Differential Diagnosis for a 2.5-Year-Old with Reactions to Milk
Single Most Likely Diagnosis
- IgE-Mediated Cow's Milk Allergy: This is the most common cause of milk reactions in infants and young children, characterized by symptoms such as oral-facial reactions, which can include swelling, redness, and itching around the mouth and face, often occurring shortly after milk ingestion.
Other Likely Diagnoses
- Non-IgE-Mediated Cow's Milk Allergy: This type of allergy presents with symptoms that can be similar to IgE-mediated reactions but often involves the gastrointestinal tract, such as diarrhea, vomiting, and abdominal pain, without the immediate oral-facial reactions.
- Lactose Intolerance: Although less common in very young children, lactose intolerance can cause gastrointestinal symptoms like bloating, gas, diarrhea, and abdominal pain after consuming lactose-containing products.
- Food Protein-Induced Enterocolitis Syndrome (FPIES): A non-IgE-mediated food allergy that typically presents with severe vomiting, diarrhea, and abdominal pain, usually 2-4 hours after ingestion of the offending food, which can include milk.
Do Not Miss Diagnoses
- Anaphylaxis: A severe, life-threatening allergic reaction that requires immediate medical attention. Symptoms can include difficulty breathing, rapid heartbeat, dizziness, and a drop in blood pressure, in addition to oral-facial reactions.
- Eosinophilic Esophagitis (EoE): A chronic inflammatory disease of the esophagus that can be triggered by milk and other foods, leading to symptoms like difficulty swallowing, vomiting, and abdominal pain.
Rare Diagnoses
- Galactosemia: A genetic disorder that affects the body's ability to metabolize galactose, a sugar found in milk, leading to symptoms like vomiting, diarrhea, and failure to thrive if left untreated.
- Milk Protein Enteropathy: A rare condition characterized by inflammation of the small intestine due to an immune reaction to milk proteins, leading to chronic diarrhea and malabsorption.