Frequency and Severity of Cow’s Milk Allergy Reactions in Children: A Prospective Audit

Abstract

Milk ranks as the second most common allergen, following peanuts. Recent studies from Spain and the
USA reports an annual frequency of accidental allergic reactions (AAR) ranging from 34% to 40%. AAR severity is influenced by food allergens and the presence of atopic diseases such as asthma, eczema, hay-fever, and recurrent wheezing. This study aimed to determine the frequency of accidental allergic reactions in children with cow’s milk protein allergy between September 2011 to September 2012. The study design employed is missing. A structured questionnaire was used and the guardians of the patients were guided in answering by the research assistants (Students). The questionnaire was conducted on 62 patients (35 males, 27 females) with a median age of 67 months. The inquiries were about the number and locations of accidental reactions, their severity, other food allergies, and risk factors such as asthma, hay-fever, recurrent wheezing, and eczema. Symptoms were classified as mild, moderate, or severe, and previous and current skin prick test results were recorded. Between 2011 and 2012, the frequency of AAR was found to be 57% (inclusive of adults). Among the children, 37 (60%) experienced 51 accidental reactions in the past year, with 43% classified as mild, 19% as moderate, and 38% as severe. The majority of reactions (60%) occurred at home, and treatment primarily involved the use of Chlorphenamine [Piriton©] (79%). Three anaphylactic reactions occurred and were identified leading to hospitalization and administration of epinephrine. Oral exposure was the primary route (89%), with milk-containing products being the most common allergen sources (51%). The main cause of AAR was attributed to mislabeling and misreading of labels, especially in newly implemented recipes and non-packaged cereal products like homemade croissants sold in cafes and restaurants. Other causes included high levels of peanut traces and hazelnuts in cookies and chocolates. In conclusion, accidental allergic reactions are prevalent in children and are often caused by contamination, mislabeling, recipe changes by companies, misinterpretation by caregivers, and direct milk intake. Risk factors for AAR severity include hay fever, peanut allergy, multiple atopic diseases, and wheal size.