Diagnosis Girl with Teddy

If you suspect that your child may have cow’s milk allergy, it is important to seek advice from your child’s doctor.  A reliable diagnosis ensures your child does not unnecessarily avoid cows’ milk and all the nutrients it provides.

If your child has cows’ milk allergy, the symptoms may occur either immediately or may be  delayed3. Immediate reactions to cow’s milk protein occur straight away after consumption. These reactions are usually quiet obvious and are therefore easier to pick up.  Delayed reactions occur much more slowly, from a few hours to a few days after consuming cow’s milk protein. These reactions are not as obvious and can make diagnosis more difficult.

What should happen when you visit your doctor?

Your doctor will want to ask a lot of questions about your child’s medical history and symptoms, as this will help them come to a diagnosis1. They may also want to perform allergy testing2.  Unfortunately cow’s milk allergy cannot be diagnosed by a single test. The diagnosis may take time, particularly if your child has a delayed reaction to cow’s milk.
How can you best prepare yourself for the doctor’s visit?

If you think your child may have a delayed reaction to cow’s milk, it is important to keep a food and symptom diary. If you are solely breastfeeding then this should also be a diary of the foods you have eaten. A symptom checklist may help with this, you can find one here. Identifying the symptoms of cows’ milk allergy is the first step towards providing relief for your child.

 

Your child’s medical history will also be an important part of the diagnosis. It is a good idea to think about this before your appointment. Your doctor will ask about other medical conditions, in particular allergic conditions such as other allergies, asthma and eczema1.  Your doctor will also want to know about whether you or your partner, or your child’s siblings suffer from allergies1.

 

You will, of course, have many questions for your doctor. To ensure you don’t forget anything, you may find it helpful to take a written list of questions to the appointment. Some questions you might like to ask your healthcare professional include:

  • Could my child’s symptoms be caused by food allergy?
  • Is it possible to confirm my child’s food allergy?
  • Which tests will have to be performed?
  • Do I need to see a specialist?
  • What will be the next steps?

Which diagnostic tests might your doctor want to perform?

Along with collecting your child’s medical and symptom history, your doctor may also perform allergy testing. There are a number of different tests that are used to help diagnose food allergies. These can involve skin or blood tests as well as diagnostic diets4.

The most suitable allergy tests will depend on the type of reaction your child is suffering4.  For immediate reactions, also known as IgE mediated reactions, skin prick tests or blood tests for allergen specific IgE may be performed. For delayed reactions, also known as non-IgE mediated reactions, a dietary elimination and/or an oral food allergen challenge may be chosen.

IMPORTANT:

All these tests must be performed under medical supervision by a formally-trained health care professional. There is no place in allergy diagnosis for unproven tests such as Vega, kinesiology, Alcat or allergy elimination tests3.

 Test Description
 

Skin Prick Tests5

(SPT’s)

Skin prick testing is usually performed on the forearm or back. The area is first cleaned and then small drops of the suspected allergens are placed on the skin. A small prick is then made through each drop into the skin. If the child’s skin becomes red and itchy, it usually means that they are allergic to that particular allergen. This is called a positive reaction. If no reaction is shown in this test, there is still a chance of your child being allergic to that food. This can happen in delayed or non-IgE mediated reactions. The results of Skin Prick Tests are available in about 20 minutes and for this reason they are often used as the first method of allergy testing. SPTs should only be performed by a health care professional who is trained in the procedure and who is able to interpret the results.
Serum specific IgE tests5 (formerly known as RAST test) Serum specific IgE tests are blood tests that can measure the concentration of particular antibodies in the child’s blood. These antibodies, known as IgE antibodies, are released in response to food allergens. This test is often performed when skin prick testing is not possible.
Dietary elimination This diagnostic diet involves eliminating the suspected food allergen (cow’s milk) from your child’s diet, or from the breastfeeding mother’s diet2.  Removing cow’s milk and dairy may limit the intake of some important nutrients so it is important for this diet to be completed with medical supervision and support. The suspected problem food will usually need to be avoided for two to four weeks, although the length of time may vary depending on your child’s symptoms1,2. If symptoms improve, a food allergen challenge may then be performed. If there is no change in your child’s symptoms, then your doctor may look for a different diagnosis.
Food allergen challenge This test involves consuming very small amounts of a food allergen (like cows’ milk) under medical supervision2. If a reaction is observed it is likely that the child is allergic to that particular food. This test is sometimes used to confirm a diagnosis in children with delayed non-IgE reactions2. It can also be used to prove a child has outgrown cow’s milk allergy4.

 

If you think your child may have a delayed reaction to cow’s milk, it is important to keep a food and symptom diary. If you are solely breastfeeding then this should also be a diary of the foods you have eaten. A symptom checklist may help with this, you can find one here.

 

 

  1. Vandenplaus et al. 2007. Guidelines for the diagnosis and management of cow’s milk allergy in infants. Archives of Diseases in Childhood. Volume: 92, pp: 902-908
  2. Koletzko et al. 2012. Diagnostic approach and management of cow’s milk protein in infants and children: ESPGHAN GI committee practical guidelines. ESPGHAN. JPGN. Vol: 55. No:2 pp: 221-229
  3. 2016. Cow’s milk (dairy) allergy. Australasian Society of Clinical Immunology and Allergy. Viewed 13 June 2016. http://www.allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy
  4. 2016. Information for health professionals: Food allergy clinical update. Australasian Society of Clinical Immunology and Allergy. Viewed 13 June 2016. http://www.allergy.org.au/health-professionals/hp-information/asthma-and-allergy/food-allergy
  5. 2016. Allergy Testing. Australasian Society for Clinical Immunology and Allergy. Viewed 13 June 2016. http://www.allergy.org.au/patients/allergy-testing