Cow’s Milk and Egg Allergy
Cows milk and Egg are the two most common food allergies encountered in children. Reactions can range from eczema flare to hives/urticaria and anaphylaxis.
It is very important to see a qualified Allergist/Immunologist for proper evaluation of food allergies. During the consultation, a detailed history is obtained followed by confirmatory allergy testing to determine allergic sensitization. This is then followed by dietary advice on avoidance. There will be a detailed discussion on the use of Epipen for instances of severe allergic reaction.
Can Cow’s Milk or Egg Allergy Resolve?
In general, cow milk and egg allergy can be outgrown by children. The rates of resolution of these food allergies varies by country as well as the individual. From what we can gather from medical literature, the more severe the food allergic reaction, the less the chance to outgrow. Other factors responsible include presence of other allergic diseases such as the severity of eczema, presence of allergic rhinitis or asthma. Studies show that children with cows milk or egg allergy can tolerate these food allergens in a baked form such as cakes or muffins. If these children ingests the baked form of cow milk or egg regularly, they can gain tolerance and outgrow the allergy compared to those children that do not eat.
At the Allergy Immunology Clinic, we have developed a treatment protocol to help children with cow milk or egg allergy. We perform allergy skin prick test to a specific baked cow milk or egg muffin (recipe and instructions given to the patient to prepare). Based on the reaction of the skin prick test, the patient is then given an Oral Food Challenge in the Allergy Immunology Clinic under proper observation. This must be done carefully as there has been reported severe reaction.
The Allergy Immunology Clinic Protocol is designed to be safe
The proper amount chosen for the Oral Food Challenge is based on the skin prick test reaction. The aim for the food challenge is to find and document the dose of the challenged food given that can be tolerated. If the patient passes the challenge, instructions on regular ingestion is given. The patient is also monitored regularly for side effects or problems. If the skin prick test reaction reveals high levels of sensitivity, the initial chosen food dose will be a very small amount. Future follow up appointments are then given for further up-dosing of the food.
If everything goes well, the patient will gradually be able to eat increasing amounts of the specified treatment food (baked milk/egg muffin) and begin to develop tolerance to the cow milk or egg allergen and outgrow the allergy.
During the treatment of food allergy, it is important to ensure that other allergic conditions such as eczema, allergic rhinitis and asthma are well controlled. We have found that allergic diseases are all interconnected and we have to treat the entire person rather than separating the diseases. By having all allergic diseases under good control, we found that our patients have faster resolution of their food allergies.
We have also found that using probiotics can help food allergy resolve. A probiotic that we usually recommend is Duoflora, which contains the proper strains that have evidence for food allergy.
How do we know that the milk or egg allergy has resolved?
We do this through regular follow ups and also rechecking the skin prick test towards milk or egg. Signs of the person outgrowing allergy includes decreasing sIgE levels to the food allergen or decreasing skin prick test size. The final confirmation on outgrowing the food allergy to cow milk or egg is done with an Oral Food Challenge procedure where the person is given the actual milk or egg and observed for any reactions.
If the Oral Food Challenge reveals no reaction, then the person is deemed able to tolerate the food and is encouraged to eat it regularly to continue to induce tolerance to the food. We will still need to schedule regular follow ups to monitor food tolerance.
