STUDY: Severe Reactions Increasingly Associated with Milk Allergy in Older Children

Milk allergies are often associated with young children. But according to recent research, severe milk allergy reactions are becoming increasingly prevalent in older children, and milk allergies were linked to the most severe food allergic reaction symptoms more often than peanut allergies were. Here’s what families need to know about this new research.

Milk Allergies, Severe Allergic Reactions, And Older Children: What the Study Shows

Milk allergies tend to be associated with younger children, especially since milk allergy is the most common food allergy in children under the age of 5. But many children don’t outgrow their milk allergy until their teenage years, and some people end up with lifelong milk allergies.

In fact, in one of Dr. Ruchi Gupta’s landmark food allergy prevalence surveys covering over 38,000 children, one-third of the milk-allergic children were age 11 or older.

Now, a U.S. study on anaphylaxis rates (life-threatening allergic reaction rates) from food allergies has shown that milk allergy is the food allergy most often associated with anaphylaxis in older children.

This study, published in 2019, examined the rates and causes of food allergy-induced anaphylaxis in 3427 U.S. children 20 years of age and younger, based on reports from hospitals.

The study showed that, between 2006 and 2012, anaphylaxis rates among all children rose by 25%, for all types of food allergies: “from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012.”

And milk allergy reactions were a significant cause of anaphylaxis, particularly in older children.

Specifically, the study’s results showed that “Milk products, ages between 13 and 20 years, and comorbidities of asthma” were significantly associated with the “severity and morbidity” of food allergies.

The study also showed that rates of life-threatening milk allergy reactions have been on the rise, across all age groups.

To quote the study’s abstract, “The leading causes of hospitalizations due to food-induced anaphylaxis were peanuts, tree nuts and seeds, and milk products,with significantly increasing trends during 2006–2012. Milk products were significantly associated with severity.”

In addition, the study’s researchers reported that milk was linked with the most severe food allergy symptoms more often than peanuts or tree nuts were, particularly in older children. This is significant because peanuts and tree nuts tend to be the foods most often associated with severe allergic reactions.

“Milk products were significantly associated with severity [of food allergic reactions].”

Other studies on the severity of milk allergy

The anaphylaxis study aligns with and builds on the results of other studies that have shown how commonplace, and how severe, milk allergies are in school-age children.

An earlier, smaller study focused on allergic reactions in schools indicated that milk allergies are the most common cause of food allergic reactions in schools, among children ages 3-19. Milk was the cause of food allergic reactions 32% of the time, in cases where the food causing the reaction could be identified.

In addition, a UK analysis published in the BMJ (British Medical Journal) has shown that milk allergy was the food allergy responsible for the most deaths in school-age UK children.

Why might milk allergies cause so many severe allergic reactions, especially in older children?

Milk is such a common ingredient

Milk is a very common ingredient, and one that is harder to identify in foods than many other common allergens (including peanuts).

Because milk is a staple in so many foods, many people don’t realize just how ubiquitous it is, and how many foods are dangerous to people with milk allergies. They might also fail to realize that milk allergies can cause life-threatening reactions.

As Carla Davis, M.D. (Texas Children’s Hospital in Houston, Director of Food Allergy) shared with WebMD, "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. People do not think about how much of this is in our food."

Milk allergies are not taken seriously enough, especially in schools

In addition, even though milk is a common ingredient in many foods, milk allergies are often not taken as seriously as peanut allergies, especially in schools and other educational settings. While peanut-free tables and policies are commonplace to protect peanut-allergic children, educators may not be aware that milk allergies can be just as life-threatening as peanut allergies (if not more so).

People might be confusing milk allergy with milk intolerance

Others might not realize that a milk allergy is different from a milk intolerance. Milk intolerances are extremely common; they cause digestive symptoms when someone consumes milk, but they don’t involve the immune system. Milk intolerances are not life-threatening. But milk allergies involve the immune system, and have the potential to cause life-threatening symptoms.

Allergies as a whole are on the rise

Milk allergies aren’t the only allergy increasing in prevalence. As a whole, food allergies have been on the rise over the past two decades. And as food allergies rise, so does the potential for hospitalizations related to severe reactions.

Why might food allergy prevalence be increasing? As Dr. Jonathan Spergel (Head of Allergy at Children’s Hospital of Philadelphia) shared with the Washington Post: “There are several strong theories to explain the uptick [in food allergies], but one stands out: In 2000, a small study suggested that if parents delayed the introduction of potentially allergenic foods, kids were less likely to develop those allergies. The guidance was wrong, with subsequent studies revealing the exact opposite: Early, careful introduction of these [potentially allergenic] foods lessens the risk of serious allergy.”

Milk allergies are wrongly thought of as a young child’s allergy

The tendency to associate milk allergy with younger children might be another major reason why so many severe milk allergy reactions are occurring in older children. People may not be aware that a milk allergy can cause such severe symptoms in older children and teens. So, again, they might not take a milk allergy as seriously as a peanut allergy.

But any food could cause a severe allergic reaction --- and we now know that milk is an especially common cause of life-threatening reactions.

The bottom line: The need for more food allergy awareness

More awareness of milk allergy’s severity is desperately needed, so when someone has a milk allergy, people will take the needed steps to protect them.

As Paul Turner, PhD, (Imperial College, London) shared with WebMD, "We need to get that information [about the severity of milk allergy] 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."

Unfortunately, though, compared to peanut allergy families, not as many milk allergy families are taking one of the most vital precautions themselves --- having an epinephrine (Epi-pen) prescription ready to treat a severe reaction, in case one does occur.

As Dr. Ruchi Gupta told WebMD, “only 1 in 4 children with a milk allergy [in the food allergy prevalence survey of over 38,000] had a current prescription for an epinephrine autoinjector, compared with about 70% of children with peanut allergy.”

In addition, more food allergy awareness is needed as a whole, so people know to take any food allergy seriously, regardless of someone’s age.

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