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Month: September 2024

Milk Allergy

Milk is one of the most common foods to cause allergic reactions.  Almost 3% of children younger than 3 years of age are allergic to milk.  Notwithstanding, a vast majority of children spontaneously outgrow their milk sensitivities.

CAUSES:

In children with milk allergy, the immune system falsely identifies the protein in the milk as potentially dangerous, and as a result, mounts a defensive attack.  The “pre-formed” milk specific antibodies (i.e., immunoglobulin E or IgE) react with the protein in the milk (i.e., antigen), causing release of chemical substances (e.g., histamine, leukotrienes, prostaglandins) into the tissues.  These chemical substances are what causes the symptoms of allergic reactions.

Cow’s milk is the most common cause of milk allergy although milk from sheep and goats can also cause allergic reactions in certain sensitized children.  Children are more likely to have a milk allergy if there is a history of a food allergy in other family members.

SIGNS and SYMPTOMS:

Children usually begin manifesting symptoms of milk allergy within a few minutes after consuming milk products.  In some children, however, symptoms can sometimes be delayed for a few hours.

  • Skin itching, hives, and/or swelling of soft tissues
  • Redness, itching, and/or tearing of the eyes
  • Fullness/tightness in the throat, difficulty in breathing and/or swallowing
  • Nasal congestion, itching, sneezing, and/or clear runny nose
  • Abdominal pain, cramping, vomiting, and/or diarrhea
  • Irritability, restlessness, and/or dizziness
  • Drop in blood pressure, and/or loss of consciousness

The severity of symptoms can vary from mild to severe life-threatening anaphylactic reactions, depending on the severity of the allergy.

DIAGNOSIS:

  • Comprehensive history taking of the milk reaction with focus on the time of exposure to milk, onset time of symptoms, and progression of symptoms.
  • Family history of food allergies
  • Skin prick testing with a commercially available milk protein antigen with negative and positive controls.  If the wheal diameter of the milk protein is more than 3 mm. than that of the negative control, the test is considered positive, signifying the presence of IgE antibodies to milk.
  • A blood test can also be utilized to detect and measure the quantities of milk specific IgE antibodies and should be obtained for more severe milk reactions.
  • Oral challenge with incremental exposure to milk beginning with a tiny amount and slowly increasing the amount at regular intervals while closely monitoring for signs and symptoms of a reaction.  These oral challenges should be undertaken only when trained professionals are readily available to identify and treat possible untoward reactions as soon as they occur.

TREATMENT:

  • Total avoidance of milk and dairy products
  • Read labels and identify the ingredients of packaged foods
  • In cases of accidental exposures, antihistamines can be given orally or by injection if the symptoms are limited to hives and/or itching of the skin.
  • If the symptoms are rapidly progressing and/or in case respiratory, gastro intestinal, and/or cardiac symptoms, epinephrine should be injected into the muscle on an urgent basis.  Patients should be prescribed a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick) and told to go immediately to the closest emergency room if that device is used.
  • Oral immunotherapy is a process of desensitization to milk, which reduces the risk of severe reactions after inadvertent exposure to milk products. This process entails ingestion of small quantities of milk protein in a controlled setting to monitor for reactions.  The amount of milk protein will be gradually increased under close medical supervision.
  • Xolair (i.e., omalizumab) injections can be given either every 2 or 4 weeks in order to prevent a severe milk allergy, as well as any other food allergy.

 

Note:  “Lactose intolerance” is sometimes confused with milk allergy.  Intolerance in this case signifies a difficulty in processing and digesting the sugar in the milk (i.e., lactose) as the enzyme that is needed to break it down (i.e., lactase) is lacking in sufficient quantities.  This process does not involve the immune system and the symptoms are usually limited to the gastrointestinal tract. The typical symptoms may include abdominal bloating, abdominal pain, diarrhea, nausea, and/or vomiting.  These children will be able to tolerate lactose-free milk and dairy products.

PREVENTION:

  • Milk allergy itself may not be preventable, due to a genetic predisposition and susceptibility.
  • Diligent avoidance of milk and dairy products such as cream, cheese, butter, ice cream, and yogurt may prevent severe reactions.
  • Having a self-injectable epinephrine (e.g., EpiPen, Auvi-Q, Adrenaclick) device readily available at all times can reduce the risks of life-threatening anaphylactic reactions.

Close monitoring by a board certified allergist, like the ones at Black & Kletz Allergy, as well as testing for milk allergy at regular intervals, may identify the children who outgrow their milk allergy.  At this point, milk and dairy products may possibly be gradually reintroduced into their diets.

The board certified allergy doctors at Black & Kletz Allergy have been diagnosing milk and other food allergies in both adults and children for over 50 years.  We have 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The allergists are able to test for milk allergy and most foods which can be done by either blood tests or allergy skin tests.  We offer onsite parking at each one of our locations and both the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you feel you may have a milk allergy, other food allergy and/or a food intolerance, please call us today to schedule an appointment. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy are eager to help you find out if you are allergic to milk or other foods.  This will allow you live in less fear as you will be able to avoid the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.

Update on Generalized Itching (Pruritus)

Update on Generalized Itching (Pruritus)Generalized itching (i.e., generalized pruritus) is a condition which can be quite annoying.  It is when an individual has diffuse itching of the body usually without an associated rash.  Approximately 20-25% of the general population experiences generalized pruritus at least one time in their life.  The itching may be intermittent or it may be chronic in nature.  “Acute” itching is when the itching has been present for less than 6 weeks.  “Chronic” itching is defined by having it for 6 or more weeks.  The itching may last for years in certain individuals.  The severity of the itching may vary from very mild to very severe where it can interfere with one’s quality of life.  If the itching becomes chronic, it is important to see a board certified allergist, like the ones at Black & Kletz Allergy, so that a cause of the itching can hopefully be identified.  Note that generalized itching may also be associated with hives (i.e., urticaria) and/or swelling (i.e., angioedema).

There are many causes of generalized itching.  Allergies are a very common cause of itching.  Allergies to oral and topical medications, foods, cosmetics, fragrances, metals, shampoos, nail polish, latex, poison ivy, poison oak, and poison sumac are just some of the common allergies that may cause itching.  Contact dermatitis and eczema, (i.e., atopic dermatitis) are 2 other allergic conditions that may cause itching.   Although allergies may be the cause of a lot of individual’s itching, it by no means the only reason for the pruritus.  There are a variety of underlying conditions that may cause a person to have itching even though it may not be the most common symptom of the disease.  Some of the underlying conditions that can cause itching may include diabetes mellitus, hepatitis B, hepatitis C, kidney disease, thyroid disease, malignancy, iron deficiency anemia, dyshidrotic eczema, HIV, folliculitis, ringworm, seborrheic dermatitis, neurodermatitis, shingles, xerosis (i.e., dry skin), psoriasis, bed bugs, parasitic infections, pregnancy, as well as many others.  It is important that a cause be identified so that either the allergen is avoided or the management can be focused on the underlying condition responsible for the itching.

The diagnosis of generalized itching begins with a comprehensive history and physical examination.  By performing a comprehensive history, the allergist is trying to ascertain the cause of the itching.  It is common for a patient to forget or not bring up pertinent information that can help the allergist figure out the cause, so it is important for the allergist to ask a variety of questions in order to try to establish a cause or trigger of the pruritus.  Asking questions such as, “Have been on any recent antibiotics or new medications?” or “Do you take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)?” are good questions because many patients will not volunteer this information because they do not feel that it is important enough to mention to the physician.  In reality, antibiotics, new medications, aspirin, and NSAIDs use are very common reasons for generalized itching.  If no obvious allergen can be identified and the itching has lasted 6 weeks or more, looking for an underlying condition is the next step.  This is usually done by blood tests.

The treatment of generalized itching is directed at avoiding the offending agent.  If for example a new medication appears to be causing the itching, the medication should be stopped or changed to another appropriate medication.  If it is a certain cosmetic or a specific food, then obviously the cosmetic or food should be avoided.  In addition, using oral H1 blockers (i.e., antihistamines) is the most common treatment.  Sometimes, adding an H2 blocker and/or a leukotriene antagonist to the Hi blocker is needed.  Rarely, oral corticosteroids are needed for severe cases.  Topical creams/ointments have been used with limited success.  In most cases, medications may only be needed for 1 or 2 weeks, but can be necessary is some individuals for several years.  If the itching persists for more than 6 weeks and bloodwork is obtained in order to rule out underlying conditions, then treating the underlying condition may in fact get rid of the itching.

The board certified allergy doctors at Black & Kletz Allergy have been diagnosing and treating generalized itching for more than 50 years.  We treat both pediatric and adult patients.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from generalized itching, hives, swelling episodes, or any other allergic condition, the allergy specialists at Black & Kletz Allergy are happy to help you.  We are dedicated to providing you with the highest quality allergy care in a relaxed, considerate, and professional environment.