Allergy or intolerance?

[CosmicMouse]

I'm unsure as to whether to push for diagnosis for my 15mo.

She has begun to react to cow's milk. Her symptoms so far are relatively minor (ie nothing involving airways or swelling).

I saw a GP who told me reactions to milk are common and if I wanted to give another milk I could but he wasn't going to prescribe anything for her Guess he thought I was there for a hand out.

The HV was more sympathetic and seemed surprised that the GP had dismissed what could be an allergy out of hand. She suggested a food diary in order to confirm my suspicions. Which worked as within a week my suspicions were indeed confirmed that cow's milk, butter & cheese cause reactions. She managed to convince the dismissive GP to refer DD to a dietician as she wasn't sure the best course of action.

Great. But I found out today it will be October before we get to see anyone. I've had no input as to whether I should treat this as an allergy or an intolerance. No guidance as to how strict I need to be. No idea if/when I should reintroduce these foods. Nothing.

I'm stuck with what to do next.

Should I just assume it is "just" an intolerance, quit the trigger foods, and wait til Oct.

Or go and see another GP for more immediate guidance in case it's more complex than that?

Anyone got any advice?

What are the symptoms of the reactions?

A drink of cows milk has her up in the night with tummy pain, followed by awful dark green mucousy nappies the next day.

Cheese and butter both give her a bright red chin.

We did also get two full face rashes after drinks of milk, but that seems to have been replaced by this gut reaction?

I feel like she's getting more and more sensitive though.

She doesn't seem to have ever reacted to cow's milk via my breast milk.

If it is an allergy, I think it must be non-igE as it's a delayed reaction each time. Or maybe it's an intolerance.

It's the uncertainty I don't like!

It does sound like either a non-Ige allergy or an intolerance given the symptoms you describe. Both are very unpleasant for your child (and you!) and it clearly needs investigating. If your child was much younger I would definitely be saying push the GP for a prescription for an alternative milk but given her age and the current restrictions on the NHS I think it's probably unrealistic at this point. However, when you get to see a specialist they may well prescribe a hypoallergenic formula but sadly it is very common to have to wait a long time for these appointments no matter how severe the allergy/intolerance. You must definitely push for a referral to a consultant though, not just a dietician. Here's a link to the NICE guidelines for the diagnosis and assessment of allergies in children (you might want to wave these at your GP if necessary): publications.nice.org.uk/food-allergy-in-children-and-young-people-cg116/guidance

In the meantime, I would recommend cutting out all dairy from her diet - this will involve scouring ingredients lists on absolutely everything as you'd be amazed how many things contain milk in some form or another. You could try fortified soya, oat or almond milk but be aware that quite a few children who are allergic/intolerant to cow's milk also react to soya so it's best to keep a detailed food diary to monitor any symptoms. There's a really helpful Facebook page called Cow's Milk Protein Allergy Support where you can get lots of advice (it doesn't matter to them whether it's an allergy or intolerance). You will need to make sure she's getting plenty of calcium so lots of dark green leafy veg (including broccoli) and canned fish is good too (eg sardines). We also give DS Morrison's hot oat cereal (cheap version of Ready Brek) as it has added calcium and vitamins. It does state 'not suitable for milk allergy sufferers' due to manufacturing process but we made the personal decision to take the risk and thankfully so far he's never reacted to it despite being severely allergic.

Just to add that while some babies do react to cow's milk through mum's breast milk, most don't as the protein is so broken down that it doesn't cause a reaction. It's normally when weaning starts that the allergy or intolerance becomes apparent.

Good luck and let us know how you get on.

Thanks so much for your detailed reply.

I think she reacted to a drink of milk I has last night, so I really do think she's getting more sensitive :-(

I'll cut it all and try and get back in and see the GP to discuss it again.

there is nothing wrong with asking for a blood test (RAST) to confirm that it is not a ige response. It does sound like an intolerance, and it would confirm that exclusion of mlk is the way forward.

I have a teen with milk and soya intol, milk is the lesser problem. we are exploring the possibilty of soya ige response, due to some odd symptoms after accidental exposure, esp as her sibling has a long list of ige allergies.

Thanks.

I've got an appt with a different (historically very good) GP.

So I'm going to push for more info, ask her to confirm an exclusion diet is the correct course of action and enquire as to whether we need a paed referral too.

Any other questions I should be asking?