An updated epidemiological review paints a concerning picture of pediatric cow’s milk allergy in the US.
Ruchi Gupta, MD, MPH
A new, randomized, cross-sectional survey including 53,575 parents from a representative sample of US households has found that 1.9% of children have a convincing milk allergy, bolstering it once again as the most common food allergy in the United States.
Among children with food allergies, study authors discovered that milk allergy is found in 53% of infants. That’s a sizable increase from the investigators’ previous epidemiological study published in 2013, which identified milk allergy in just 19.9% of survey respondents (N=657). In that study, which pulled data from a randomized, cross-sectional survey of 38,480 parents, 1.7% had a convincing milk allergy. Asian (OR, 0.5) and black (OR, 0.4) children were half as likely as white children to develop milk allergy. The highest proportion of milk-allergic children were aged 6 to 10 years (23.8%) and the lowest percent of milk-allergic children were aged 11 to 15 years (15.0%).
Further, nearly one-third (31.4%) of children with milk allergy had a history of severe reactions. Compared with children with other food allergies, children with milk allergy had higher odds of having physician-diagnosed allergy (OR, 1.7) and were twice as likely (OR, 2.1) to outgrow their milk allergy.
“Children in the U.S. spend their early years drinking milk, so it’s important to know that many of them — at least in the first few years – may be allergic,” said Christopher Warren, PhD(c), lead author of the updated epidemiological study, which was presented at the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle, Washington. “Our findings suggest that while milk allergy is relatively common during infancy, many children are likely to outgrow their milk allergies. We observed that while an estimated 53% of food-allergic infants under age 1 have a milk allergy, the number drops to 41% of 1-2-year-olds, 34% of 3-5-year-olds and 15% of 11-17-year olds.”
In the updated epidemiological study, perhaps the most problematic data point uncovered by investigators was that roughly 1 in 4 children with milk allergy sought emergency care in the last 12 months, but less than half had their milk allergy diagnosed by a physician.
“We know confusion exists over what a real milk allergy looks like,” said Ruchi Gupta, MD, co-author of the updated study. “A child may have a milk intolerance that his parents mistake for a milk allergy. It’s important that any child suspected of having a milk allergy have the allergy confirmed with an allergist. A food allergy of any kind can have a big effect on a household, including food costs and quality of life. A child with a milk allergy should receive counseling on how to avoid milk, but also on what it means to unnecessarily cut out foods. You don’t want to get rid of necessary nutrients.”
To arrive at these conclusions, investigators administered a randomized, cross-sectional survey to 53,575 parents from a representative sample of US households with children from October 2015 to September 2016. Data regarding demographics, allergic symptoms and severity, diagnosis, and baked milk tolerance were collected and analyzed as weighted proportions. Adjusted models were estimated to examine association of these factors with odds of milk allergy.
“Parents need to make sure they have an epinephrine auto-injector available and should talk to their child’s allergist if they have any questions,” Gupta said.