Infant baked milk challenge

[hithisisme]

My DS is currently 7 1/2 mos old.  He gets contact hives from dairy/egg and tested positive on a skin prick test to both plus almonds.  Saw two allergists...first one said to come back a 1 year to repeat the skin test for comparison.  The second said to come back in Nov. for a baked milk challenge.  Does barely 9 months old seem too young for a baked challenge? What is the  earliest age you had this completed?

[my3guys]

I would say yes it seems too young for a baked milk challenge, but I'm not a doctor or allergist...so take my opinion for what it's worth.

Personally, I would want my child older, being able to communicate symptoms, handle chewing/swallowing more appropriately before risking a reaction through a challenge.

FWIW, Mt. Sinai requested children be 4 years old to participate in their baked milk study.  I'm not sure how they arrived at those parameters though.

[twinturbo]

I went through a (failed) milk challenge with a 1 year old infant.

They cannot communicate early symptoms so realistically there is no way a clinician can truly measure all symptoms for clean results. A gut pain would manifest as crying, an itchy tongue would be lip smacking at best. They just keep shoving the allergen dose in until something outer skin related or vomiting/diarrhea, or respiratory shows up.

[hithisisme]

What was fed to your child during the challenge?  If you could do it over, would you have waited?

[lakeswimr]

Has your child ever had any dairy?  If so, what was the reaction?

[CMdeux]

We challenged dairy at 12mo.

My DD wasn't most 12mo kids-- she was quite communicative and self-aware-- but even so, I'd NOT recommend this to most people.

We did it to "clear" + RAST results that didn't match a - SPT.  She also didn't have any anaphylaxis history and we hadn't been avoiding traces, though...

in retrospect, it was still a pretty high-risk thing to have done. 

I definitely see the wisdom of waiting until they are a bit older (minimum 2-4yo) to do this.

[Macabre]

And also having a RAST done.

[twinturbo]

Are you using any form of milk based formula right now? It's not necessarily indicative if a child will pass any sort of milk challenge but either way you're not challenging unbaked milk so you'll need something to get child until year 2. Mt. Sinai recommends either continuing breastmilk, or whatever formula you have been using.

Is there a reason beyond your infant eating milk right now that is prompting a challenge? Such as daycare, needing a formula, etc? Something isn't fitting here.

I'd amend my earlier statement a bit. I think challenging an infant is stupid, not unwise but stupid, because if you're already in need of a challenge you know there's a minimal significant risk which means two things: 1) you need good data including patient reporting of symptoms 2) what's the EAP for the anaphylaxing 9 month old? Mr. or Ms. Allergist had better be prepared for that event, and if he or she is not they have no business calling for a challenge on an infant to begin with.

In philosophical approach I am totally in agreement with starting with a form of a suspected allergen that is partially denatured. I think that is smart. Even then you have to look at the challenge as a whole rather than the isolated part of consumption.

How much solid can this 9 month old eat? How much total milk will actually be consumed? How will it be baked? Temp? Volume? How much is the starting dose? At what intervals will additional doses be given? Will the doctor be present during the challenge (they often leave it to a nurse to dose and monitor)? How will the doctor interpret symptoms related to gut, tongue, lips, more internal symptoms that usually require the patient to report? How will the doctor call a pass or fail? At what point will he or she call a fail? What dose of Benadryl will the doctor administer? How much epinephrine, if needed? Who will administer the epinephrine? What are the risks of that given weight and age of patient?

Minimally your baby will be in office for around two hours and will have to cooperate with the amount of food given. We were not allowed to feed anything else while challenging. I'm not sure how any doctor would be able to distinguish a fussy infant who is tired of being in the office from one with gut pain associated with consuming an allergen.

The challenge is important, ruling out milk is really important, but whatever the case a challenge needs to be measured. I think if the doctor is truly ready and there is clear communication on all related protocols including interpretation on symptoms and emergency management then a challenge at 12+ months and a weight reasonable enough to withstand an epinephrine dose is reached for the intentional ingestions purposes of a challenge. In the meantime I'd get an emergency action plan from the doctor now and an EpiPen, Jr. prescription including training from doc for accidental ingestion that induces reactions... if they manifest.