When to re-introduce cow milk in milk-allergic children? Check specific IgE level pre-challenge

Clinical tolerance develops in most cases of allergy to cow milk (CM) but food challenges are still required to reintroduce CM into the diet.

The purpose of this Greek study was to identify risk factors for clinical reactivity in CM-allergic children. Specific IgE (sIgE) levels and skin prick tests (SPT) were obtained at diagnosis and pre-challenge.

In conclusion, milk sIgE level pre-challenge was a good predictor of challenge outcome in milk allergy. SPT did not offer an additional predictive value, but can be used when sIgE is not available.

30-50% of infants allergic to cow milk protein will also be allergic to soy protein. These infants should be given protein hydrolysate formula. 5% of infants with hypersensitivity to cow milk formula will also react to hydrolysate formula and will require elemental formula.

Hydrolysate formulas are enzymatically hydrolyzed and contain charcoal-treated casein or whey. Whey or "milk plasma" is the liquid remaining after milk has been curdled and strained.

What is the prognosis in milk allergy?

Milk allergy usually occurs within the first year of life, and 60 to 75% of children undergo remission by age 2 years. By age 3 years, 85-90% can tolerate milk. Approximately 68% of milk-allergic children can tolerate extensively heated milk.

What is the most common food allergen in children?

(A) Gal d (egg)

(B) Tri a 19 (wheat)

(C) Mal d 1 (apple)

(D) Gly m (soy)

(E) Ara h (peanut)

(F) Bos d (milk)

(G) Api g 4 (celery)

Answer: F.

References:
Reintroduction of Cow's Milk in Milk-Allergic Children: Safety and Risk Factors. Int Arch Allergy Immunol. 2008 Jan 18;146(2):156-161.
Child with perioral rash upon milk ingestion; prognosis. Ask the Expert. AAAAI, 2009.
Milk allergy resolution calculator from CoFAR http://bit.ly/U6TkNS - Mobile version: http://bit.ly/U6TmFn
Image source: Wikipedia, GNU Free Documentation License.

Updated: 10/26/2009