Is It Milk Allergy or Not? Differential Diagnosis

Abstract

Milk allergy is common in infancy, and single or multiple food allergies are present in about 82% of children younger than 2 years. The majority of milk-allergic children have their first adverse reaction before 1 year of age, most frequently attributable to milk. In 80% to 90% of children with a challenge-proven milk allergy, tolerance develops over time. Health care providers and patients' families must also be able to differentiate a milk allergy from milk intolerance. The goal of the initial assessment of food-allergic reactions, therefore, is to identify an IgE-mediated allergic reaction and confirm the diagnosis with diagnostic allergy testing. Individuals with high allergic susceptibility can be identified, and test results can provide caregivers with guidance on tolerance development. Nutritional recommendations may include incorporating milk into the diet and managing unintended or hidden consumption. The differential diagnosis of cow's milk allergy can usually be made on the basis of the clinical history and food skin testing or blood tests for cow's milk-specific IgE antibodies, with the addition of an open, oral food challenge in a few cases.