So it's a bit of an adjustment for the child.  Some parents will mix it with some formula or breastmilk initially, or just give it with other foods like cereal or milk shakes (with no added sugar), which is fine.  And if that still fails, try yogurt and cheese and talk to your pediatrician about incorporating other foods high in calcium and vitamin D in your child's diet.  

Hope that helps, and feel free to email me at dr.allergeez@gmail.com for any other questions!

Regards,

Dr. Sharif

Dr. Naba Sharif  is  director of allergy and immunology at Allergy and Asthma Associates, A Division of Riverside Medical Group, located in Upper Marlboro. She'll be answering your allergy questions regularly on Patch. Email questions to Dr. Sharif at dr.allergeez@gmail.com.

Stephen June 05, 2012 at 01:36 PM
Allergy / Asthma Parents of Allergy Children > Pls know that Milk Allergy ala Eczema is the first Disease manifestation of Allergy's March to possibly Allergic ASTHMA. If your Child is geneitcally predisposed to Allergy / Asthma, a Simple IgE Blood Draw / Test WILL identify if the progression of allergy is present. If YES .. expanded Testing followed by Sublingual ImmunoTherapy Allergy DROPs will STOP this Progression. Stephen
Naba Sharif, M.D. June 05, 2012 at 06:08 PM
Hi Stephen, Thank you for taking the time to post. Allow me to clarify the information in your post. Eczema is not always related to a food allergy, and is only sometimes part of the atopic triad of allergies and asthma. You are right that any of the factors in the triad makes it more likely to have the others, but this is not a rule of thumb. A blood draw looking for IgE or antibodies for milk is not conclusive, and can lead to false positive results if not used in conjunction with a thorough history, physical exam, and possibly allergy skin testing. Also, sublingual immunotherapy (oral allergy drops) are *not* FDA-approved, are only in the testing phase, and should only be available in clinical trials at this time. The American Academy of Allergy, Asthma and Immunology recommendations are that this experimental treatment should not be used until approved due to the risk of serious adverse events. See: http://www.jacionline.org/article/S0091-6749%2810%2901486-7/fulltext Dr. Sharif
Stephen June 13, 2012 at 02:53 PM
Dr Shariff: Thank You for taking the Time from your Busy Schedule to speak to my Milk Testing Comment. I guess I what I was trying to say is that FOOD Allergies are typically the Fisrt manifestation of Allergy MARCH on its way to Allergic ASTHMA . That if an Infant begins to present with the Eczema / Colic signs ( typically FOOD related ) that IgE Blood Testing for Enviro Sources is in order to confirm migration / progression of Allergy March to possible Allergic ASTHMA. Which is then addressed via Sublingual ImmunoTherapy DROPs > which STOP the Progression. As an added note, my other Company Healthy GOO under the Medical Leadership of Dr. Kristin Holm DVM DACVD will July launch a Product GOO GUT RESCUE > Which RESCUE's / Restores / Repairs / Retains a Dog's GUT / GI System to a Healthy MicroBiome Balance after it has been decimated by Antibiotics and RePopulated by Pathogenic Bad Bacteria .. But to our Sublingual / FOOD Discussion, you may find it interesting that Dr. Kristin ala RESCUE is also Sublingually building Tolerance in our DOGs to Beef, Chicken, Pork, Lamb, Wheat, Corn & Soy. We have found that many Disease / Health / animal Ailment manifestations that are attributed to FOOD are Food related BUT are strongly brought about becasue of a Pathogenic GUT . That if you ReBalance the GUT and REPAIR GUT Permiability . that many FOOD Issues are resolved. Stephen PS 80% of all Drugs are prescribed Off Label .. under the Scope of Medicine via any MD
Naba Sharif, M.D. June 13, 2012 at 04:23 PM
Thanks again Stephen, for your passion about food allergies! For patient education, it's really important to explain that my previous comment on allergies, the atopic march/triad and IgE testing still hold. While Consumer Reports Health experts state that up to one in five medications are prescribed off-label (20%), that does not mean that it is automatically justified in all cases, particularly when life-threatening reactions are the consequence and the recommendations by the major national organizations advise against public use for these legitimate reasons. We also certainly cannot compare what is okay in the practice of veterinary medicine to medicine to treat humans; there are different guidelines for each. Hopefully in the near future we will all look forward to sublingual immunotherapy (SLIT) as an exciting therapy for food allergies, once approved. I admire and applaud the efforts of those involved in research and clinical trials for SLIT to help us reach this goal soon. Good look with your company for canine products; it sounds interesting! You can always email me at dr.allergeez@gmail.com for any further comments or questions. Dr. Sharif

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