Maryelle and other very wise ones,
I have a breastfeeding cow's milk allergic pateint who
is approaching her first birthday. I plan on orally challenging her
at one year old.
This pateint presented at 2-3 months old while exclusively BF
with blood in stools, increasd eosinophils on white count
and inflamatory changes on colon biopsy. With mom on
a completely cow's casein and whey free diet all is well. I think
this mom is a saint.
Some questions;
I got different opinions from ID and GI specailist as to
challenging this baby at the one year well visit on the same
day she gets HiB and chicken pox vaccines. GI
specialist concerned of possible immunization reaction
being confused as cow's milk reaction. ID specailist
not concerned with these vaccines.
Usually Ive done these challenges by giving the baby 1 once
(30 cc) of cows milk and observing her for 2 hours in the office.
If this works all is well. However in this baby's case could
she have matured to the point of not being allergic to cow's
milk protien that would be passed in BM if mom comsumed it
but still allergic to cow's milk that she herself would
directly consume? (I have a different pateint who fits
this discription, hives to cow's milk formula). If so can she
be challenged by having mom consume the cow's milk
then breastfed 2-3 hours later? If we did this and baby
reacted how long most mom then avoid breastfeeding her?
thanks,
-Rob
(pediatrician Wilkes Barre, PA)