Allergist Referral for Infant with Dairy Allergy
Yes, an infant with a dairy allergy should be referred to an allergist for diagnostic confirmation, longitudinal management, and development of an emergency action plan. 1
Immediate Actions Before Allergist Consultation
While awaiting the allergist appointment (which averages 4 months), you must take these critical steps to protect the infant:
- Prescribe an epinephrine autoinjector immediately, even if you are uncertain about the diagnosis, as the infant remains at risk for life-threatening reactions during the waiting period 1, 2
- Provide hands-on training to caregivers on proper epinephrine administration technique 2
- Instruct temporary avoidance of dairy products until allergist evaluation 1, 3
- Prescribe antihistamines as adjunctive therapy for managing non-severe allergic symptoms 1, 2
- Create a written food allergy emergency action plan specifying when and how to administer epinephrine 1, 2
Why Allergist Referral is Essential
The allergist provides specialized services that primary care cannot replicate:
- Diagnostic confirmation through oral food challenges when necessary, as the double-blind, placebo-controlled food challenge remains the gold standard for diagnosis 1, 2
- Formulation of a comprehensive emergency anaphylaxis action plan 1, 3
- Education on avoidance strategies including label reading 1
- Facilitation of dialogue with schools or childcare centers 1
- Assessment of longitudinal prognosis and development of tolerance over time 1
- Yearly follow-up for retesting, as many childhood food allergies resolve 1, 2
Nutritional Considerations
- Arrange nutritional counseling immediately for all infants with confirmed dairy allergy to ensure elimination diets provide adequate nutrients, particularly calcium and vitamin D 2
- Monitor growth parameters regularly, as avoidance diets can lead to nutritional deficiencies if not properly managed 1, 2
Co-Management Strategy
- Continue co-managing with the allergist rather than transferring care entirely, maintaining awareness of the infant's special needs 1, 2
- Provide social support given the effects that food allergy can have on quality of life 1
- For exclusively breastfed infants, maternal dietary allergen avoidance may be necessary 4, 5
Critical Pitfalls to Avoid
- Never delay epinephrine prescription while awaiting allergist consultation, as this leaves infants vulnerable to potentially fatal reactions 2
- Do not rely solely on positive IgE testing without clinical history, as sensitization does not equal clinical allergy 1, 3, 2
- Avoid implementing unnecessary dietary restrictions beyond confirmed allergens, as this can impair growth and nutrition 1, 6