Browse through our Journal

Educational lectures for junior Paediatricians, community Health visitors and GP on growth and nutrion from 0-18years

BLOG

Milk Allergy and testing

So many families contact me asking for a test to confirm if their infant or child has an allergy to a certain food.

In truth allergy testing isn’t actually helpful for the majority of the parents that contact me for advice and Google is a minefield. I worry that if we don’t support these families and infants asap, this could delay the introduction of safe foods and delay feeding skills and increase their risk of developing food allergies.

Food allergy testing is not helpful for Non IGE food allergy. These are delayed milk allergy symptoms such as reflux, soft stool constipation, unsettled, faltering growth, eczema. In fact testing such as specific IGE blood tests and skin prick tests may show sensitivity to food proteins and lead to unnecessary food avoidances unless the right person is there to interpret these results and guide these families!

The gold standard for confirming a delayed milk allergy ( the majority of infants present with this) is an exclusion diet for 4 weeks followed by a challenge and see if symptoms return. ( please do not do the challenge if your infant has severe symptoms or an Immediate IgE allergy).

Specific IGE blood tests and skin prick tests are helpful to confirm a diagnosis if the infant or child presents with immediate IGE symptoms; such as hives, swelling, breathing difficulties. This should be done in combination with an allergy focused history by the paediatrician or dietitian. These tests confirm the reactions observed after a food allergy reaction.

IGE and non IGE food allergy both involve the immune system, but they use different mechanisms hence IGE ( immunoglobulin mechanism and trigger IGE antibodies ) can be tested for and non IGE uses a T cell mechanism which doesn’t produce antibodies or histamine that can be tested for with specific IGE blood tests or skin prick tests.

Eczema and food avoidances

So many families start avoiding foods when they start weaning their infants, because they have had a reaction on their skin. Eczema is an itchy red rash which comes and goes affecting 1/5 children in the UK.In young children it is common on the face, while in older children the elbows, wrists, knees and ankles. It generally starts in the first year of life and improves with time. Infants are more affected because their skin barrier isn’t as tough as us adults and it becomes more sensitive to anything that touches the skin.

The diagnosis is made on the symptoms and appearance, rather than tests.

Allergy tests are not helpful as they only test for immediate allergic reactions and not those delayed by many hours, as with eczema

Eczema is due to the skin barrier being leaky. The skin becomes dry and exposure to many factors causes it to become inflammed. Treatment is the regular use of moisturiser to help protect the skin barrier. We often describe babies with eczema to be slippy because the best way to protect their skin and support weaning and exposure to foods is to keep them constantly moisturised.

Food avoidances with eczema shouldn’t be taken lightly, the infant is atopic and often excluding foods helps short term then the eczema worsens again and all we do in an atopic child is increase their risk of developing food allergies by these exclusions.

Antihistamines do not relieve the itch in eczema, once the eczema is red and inflamed it can reduce the histamine at the skin surface but the best way to reduce itching is to keep them cool, avoid any toys or pillows in the cot that can gather dust and make eczema worse and lots and lots of moisturiser

Changes to the diet of growing children should not be taken lightly as they may reduce nutrition and lead to new or worsening of existing allergies and you should always seek the advice of a health professional before excluding major food groups, however their are children with severe eczema where a specific food consistently causes eczema to flare, this should be guided by a doctor dietitian

Understanding infant feeding disorders

check out the link below to read the article I wrote for Kendamil for managing infant feeding disorders and their misconceptions