Milk Re-challenge Information

Introduction

It is recommended that a re-challenge of milk takes place to confirm the allergy to milk.  This should take place after symptoms have settled at 2 – 4 weeks.  This information is for those with mild to moderate cows milk allergy.

Questions to consider prior to challenge:

If you can answer YES to the following questions then advise the family to go ahead with the re-challenge:

Has the infant been on a milk free diet for a minimum of 2 – 4 weeks?

Have the symptoms of cows milk allergy resolved?

Is the infant currently well (ie no recent illnesses or immunisations, not teething)

Is the infant growing well?

Questions to consider if they are having ongoing symptoms consider:

Is the diet fully milk free?

Has there been a partial response to the extensively hydrolysed formula and do they require trial of an amino acid formula?

Have they recently had immunisations like rotavirus which are known to affect bowels?

Is there another cause apart from cows
milk allergy?

Once the previous questions have been answered and any issues addressed then proceed to milk re-challenge as per the guidelines.

How to rechallenge with Cow’s milk

Formula fed

• Day 1 – add 1oz (30mls) of normal formula to each bottle of the milk substitute
• Day 2 onwards – Increase by 1oz (30mls) per bottle, each day, until all is normal formula.

Breast fed

• If baby is still exclusively breast fed, re-introduce milk to the mum’s diet.
• If your baby is taking solids, then you can re-introduce milk containing solids to their diet
• Do not introduce any other new foods during this period.

Mixed feeding

• If the child is breast and formula fed follow formula fed guidance above

If symptoms recur return to milk free diet for mum if breast fed or specialist formula.  Advice will then be required for milk free weaning as per pathway.

If you need this information in another language or format, please e-mail:

Translation.Services@lanarkshire.scot.nhs.uk