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Tests for Cow’s milk (protein) allergy

I get asked this very often when I diagnose CMPA in a baby. The most common type of CMPA is Non IgE mediated. It presents at the age of 4-6 weeks onwards. The symptoms are dry skin, reflux (unsettled, vomity baby), runny stools or worsening constipation. Some babies are also snuffly and have blocked nose, all the time.

The severe form, which is IgE mediated CMPA, presents earlier, within days as vomit as soon as milk is given (usually formula), sneezes, rash over face and sometimes breathing difficulty. This can be diagnosed with a blood test (specific IgE for milk) or a skin prick test to milk. Fortunately, this is much less common than Non IgE mediated cases.

There is no test for the Non IgE mediated CMPA as IgE (Immunoglobulin E) is not involved in the allergy. It is still a true allergy. The good thing is that children with this condition grow out of it between the age of 1 to 2 years. (IgE mediated CMPA may persist for 7-8 years or even longer).

The best test is going dairy free (if you are breast feeding) or giving a special (Extensively Hydrolysed) formula, which is on prescription (Aptamil Pepti, Nutramigen or Similac Alimentum). They all taste bad but the babies get used to it pretty quickly as their taste buds are not very well developed. It may take 2-4 weeks before you see marked improvement in symptoms.

Then at 4 weeks, you reintroduce the dairy in babies or mother’s diet.

If symptoms return – It confirms CMPA and you should go back to ‘dairy free diet’

If they don’t – It possibly was not CMPA and you can relax !

https://www.allergyuk.org/assets/000/002/176/iMAP_2_Management_of_Mild_to_Moderate_Non-IgE_Cow’s_Milk_Allergy_original.pdf?1539852537

 

Peanut Immunotherapy (desensitisation)

There have been recent trials for Peanut Immunothearpy, which have been quite successful. Sublingual Immunotherapy for Peanuts is also being trailled and if successful, will be veru useful, as many children who are allergic to Peanuts, do not want to eat Peanut for the desensitisation.

https://www.evelinalondon.nhs.uk/about-us/news-events/2018-news/20181119-landmark-study-peanut-allergy.aspx

Currently, the only clinic that I can find offering Immunotherapy for Peanut is at Addenbrooks Hospital, Cambrodge.

http://www.peanut.cuh.org.uk/

EEG (Electroencephalogram)

EEG or trace of the brain is used to pick up electrical brain activity in the brain by placing leads on the head. It is very similar principal to ECG (Electrocardiogram), which picks up electrical activity of the heart.

Epilepsy, though is primarily a clinical diagnosis as EEG can be normal in children with Epilpepsy and many normal people (upto 5%) can have abnormal EEG. It is helpful though to know the type of seizures, their origin etc.

Various types of EEG are described in this section in the excellent Epilepsy Society website https://www.epilepsysociety.org.uk/eeg-electroencephalogram#.XD-4qc_7St8

Persistent swollen glands (Lymphadenopathy)

Persistently enlarged lymph nodes (glands) cause terrible anxiety in parents. They are most commonly caused by infections. They are usually limited to the area they drain, for example in the neck after infections of throat/ear/scalp etc. Sometimes it can take weeks or months for them to shrink in size and that can be worrying for parents and carers.
Most often, parents only need reassurance but if there are features like fever, night sweats, weight loss etc. or if there is generalised enlargement in multiple places, then, blood tests can be done to rule out rare but serious conditions like Leukaemia and Lymphoma etc.

https://www.nhs.uk/conditions/swollen-glands/

 

Normal baby movements vs Infantile spasms.

It is fascinating to see babies develope and learn new skills.  Every baby is different and so is the development. Some babies do things sooner than the others. Sometimes they may be having movements which might happen suddenly and repeatedly. These can be normal or abnormal. Some babies are very active and can move their arms and legs, try to lift their trunk and these may appear abnormal. Usually these are normal and you can stop them if you hold them.

Abnormal movements are usually sudden and happen repeatedly. It is difficult to stop them by holding the baby as they are due to abnormal electrical activity in the brain. The most common and serious ones are ‘infantile spasms’, in which the baby suddenly startles and this keeps repeating for few seconds. The baby may be staring and vacant when these are happening. The diagnosis is confirmed by an EEG (trace of the brain activity). If you are concerned about your baby movements, you should see your GP or specialist.

https://www.epilepsy.org.uk/info/syndromes/west-syndrome-infantile-spasms