From the Guidelines
A patient with a positive allergen panel for milk should be referred to an allergist or immunologist for further evaluation and management, as this positive result suggests a milk allergy, but additional testing may be needed to confirm a true allergy. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of confirming a food allergy diagnosis through a combination of clinical history, physical examination, and diagnostic tests such as skin prick tests or oral food challenges 1. A true milk allergy involves an immune system response, typically mediated by IgE antibodies, which can cause symptoms ranging from mild (hives, itching) to severe (anaphylaxis) 1. The allergist will likely perform additional tests to confirm the diagnosis and determine the severity of the allergy, and provide guidance on milk avoidance, reading food labels for hidden milk ingredients, and managing accidental exposures. For patients with confirmed milk allergies, the allergist may prescribe emergency medications like epinephrine auto-injectors (such as EpiPen or Auvi-Q) for severe reactions. It's essential to distinguish a true milk allergy from lactose intolerance, which is not an allergic reaction but rather an inability to digest lactose due to enzyme deficiency, as this distinction affects management strategies and potential risks to the patient 1.
Some key points to consider in the management of milk allergy include:
- The importance of strict allergen avoidance to prevent accidental exposures and reduce the risk of anaphylaxis 1
- The need for comprehensive counseling on food allergy management, including label reading, recognition of symptoms, and use of emergency medications 1
- The potential benefits and risks of oral immunotherapy (OIT) as a treatment option for milk allergy, including the need for careful monitoring and management of adverse reactions 1
- The importance of distinguishing between a true milk allergy and lactose intolerance, and tailoring management strategies accordingly 1
Overall, the management of milk allergy requires a comprehensive and individualized approach, taking into account the patient's specific needs and circumstances. By referring the patient to an allergist or immunologist for further evaluation and management, we can ensure that they receive the best possible care and support to manage their condition effectively.
From the Research
Allergen Panel Labs Positive for Milk Allergen
- A patient with a positive result for milk allergen on an allergen panel lab may have a true allergy, but further testing is necessary to confirm the diagnosis 2.
- The patient should be referred to an allergist or immunologist for further evaluation and testing, which may include an oral food challenge to confirm the diagnosis 2.
Referral and Treatment
- If the patient is diagnosed with a milk allergy, they should be referred to a healthcare provider for guidance on avoiding milk and milk products, as well as for treatment options such as oral immunotherapy (OIT) 3.
- OIT has been shown to be effective in desensitizing children with cow's milk allergy, and may be a treatment option for patients with a milk allergy 3.
- In the event of an anaphylactic reaction, the patient should be treated with epinephrine, which is the first-line treatment for anaphylaxis 4, 5, 6.
Diagnosis and Testing
- The diagnosis of a milk allergy is typically made through a combination of medical history, physical examination, and testing, including skin prick tests and serum IgE-specific antibody tests 2.
- An oral food challenge may be necessary to confirm the diagnosis, and should only be performed under the supervision of a healthcare provider in a medical setting 6, 2.