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Food allergy, including cow’s milk allergy, can have a dramatic effect on quality of life.10 Many studies have detailed the negative affect of food allergy on health-related quality of life (HRQoL), as well as the financial and emotional toll a food allergy takes.9 Identified issues include feeling different because of the diet, worrying about foods, the presence of physical and emotional distress, increased responsibility, effect on social activities (e.g., social restrictions, school, travel, and dining out), anxiety, stress, bullying, and having to consistently exercise greater caution.8
Cow’s milk allergy patients and their families must be educated to avoid accidentally ingesting food allergens (e.g., by reading food labels), to recognize early symptoms of an allergic reaction, and to initiate early management of an anaphylactic reaction.2
Cow’s milk can be an ingredient in many foods, making it integral for healthcare providers to educate patients on the importance of reading food labels. A high level of patient education is needed to maintain safety when it comes to allergy avoidance.8
Cow’s milk can be hidden in a variety of foods including:12
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Avoidance of cow’s milk protein in any form is currently the only available treatment for CMA.1,2 Effective management of food allergy requires avoidance of ingestion and prompt treatment in the event of an allergic reaction.9
Strict avoidance of cow’s milk is usually advised, however, some children with milk allergy can tolerate it when extensively heated in baked goods.9 Studies have shown that 75 percent of children with a milk allergy can actually tolerate baked foods containing milk, such as a muffin or cake.12,13 A specific IgE blood test can help you determine if your patient is a good candidate for an oral food challenge to see if they’re likely to tolerate baked milk.
Practice parameters have been developed to help guide the management and treatment of patients with milk and food allergies.