When Lesley Solomon’s son was 10 years old, he was standing in an unlucky spot on the playground when a schoolmate kicked over a cup of hot chocolate, sending droplets flying into the air. For the young boy with a severe milk allergy, the hot liquid splattering was less of a hazard for him than the dairy stirred into the drink.
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Ms. Solomon’s son quickly washed the fluids off his clothes and skin, took some Benadryl, and called his parents. But on the car ride home, his throat began to close and his pulse raced. It was one of about a dozen times he has needed an epinephrine injection, which increases blood flow, reduces swelling, and reverses anaphylaxis.
“Until you see a child going through that anaphylaxis and not being able to breathe, or throwing up so much that they can’t breathe, you don’t understand” how serious food allergies can be, said Ms. Solomon, who is senior vice president and chief innovation officer of the Dana-Farber Cancer Institute in Boston and cofounder of the Food Allergy Science Initiative, an independent nonprofit that funds food allergy research.
The rate of children hospitalized for food-induced anaphylaxis rose by 25% from 2006 to 2012 – from 1.2 to 1.5 per 100,000 – according to a 2019 analysis of data from pediatric hospitals in the United States. And severe symptoms were more often linked to milk than to peanuts or tree nuts, the study showed.
Cow’s milk is the most common food allergy in children aged younger than 5 years, and accounts for about half of all food allergies in children younger than 1. Most children grow out of it, but when milk allergy persists into the teenage years and adulthood, it is more likely to cause severe reactions.
A dangerous allergy
“Cow’s milk allergy is the most distressing of the food allergies. Many people are unaware that it can cause anaphylaxis that is so severe,” said Carla Davis, MD, director of the food allergy program at the Texas Children’s Hospital in Houston. “People do not think about how much of this is in our food.”
And cow’s milk was shown to be the food allergy most likely to lead to death in school-aged children in the United Kingdom, according to an analysis of national data reported by this news organization.
Lack of awareness is what makes milk allergy so dangerous, said Paul Turner, BMBCh, PhD, a pediatric allergist and immunologist from Imperial College London, who was involved in the British analysis. “We need to get that information out to the public and businesses so they take the same level of care that they have with nuts, and when someone says they have milk allergy, they take it seriously.
In food allergy, the body treats certain proteins, such as the casein and whey in milk, as invaders, mounting an immune response. Antibodies known as IgE – which normally protect against bacteria, viruses, and parasites – trigger inflammation, the release of histamine, and can lead to symptoms, typically within minutes, ranging from rash and swelling to vomiting, difficulty swallowing, and difficulty breathing.
So, the very thing that makes milk a healthy choice for kids – its high protein content – can cause serious reactions in a small portion of children and adults. “You don’t need much milk to get a decent dose” of the allergen, Dr. Turner pointed out.
The mechanisms of milk allergy are complex, even compared with other food allergies. The IgE antibody can be detected with a skin-prick test or IgE blood test, but some people have positive results even though they are not allergic. To complicate things further, people can also have non–IgE-mediated milk allergy, which cannot be detected with testing and can lead to symptoms that emerge hours or even days after exposure.