Cow’s Milk Allergy And Accidental Exposure

January 10, 2010

There is an interesting recent study out of Madrid looking at reactions to cow’s milk protein after accidental exposure in a group of young children known to be allergic to cow’s milk protein.   Eighty eight children with a mean age of about 2 1/2 year were followed for one year.

Forty percent of the children, or 35 children, had 53 reactions over the course of the year.  Almost 50% of the accidental exposures took place at home with about 20% at a neighbor’s home and another 25% at daycare/school.  15% of the reactions were classified as severe, meaning that they involved symptoms of respiratory distress or symptoms related to a drop in blood pressure such as dizziness or passing out.  All children were successfully treated for their reactions with 20% requiring ER treatment.  Two children needed to be hospitalized.

Children who had severe reactions had significantly higher allergy blood test results (level of cow’s milk specific IgE) compared to children with mild reactions.  Those with severe reactions had a median IgE of 37.7 compared to a median IgE of 3.3 in those who had mild reactions.

Twenty eight percent of the reactions were the result of eating dairy products such as cow’s milk, yogurt or cheese.  Fifty five percent of the reactions were the result of eating foods that contained cow’s milk as an ingredient.   Labels were not read in 1/3 of these cases.  Eight reactions resulting from eating cold cuts that contained cow’s milk proteins.   Seven reactions occurred because cow’s milk was not listed as an ingredient in the food eaten.  It is important to note that this study took place in Madrid.   In the United States food labeling regulations are more strict and it is likely that cow’s milk would have been listed as an ingredient for these foods in the United States.

The take home messages from this interesting study are as follows:

1. Accidental exposure to cow’s milk protein in young children allergic to cow’s milk is common.

2. Almost 50% of reactions occurred at home.

3. Children with higher levels of cow’s milk specific IgE, as determined by a blood test, are more likely to have severe reactions.

4. It is extremely important to read ingredient lists on purchased food products carefully.

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