>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. WHY? what's the point? >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. I think she's like every other mother I know who realises that she can help her baby by altering her diet. It annoys me that people make out that avoiding milk is so hard. Yes, it is a mental hurdle because milk is so common, but 1) once done it's dead easy to have a life and eat well, and 2) in nearly every case the mother herself will be better off without the milk, as it is likely that this is a case of in utero sensitisation thanks to the mother having been made allergic as a child by inappropriate feeding...(Could just be comp feeding in hospital, but severe allergy in teh breastfed baby usually means allergy in teh mother.) And it's ten thousand times harder to live with a miserable baby with bloody stools and severe pain...I think the "diet is so difficult" theory is held by people who don't have to live with the consequences of anything else. >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 is right to be concerned, and not just about confusing symptoms. This baby has just one immune system and it has enough to deal with (and a kid this severely sensitive while breastfed often has bad reactions to vaccines anyway.I always get mothers of allergic kids to stock up on their anti-oxidant and anti-inflammatory nutrients before kids are vaccinated, and teach them about conservative management of symptoms such as fever, as often highly coloured/flavoured drugs make things worse.) Joy said:> 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.< I agree. In fact I agree with everything Joy said. She must see the same problems as I do, and gets the same results from the same suggestions. >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. Not necessarily. Being able to tolerate one ounce one day does not prove anything except that the child can tolerate one ounce one day. Reactions can be dose dependent, adjuvant-dependent, nutrient-dependent, dependent on other stresses to the immune system. Fact is, reactions may be occurring but not visible symptoms we can assess because today the immune system can keep them in check, tomorrow it's too busy fighting off a virus and can't.... Read Doris Rapp's work, or that excellent book, Brostoff and Gamlin's Complete Guide to Food Allergy and Intolerance. (Bloomsbury Publications in teh UK, don't remember date) >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 Still allergic but able to tolerate it without symptoms because of breastmilk's anti-inflammatory and other bioactive agents, perhaps. >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). Absolutely. Formula adds a zillion other defects to the diet. And of course this is a very different dose to deal with! My advice, for what it's worth, is prepare the mother for the possibility of long-term breastfeeding (normal breastfeeding, that is, like 4 years or so) as these kids (severe enough to have colitis) are likely to want not to be weaned. they know breastmilk is all that helps them tolerate other food sometimes. They often have no major problems until about 2-4 weeks after the very last breastfeed, when serious symptoms of allergy show up once again: not the same ones, but say asthma.. They often don't grow brilliantly as so much of their diet goes into feeding their immune system's need for nutrients (omega 3 fatty acids very useful and some parents find maternal and then after weaning kid supplementation with safe amounts of zinc and full spectrum B vits useful too.) Useful to have friends you trust who can donate milk in case of reactions too. But they do worse (except for more adipose tissue occasionally) if they lose breastmilk's protections. If they're having problems with weaning diet, they go off all other foods and back to the breast every so often to deal with reactions to foods... My bottom line question remains. WHY? Why take a risk like this when you don't need to? It proves nothing useful at all. And it is risky. I remember hearing John Walker-Smith say at a British College of Allergy and Clinical Immunology meeting,that it is the frequent (6 monthly) tests done on children diagnosed as allergic which damages the gut and makes recovery less likely. In the UK, at least at his clinic (one of the very best) once diagnosed they are not challenged before the age of 2, and not necessarily then. In fact, given the world we live in, challenges will occur in this next year, as sensitive caring people take no notice of stupid mothers and offer all sorts of food with "just a bit won't do any harm" . or "she's imagining it and I'll prove her wrong, she'll never know there's milk in this" rationalisations.. or the label doesn't say milk but caseinate or dairy whitener or some such. Just get the mother to record exposures and reactions over time; she'll know when things are improviong. But for now, I'd strongly suggest that you leave well enough alone, and never ever combine severe immunological stresses to infants. Vaccination is such a stress, however much we consider it warranted. Sorry about the length: it's an important topic. MM Maureen Minchin, IBCLC. Christ Church Vicarage, 14 Acland St., St.Kilda, Vic. 3182 Australia. tel/fax: 61 3 9537 2640 "Taking paths of least resistance is what makes rivers - and people - crooked." poster in Palmerston North NZ bookshop...