E.B. asks from Lake Zurich, IL on November 17, 2010
Confused by My Son's Allergists Advice
I am confused by my son's allergist advice. My son had bad eczema since 2 months old, and he was diagnosed with milk and egg allergy (by skin prick test and blood test) at 6 months. He also has a FPIES to soy and oats (FPIES is another type of allergy that manifests itself in severe vomitting and diarrea). We saw allergist at 6 months, and then he gave me a print out on how to read labels to avoid milk and egg foods, he also prescribed epi-pen and a cream for eczema, and over-the-counter Zyrtec daily.
We went back at 9 months, and he did another skin prick test, and again, milk and egg reaction showed up. He said to come back in 6 months.
Then I asked about what can I give my son instead of cow milk after he turns 1. He acted like he wasn't sure, since my son can't have soy also, and then he said, just try cow milk, as he doesn't think my sons allergy is that bad. His exact words - "try milk and see what happens, call me if you need". So now I am confused. At first he tells me to avoid all foods that have milk in them, prescribes my son epi-pen, and then 6 months later he just says try giving milk to him. To be honest, I am a bit afraid. Granted he did have milk-based formula before his allergies were discovered, and just had eczema from it (no life threatenning reaction), but still. Is this a normal course of action?
The allergist himself has good credentials, and used to be on staff at Childrens Memorial hospital.
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J.K. answers from Chicago on November 18, 2010
If you go with the rice milk option, Trader Joes has the cheapest and best testing, IMO. Do know though, that there is no fat in rice milk and you will need to supplement some fat. We added both fish oil and flax seed oil to the rice milk, but you will also want to up his fat in other ways too like avocado and olive oil, etc. Both my boys were partially breast fed and on a rice milk formula as infants because of dairy and soy sensitivities. They both are small for their age though, and my younger one was falling off the growth chart because he wasn't getting enough fat. You might want to see a nutritionist to get an idea of how much fat he'll need.
Regarding the milk - generally people with milk allergies don't get hives or anaphylaxis (sp?), but his eczema could be exacerbated, and ear infections and other problems could arise. btw, if he has dark circles under his eys on a daily basis, that is an allergic reaction too so watch for that.
J.P. answers from Austin on November 17, 2010
Here is an article that my friend (who is a family doctor) sent to my BiL who has a 3 y.o. that has had bad eczema since she was a few months old:
Dear Clinician, Here is the information you requested (sourced from Journal Watch).
Making Sense of Food Allergies
Food allergy management is hampered by overdiagnosis and lack of consensus on diagnostic criteria.
Food allergy affects more than 1% to 2%, but less than 10%, of the U.S. population, yet this potentially life-threatening condition is poorly understood. In an NIH-sponsored review of food allergy studies from 1988 to 2009, the authors note their analysis was hampered by lack of high-quality studies and by lack of consensus on the definition and diagnosis of food allergy. They make the following observations:
The general perception that food allergy prevalence is increasing has not been established in well-designed studies.
Skin-prick testing and in vitro specific IgE (sIgE) determination are both sensitive, but not specific: Roughly 50% of patients with a questionable history and positive test result will not have true food allergy. Food challenges are the gold standard but are cumbersome and potentially dangerous.
Specific food immunotherapy looks promising, but studies are still under way to distinguish between tolerance (long-term clinical nonreactivity) and desensitization (temporary ability to tolerate food). Anti-IgE therapy appears to confer protection against peanut reactions in some patients.
Probiotics plus either breast-feeding or hypoallergenic formula for high-risk infants may slow or prevent the onset of allergic disease. Evidence is conflicting on the effect of allergen-free diets in pregnant and lactating women.
Comment: This review highlights the difficulties in diagnosing and treating food allergy. Inappropriately diagnosing food allergy restricts diets, causes anxiety and social challenges, and trivializes a life-threatening condition. Because of the potential for life-threatening events, patients with suspected IgE-mediated food allergy should undergo testing with either skin-prick or sIgE. Patients who have positive test results but do not have a convincing history should be considered for food challenge. Primary care physicians who are not comfortable with this testing should refer patients to allergists. Avoidance and self-injectable epinephrine are the current standard of care. We can hope that specific food immunotherapy will soon be a viable option.
— David J. Amrol, MD
David J. Amrol, MD, is an Assistant Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.
Published in Journal Watch General Medicine May 25, 2010
Here is my friend's translation:
True allergies (IgE mediated) remain very scary and potentially lethal; other (and non-IgE mediated) allergies are just more of a hassle. IgE mediated allergies can cause swelling of soft tissues, such as the mouth, lips, and throat, which can then block the airway--hence they can be deadly quickly. While it's easiest (in theory) to just maintain a plan of food avoidance, as the child gets older, that can be harder to enforce (who didn't share lunches in school?). Anyway, many of your daughter's allergies may not ultimately end up being *true* allergies, but just *potential* allergies that the Mother blew out of proportion, given the real fear of true allergies.
That being said, given your autoimmune-mediated foot rash (likely eczema or psoriasis), your daughter may have inherited a tendency to have an over-active immune system. Nevertheless, time will be the best instrument in making that determination. And she may end up with no allergy issues at all.
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N.P. answers from Chicago on November 17, 2010
My son showed (prick and blood) as having a SEVERE allergy to peanut, egg yolk, egg white, soy, corn, wheat... and the list continues. He eats all of those on a regular basis (except for peanut butter). The allergiest was confused and perplexed as my son SHOULD be having a bad allergy but isn't. He even said (since we were clear of allergy meds for the tests to be done) to go get the epi-pen filled and then give these items to my son and see his reaction... if you can believe it? No reaction. So, the article someone posted, I believe is true. We didn't feel right to eliminate all of this from his diet... I'm from the belief that the more you limit, the more of a reaction COULD happen. That's just me. He has no other symptoms having these foods...
We are to the point with our allergist that we may need a 2nd opinion (as my son has severe seasonal and dog/cat allergies) and don't want to dope him on Singular. So my point... maybe go and get a 2nd opinion.
Also, did you eliminate everything he is allergic to from your diet? It could be that he has bad excema because you are still nursing. I have bad skin allergies myself so would not be surprised if my son did... and he did, until I stopped nursing. Just something to think about... not to stop nursing but it could be from that.
Good luck. It's really tough.
A.F. answers from Chicago on November 17, 2010
Since your son is an allergic child, I would avoid Almond milk as he could develop a tree nut allergy when normally in an allergic child you would avoid nuts or peanuts till age 3. My daughter drinks Rice Milk. We buy the Original -- you can get it by the case at Costco (it is cheaper than buying it by the half gallon at the grocery). Rice Dream is the brand. She had horrible eczema (milk, egg and fish allergies are moderately bad --causing eczema -- and peanut is anaphylaxis) when she was an infant on milk-based formula and when I nursed...we found out she had all the allergies when a daycare worker accidentally let her have a piece of peanut-tainted (that's right -- not even an actual peanut) chex mix one day at 12 mos and 1 day. We got her tested shortly after. She used to scratch little holes in her poor arms and legs from the itching of the eczema. Now she has perfectly CLEAR skin. You can also buy Rice cheese at Whole Foods or similar places (some have just rice milk but others have soy so you will have to be careful and read the labels) and my daughter prefers the cheddar flavor in grilled "cheese" sandwhiches or pepperjack alone as a snack. She is now almost 3 1/2 years. Best of luck. From what I have read, most milk allergies are not outgrown till around ages 5 or 6, if at all. We let her have SOME milk items (like lasagna at a family outing) every now and then but usually pay the price for about 2 weeks with an eczema breakout.
C.H. answers from Houston on November 18, 2010
There is a line of thinking that kids can "grow out" of the allergy. That may be why he suggested the cow's milk.
My son was just diagnosed with a cow's milk allergy, a 2 on a scale of 1-5. I was told we could try re-introducing it after 6 months to see if he may have outgrown it.
I personally doubt that this really occurs. My husband had the same allergy as a baby, they re-introduced it, and he had all sorts of sinus / earaches as a child. We think he still has it.
In terms of alternatives, you have some. I wouldn't do soy . . . it's one of the top allergens and can be a pseudo-estrogen--not good for boys. Below are some you could try. These should all be available at Whole Foods, or even a regular grocery store in the natural foods section.
- Rice milk
- Almond milk
- Coconut milk (canned or fresh in the dairy case)
- Goat milk (it should be much easier to digest and is different, but you'd have to watch this one)
Because we can't tolerate rice and the almond milk has additives we can't tolerate, we use only coconut milk or goat milk.
K.R. answers from Chicago on November 18, 2010
You've had a lot of good answers, but I was wondering since you mentioned what milk to give him after he turns 1, perhaps you are thinking that you MUST stop breastfeeding at the first birthday. If this is the case, you should know that the American Academy of Pediatrics states that babies should be exclusively breastfed for 6 months, then breastfed with the addition of solid foods after that until AT LEAST one year and then breastfed thereafter as long as both mom and baby want. So you don't really need to introduce any new milks to him at one if you'd rather just continue to breastfeed him. Many mothers do choose to continue longer and have discovered the joys and benefits of toddler nursing. Check out Kellymom.com for more information.
J.E. answers from Chicago on November 18, 2010
I would give coconut milk. My kids have the EE so I understand what you are going though. You can try almond milk too. I would not try the milk, the longer you keep them away from the food the better chance they will out grow it. who is this allegist? Associated allergist? We see dr Donnell and he is fabulous. email me if you need anymore info. My kids are 5 and I hvae been though what you are describing. My one son can only eat 5 foods and my daughter aobut 15. they live off of neocate.
S.P. answers from Los Angeles on November 17, 2010
It could be that when your son was very very young,
he had a severe reaction to milk products.
It could be that now that he is older,
he might have a milder, or NO, reaction to milk products.
If I were you, I might try a little PLAIN yogurt to start with.
See how that goes.
If that's OK, then maybe try just a little low-fat or nonfat milk
and see how that goes.
Since you are breastfeeding -- YAAAAYYYY!!! --
you can actually postpone milk products.
Go with veggies and fruits and cereals for now.
I'm so glad the eczema is gone.
About doctors sometimes saying the wrong thing . . .
even though they mean well and they DO read the chart,
sometimes they slip, and have a little mind fart.
For example, one of my cousins who had a DOUBLE MASTECTOMY,
years later her doctor ask her if she had remembered to get a mammogram. Arghhhh.
K.E. answers from Buffalo on November 17, 2010
ok 1 I would give him Rice Milk, Check it, but it should be fine.
Try ENER-G for an egg replacer for baked goods for the EGGS
My son is allergic to eggs it is reactive airway and I too carry an epi pen for him, the point of all this is my allergenist told me that because he is so young he has a 45%chance to out grow it by the age of 5 and 85%chance to out grow it by age 16. The percentage he will fall into will all depend on how good of a job I do as a parent and keeping from all exposures. I would say keep him from dairy until he comes negitive for the allergy. My son out grew the milk thing by age 2 but he is 4 and still allergic to eggs; however, he was only lactose intolerant even though the blood test said he was allergic the skin test was negitive..
Keep in mind that the more he is exposed the more his system makes immunities for that item and the longer it will take, and the closer you become to an anaphalactic response. Another words the reaction will get worse the more and more you expose him if his body has time to build up immunities to it.