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Monday, March 28, 2011
Q&A with Wayne Shreffler, MD, PhD
New research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology indicates that children may not outgrow milk allergies as early in life as experts had thought.
Wayne Shreffler, MD, PhD, is a pediatric allergist at MassGeneral Hospital for Children and director of the Food Allergy Center at Massachusetts General Hospital. His research focuses on food allergy and asthma.
Q: What is the main takeaway from the study?
A: The main takeaway is that milk allergy diagnosed early in life appears to be more persistent than it was 10 years ago. This is consistent with the anecdotal impression that many pediatricians and allergists have and with earlier studies that have looked at this as well. However, there are some important qualifications that may limit how we apply these findings to the general population.
These young children (average age 9 months) were recruited as part of a study of risks for the development of peanut allergy and in addition to a positive test for milk allergy had to either have eczema or a convincing history of reacting to milk when it was consumed. Many children are diagnosed with milk allergy with less strict or specific criteria. In addition, not all children were given milk to try after the two-year follow-up period to prove whether or not they were still milk allergic, so the actual rate of milk allergy at the end of that two years is not based on the gold standard and is likely to be at least a bit lower.
It is also important to emphasize that the study does not inform us beyond these two years of follow up or suggest that children will be less likely to ultimately outgrow their milk allergy.
Q: Should parents do anything differently?
A: No. They should continue to follow this with their allergist and perhaps discuss with them whether their child might be a candidate for a trial introduction (most likely in the office) of milk in baked products as that has been shown not to prolong milk allergy and may hasten its resolution.
Q: Should parents be careful about giving babies milk for the first time?
A: The current consensus statements from all major pediatric and specialty societies regarding the introduction of milk, egg, peanut or any other food, is to follow general pediatric guidelines. They have completely veered away from treating any food differently regardless of family history or the presence of eczema, and I strongly agree.
Delaying the introduction of these foods has not been shown to be helpful in reducing the risk for food allergy and there is some evidence that it does the opposite.
Related Links: Study abstract
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