>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.

My gut feeling is that it wouldn't be a good idea to do both of these
together. Perhaps just do the vaccinations and leave the challenge until
after any reactions to these, if there are any.


>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).

Rob, I don't believe that anyone 'grows out of' allergies or intolerances.
(Maureen Minchin, are you there to comment on this??) The reactions may
change in character as the person ages, but they don't really ever
completely go away. I would be very cautious about challenges. I would
think that it would be wise to do the challenge via mum's milk first. At
least then if there is a reaction it is likely to be relatively mild. Even
if baby does react, I wouldn't recommend that mum stops breastfeeding. With
just one little 'dose' of cow's milk protein, it shouldn't cause too bad a
reaction in baby, and the alternatives may be worse (and possibly compound
the situation). But of course, this depends on what happens.

******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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