Reintroducing dairy questions

[emma_l_m]

My little boy is 2 and we found out he was allergic to dairy when we started weaning him when he came up in hives from cows milk and yogurt. We’ve been trying to reintroduce dairy using the ladder provided by our dietician: starting off with baked cakes and breads, through to things like pancakes, and then to cheese, yogurt, butter before moving onto milk.

Trying this reintroduction has been difficult with a toddler who is picky about his food and also knows he isn’t meant to eat things like that! But we think we’ve got through all the items that contain dairy that is cooked in some way.

We tried cheese the other day and from a little grated cheddar, he got a few hives on his chin. We are intending to try yogurt and the other things still on this “rung” of the ladder, but we have never got a straight answer from any medical person about whether we should stop from a very mild reaction like this or whether we should continue. Should we stop with cheese for now and leave it for a few months before reintroducing again? Also, with cheese, would a more processed cheese potentially be easier for him to tolerate? Should we still try yogurt and butter and the other things from this "rung"?

Thank
Emma

[Dr Helen Brough]

Dear emma_l_m,

Please do not continue giving you son foods that he is having hives to (in this case grated cheese). I would also not try to give him yoghurt and butter, but stick to the baked cakes and bread with extensively heated cow's milk. If he has tolerated pancakes then this is fine to continue. I would give the foods that he tolerates (without any hives) at least 2-3 times a week to try to expedite the resolution of his allergy to less well heated forms cow's milk and discuss this with your allergy doctor before trying cheese again. Please ensure you always have antihistamines to hand.

I hope to give you a straight answer about what to do about mild allergic reaction to foods. One should never try to 'push through' immediate hypersensitivity reactions (like hives) to foods. The reason for this is that one could have a more severe allergic reaction on a day when other 'cofactors' that reduce the tolerance threshold are present such as a viral illness. With delayed allergic reactions like eczema flare or mild gastrointestinal symptoms it is sometimes feasible to try to 'push' through this with close supervision as sometimes these flares would have occurred anyway (regardless of the food introduction) and for example eczema flares can be more intensively managed with emollients and topical steroids.

[emma_l_m]

Thank you so much for your response. We've only spoken to our health visitor and a dietician about this - no one ever suggested referring us to an allergy specialist. I guess that is why I jumped at the chance to ask questions here so I could finally get answers as the health visitor doesn't know a lot and the dietician wasn't very helpful about reactions! What you have said was my gut instinct really. I've heard others say that with just a mild case of hives you ought to carry on with that food, but it just didn't sit well with me. It does make sense for the delayed reactions as you say.

Thank you for the information about making sure he has the foods at the level he can tolerate 2-3 times a week. We haven't heard that before so we will make sure we do that.

Thanks again

Emma