September 24, 2024 | Black & Kletz Allergy
Milk is one of the most common foods to cause allergic reactions. Almost 3% of children younger than 3 years of age are allergic to milk. Notwithstanding, a vast majority of children spontaneously outgrow their milk sensitivities.
CAUSES:
In children with milk allergy, the immune system falsely identifies the protein in the milk as potentially dangerous, and as a result, mounts a defensive attack. The “pre-formed” milk specific antibodies (i.e., immunoglobulin E or IgE) react with the protein in the milk (i.e., antigen), causing release of chemical substances (e.g., histamine, leukotrienes, prostaglandins) into the tissues. These chemical substances are what causes the symptoms of allergic reactions.
Cow’s milk is the most common cause of milk allergy although milk from sheep and goats can also cause allergic reactions in certain sensitized children. Children are more likely to have a milk allergy if there is a history of a food allergy in other family members.
SIGNS and SYMPTOMS:
Children usually begin manifesting symptoms of milk allergy within a few minutes after consuming milk products. In some children, however, symptoms can sometimes be delayed for a few hours.
- Skin itching, hives, and/or swelling of soft tissues
- Redness, itching, and/or tearing of the eyes
- Fullness/tightness in the throat, difficulty in breathing and/or swallowing
- Nasal congestion, itching, sneezing, and/or clear runny nose
- Abdominal pain, cramping, vomiting, and/or diarrhea
- Irritability, restlessness, and/or dizziness
- Drop in blood pressure, and/or loss of consciousness
The severity of symptoms can vary from mild to severe life-threatening anaphylactic reactions, depending on the severity of the allergy.
DIAGNOSIS:
- Comprehensive history taking of the milk reaction with focus on the time of exposure to milk, onset time of symptoms, and progression of symptoms.
- Family history of food allergies
- Skin prick testing with a commercially available milk protein antigen with negative and positive controls. If the wheal diameter of the milk protein is more than 3 mm. than that of the negative control, the test is considered positive, signifying the presence of IgE antibodies to milk.
- A blood test can also be utilized to detect and measure the quantities of milk specific IgE antibodies and should be obtained for more severe milk reactions.
- Oral challenge with incremental exposure to milk beginning with a tiny amount and slowly increasing the amount at regular intervals while closely monitoring for signs and symptoms of a reaction. These oral challenges should be undertaken only when trained professionals are readily available to identify and treat possible untoward reactions as soon as they occur.
TREATMENT:
- Total avoidance of milk and dairy products
- Read labels and identify the ingredients of packaged foods
- In cases of accidental exposures, antihistamines can be given orally or by injection if the symptoms are limited to hives and/or itching of the skin.
- If the symptoms are rapidly progressing and/or in case respiratory, gastro intestinal, and/or cardiac symptoms, epinephrine should be injected into the muscle on an urgent basis. Patients should be prescribed a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick) and told to go immediately to the closest emergency room if that device is used.
- Oral immunotherapy is a process of desensitization to milk, which reduces the risk of severe reactions after inadvertent exposure to milk products. This process entails ingestion of small quantities of milk protein in a controlled setting to monitor for reactions. The amount of milk protein will be gradually increased under close medical supervision.
- Xolair (i.e., omalizumab) injections can be given either every 2 or 4 weeks in order to prevent a severe milk allergy, as well as any other food allergy.
Note: “Lactose intolerance” is sometimes confused with milk allergy. Intolerance in this case signifies a difficulty in processing and digesting the sugar in the milk (i.e., lactose) as the enzyme that is needed to break it down (i.e., lactase) is lacking in sufficient quantities. This process does not involve the immune system and the symptoms are usually limited to the gastrointestinal tract. The typical symptoms may include abdominal bloating, abdominal pain, diarrhea, nausea, and/or vomiting. These children will be able to tolerate lactose-free milk and dairy products.
PREVENTION:
- Milk allergy itself may not be preventable, due to a genetic predisposition and susceptibility.
- Diligent avoidance of milk and dairy products such as cream, cheese, butter, ice cream, and yogurt may prevent severe reactions.
- Having a self-injectable epinephrine (e.g., EpiPen, Auvi-Q, Adrenaclick) device readily available at all times can reduce the risks of life-threatening anaphylactic reactions.
Close monitoring by a board certified allergist, like the ones at Black & Kletz Allergy, as well as testing for milk allergy at regular intervals, may identify the children who outgrow their milk allergy. At this point, milk and dairy products may possibly be gradually reintroduced into their diets.
The board certified allergy doctors at Black & Kletz Allergy have been diagnosing milk and other food allergies in both adults and children for over 50 years. We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The allergists are able to test for milk allergy and most foods which can be done by either blood tests or allergy skin tests. We offer onsite parking at each one of our locations and both the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you feel you may have a milk allergy, other food allergy and/or a food intolerance, please call us today to schedule an appointment. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy are eager to help you find out if you are allergic to milk or other foods. This will allow you live in less fear as you will be able to avoid the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.
