introducing dairy to DS with cow's milk allergy

[mommykay410]

DS is 10 months old and was diagnosed via blood test with a cow's milk allergy when he was 6 months old.  We had him tested because his eczema was pretty bad at that point and the itching was keeping him up all night.  He is EBF, so when we found out about the allergy the allergist suggested that I eliminate dairy for 3-4 weeks to see if it made a difference.  It didn't make a difference with his eczema in that time so I went back to eating my regular diet.  His eczema was and still is pretty much under control thanks to moisturizing regimen and steroid cream.  But the more I researched the allergy, I realized that his nighttime gas issues were also likely caused by the dairy allergy too, and also read that a minimum of 6 weeks was necessary to see a difference, so I went back to dairy-free.  I have been DF for about 6 1/2 weeks and haven't seen any change at all in his eczema or gas, and I'm beginning to think his gas issues are more related to just not burping properly after night feeds. 

I would like to try introducing dairy into his diet, and don't really want to go back to eating it myself until I've given it to him directly so I don't have to start all over, but I'm not sure when and how I should do it.  I've read that he should be symptom-free when I start testing it out, but I'm afraid that will be never at this rate since he always has at least one small patch of eczema.  He has never had any of the more extreme symptoms that other kids with the dairy allergy seem to have (green poop, blood in stool, etc.), so it's really just the eczema and gas, both of which could also just be caused by other factors, winter weather/burping issues. 

So my question is, do you think it's ok to slowly start trying to introduce dairy to him and watch for more severe reactions?  Or should I keep avoiding it until he doesn't have any skin or gas issues?  The allergist seemed to think it would be fine to give him yogurt in small amounts to see how he handles it, but I think that was more in terms of a hive-like reaction, not just the intolerance symptoms.  Thoughts?

[Buntybear]

HI there - what made you have the blood test for an allergy in the first place? The gas and eczema? My son had these symptoms too and ended up being allergic to dairy, wheat and egg through my diet 

I ma not sure how accurate the blood test is at 6 months but if your allergist says it is ok to test him with yoghurt I would say try it?

[mommykay410]

Thanks for your reply.  Yes, the eczema is what made us decide to get him tested originally, and since his back was so broken out at the time they couldn't do the skin test, so did the blood test instead.  I have been trying to research the allergy and testing more and read that the blood test just tells whether he has a high or low chance of having an allergy, it doesn't necessarily mean that he actually is allergic.  So I called to schedule a skin test to confirm and we go for that next week.  I'm hoping that it shows up that he isn't allergic, although with his symptoms I'm guessing that won't be the case.  Since he is so close to a year, I would rather not go further with eliminating more foods from my diet (egg, wheat) and just not give them to him when he is weaned and see if his skin improves.  Although I would hope that if one of those was causing an issue in addition to the dairy I would hope it shows up on the skin test as well so we know right away.  I'm just afraid to start offering him dairy in case he were to have an anaphylactic reaction, but I'm not sure if that is the kind of allergy he has or not?  Did your son outgrow his allergies?  If so, how long did it take?

[jessmum46]

Hi there, I'm sorry you've had what sounds like some quite confusing information and advice from the allergist.  Are they a medically-qualified doctor?  (I'm asking because there are many non-medical people who set up in the allergy field and offer testing but not necessarily in the correct context and therefore can make it very difficult to actually work out what is or isn't going on). 

Essentially there are two main types of cows milk allergy - IgE (immediate type) and non-IgE ('delayed'). Eczema is more commonly a symptom of delayed type allergy - for which there isn't really a blood test as far as I know    Do you know what exactly he was tested for?  Skin prick testing is also (in my understanding) of doubtful value in this context...

There is some reliable up to date information about cows milk allergy diagnosis and management here - https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk-allergy  In my experience yoghurt wouldn't often be the first food to try if milk allergy was suspected - in the UK we tend to use the milk ladder - https://www.allergyuk.org/assets/000/001/297/iMAP_Final_Ladder-May_2017_original.pdf?1502804928

Perhaps a chat with your doctor to clarify things a bit further before putting DS through any more testing (which may not be beneficial) may be worth considering? 

[mommykay410]

Yes, the allergist is an MD and used to be a pediatrician.  I don't know if the milk ladder is as common in the US or if the doctors are aware of it, so I'm thinking that's why he didn't mention it?  At his last follow-up appointment he just asked if me eliminating dairy from my diet had helped any, and it hadn't made a difference in his skin at that point.  I was the one who originally asked if I could offer him butter and yogurt (before I learned about the ladder), and he suggested giving it to him as an allergy challenge.  He didn't seem overly concerned with the allergy, which leads me to believe it is the non-IgE as you say, and from what I've read I'm thinking that's the case as well.  The blood test results do have IgE on them though, which is why I'm a bit confused and want to confirm which allergy he supposedly has.  At this point he still has eczema and gas at night, so me being dairy-free for the last two months is not making a difference at all.  But I would like to know if he could tolerate some dairy so that it gives me more options to feed him and so I know whether or not I can attempt cow's milk when he turns one.  I do plan on following the milk ladder when I start to introduce him, but I want to make sure I'm starting at the right time.  I've also read that his symptoms could be from something completely unrelated to an allergy, so I'd rather not keep restricting our diets if we don't have to.  Both the allergist and his pediatrician seemed to think it'd be fine to slowly introduce cow's milk as I normally would at a year and watch for symptoms. 

[Buntybear]

This is a tough one as he still has symptoms. You could follow the ladder but TBH you would be looking to see if his eczema got worse or if he developed new symptoms i.e. vomiting, hives etc which are typical of the IgE allergy.

I think this is why some people would say give him some yoghurt and if he vomits etc you can then be sure of an IgE allergy but as you say this can be scary and certainly wouldn't be something I wouldn't recommend without you having your doctor agree.

Yes Olly did out grow his milk and egg allergies. We are still waiting for wheat with fingers crossed!

[Buntybear]

Hi - just following up on this thread as we are talking a bit on your son's allergy on your sleep thread - has he now been officially diagnosed with a fast acting milk allergy through a skin test?

[mommykay410]

Hi,  Yes he was diagnosed with the milk allergy via skin test and given an epipen.  Although it's not confirmed what his reaction would be if he were to have dairy.  My husband's grandmother apparently got hives when she had dairy as a kid so I'm thinking that may be where his allergy stemmed from and possibly what his reaction would be.  The allergist was going to do an oral challenge after the skin test if his result would not have been significant, but since he did get a hive the same size as the histamine control he didn't feel comfortable doing the oral challenge just yet.  He is going to test him again in a year. 

[Buntybear]

Ah yes that is what we did her in the UK. I think if the hive measures less than 3/4cm then they do the challenge x

[mommykay410]

Ah good to know!  I'd say it was around a cm, maybe a tad larger.  I had my hopes up so high!

[Buntybear]

1cm?  Maybe I am thinking 3/4 millimetres then! 1cm is probably considered quite a reaction then xx