How is CMA diagnosed?
How can you find out for sure if your child is allergic to cows' milk? What will your child's doctor do to confirm the diagnosis?
What might happen at the doctor’s?
Diagnosing CMA can mean a bit more than a single test at the doctor’s.Your child’s symptoms, medical history and overall assessment will be taken into account along with any test results when deciding if your child has a food allergy.
Here are some questions your child’s doctor may ask:
- How old was your child when you first noticed the symptoms?
- How quickly do symptoms develop?
- How severe are the symptoms?
- How long do they last?
- How often do they happen?
- Where do symptoms usually appear? (For example at home, or at school?)
- Do the same symptoms happen each time your child eats a particular food?
- Do you suspect a specific food is involved – if so, how much of the suspected food does your child need to eat for symptoms to appear?
How you can best prepare for your doctor’s appointment:
When it comes to diagnosing allergies, the child’s medical history may be as important as any diagnostic test results. So do make a note of any information about your family’s medical history as well as the medical history of your child before visiting the doctor.
Identifying the symptoms is the first step in providing relief for your baby. So the more you tell your doctor, the better.
Why not keep a diary to see how different foods affect your baby?
There is a lot to cover at the doctor’s appointment so it’s a good idea to make a note of any questions you might like to ask your doctor so you don’t forget. Questions parents often ask include:
- Could my child’s symptoms be caused by food allergy?
- Is it possible to confirm if my child has a food allergy?
- Which tests will have to be performed?
- Do I need to see a specialist?
- What will be the next steps?
Which tests might your doctor want to do to diagnose food allergy:
- How are doctors advised to manage allergies? (click to expand)
Your child’s doctor will use all of the information you provide to help decide whether allergy tests are called for. Allergy testing can involve:
- Skin tests (click to expand)
Skin tests are often the starting point because they are quick to do. When allergic reactions happen very soon after your child has eaten, a positive skin or blood test is more likely. If the symptoms of the allergy typically appear a while later, these can be more difficult to detect in the blood. Of course, these type of allergy tests are just one part of the diagnosis process – sometimes the results (both positive or negative) can be wrong. That means that your child can show allergy symptoms in spite of the test saying he or she is not allergic.
- Diets to aid a diagnosis (click to expand)
Might be suggested if allergic reactions happen hours or days after the food is eaten. These diets may require elimination of certain foods or specific food challenges All these tests need to be performed under medical supervision by a doctor or other trained healthcare professional.
- Elimination diet (click to expand)
An elimination diet can be recommended by your child’s doctor in order to prove that your child reacts to foods such as cows’ milk, eggs, wheat, or soya. With the results from this elimination diet, the medical history of your child, blood tests as well as the food and symptom diary, your doctor will have more to work on when trying to reach a diagnosis.
How elimination diets are organised: Under the strict supervision of your child’s doctor or dietitian, the food suspected to cause the trouble will be eliminated from your baby’s diet for about one to two weeks. It is important that you avoid all foods that contain the relevant trigger; your child’s doctor or dietitian will give you precise instructions on how to do this. To feed your infant adequately during an elimination diet, a special cows’ milk protein-free infant formula such as an extensively hydrolised formula (eHF) or an amino acid-based formula (AAF) might be prescribed.
- Skin Prick Tests (click to expand)
Skin Prick Tests are especially accurate in testing for cows’ milk allergy. Small drops of cow’s milk (or other foods which are suspected) are placed on the child’s forearm. A small prick is made through each drop into the skin. If the child’s skin becomes red and itchy, it usually means that he or she is allergic to that particular food. This is called a positive reaction. If no reaction is shown in the test, there is still a chance your child has a food allergy. This can happen if your child shows a delayed reaction after food intake, a so called non-IgE reaction.
Skin Prick Tests are rather quick. So they are often used as first tests to find which foods produce antibodies. Once the allergens are identified, some doctors may perform more specific tests (these are known to doctors as Specific IgE tests or RAST test).
Specific IgE tests are blood tests that can measure the concentration of specific antibodies in the child’s blood. These antibodies are called IgE. IgE levels in the blood are often higher in children who have allergies or asthma. If the test is negative, it is still possible that your child has a food allergy, but in this case it is known as a non-IgE or delayed reaction.
- Food challenges (click to expand)
Your child’s doctor may want to undertake a ‘food challenge’ if he thinks it is possible that your child has outgrown his or her food allergy. Before starting this, your child’s symptoms should have disappeared or at least have been stabilised.
What can you expect? In a challenge test, very small amounts of an allergen are taken by mouth. Foods may be masked in various infant formulas, fruit juices, pureed foods or meat patties depending on the age of the child. Food challenges can be ‘open’ (both your doctor and you know what your child is going to be given), ‘single blind’ (your doctor knows but you don't) or ‘double-blind placebo-controlled’ (this means that neither you nor your doctor know if the child is getting the cause of the allergy or a ‘dummy’ (called placebo). The kind of food challenge may vary depending on the experience and practices of the healthcare professional involved.
Important note! Challenge tests should be supervised by your child’s doctor or dietitian and are best conducted in a clinic or hospital setting with qualified personnel and equipment.
Good news! With the information from your child’s medical background, symptoms and allergy testing, you and your child’s doctor will be able to develop a plan to manage the symptoms.
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