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How buttered toast and ice cream can beat a milk allergy

We were walking home together when my ten-year-old daughter told me she had eaten a cake at school that day.

This perhaps unremarkable statement left me overjoyed because, throughout her life, Molly has lived with a potentially life-threatening milk allergy.

Holy cow: A cow's milk allergy is extremely common, affecting up to 8% of children, including ten-year-old Molly

Molly's allergy was so severe that she could not manage anything containing even the tiniest amount of milk, such as a regular sandwich with butter or an ordinary biscuit.

For years we had been among hundreds of thousands of British families meticulously planning allergen-free lives. In our case this meant dairy-free meals and hunting for alternatives to milk-based treats.

At birthday parties, Molly couldn't touch any of the cake, but would have to take her own box of dairy-free food. We'd pack soya milk cartons for holidays abroad.

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Restaurants were the hardest, when she would scour the dessert menu hoping for something she could eat. I'd normally have to shake my head and promise her an alternative at home. Molly was always incredibly accepting and mature about it.

A cow's milk allergy is extremely common, affecting up to 8 per cent of children and usually developing in the first year of life.

This means it can be difficult to diagnose because many of the symptoms, such as reflux and diarrhoea, are common during infancy, explains Dr David Luyt, a consultant paediatrician at Leicester Royal Infirmary.

'On average, it takes three months and six visits to the GP before a milk allergy is diagnosed,' he says.

Diagnosis is based on a skin prick test - a small amount of the suspected allergen is inserted under the skin with a tiny needle and raised, red skin is a sign of allergy.

Milking it: By having small doses of foods made with milk, Molly was eventually able to overcome her allergy

There is also a blood test to check levels of the antibodies which trigger an allergic reaction and a 'food challenge' - when food containing the suspected allergen is given in the controlled environment of the hospital.

But for us, the diagnosis was unequivocal and unforgettable. Molly was breastfed, so her first taste of dairy was from formula milk mixed with baby rice when she was six months old.

She had three spoonfuls and screamed. Her face quickly began to swell. By the time I had dialled 999, Molly's left eye had disappeared under the swelling.

An ambulance took us to A&E at Birmingham Children's Hospital where she was given a dose of adrenaline - this reduces inflammation and swelling in the throat, opening the airways and easing the itching. A blood test confirmed she had a severe allergy.

An allergic reaction happens when antibodies become over-sensitive and attack the proteins in certain foods.

These antibodies then bind themselves to the allergen and cause the release of chemicals, including histamine, which triggers swelling, itching, rashes and tightening of the airways.

In extreme cases, it can cause anaphylactic shock, with severe swelling, breathing difficulties and sometimes loss of consciousness.

'A food allergy, particularly to milk, which is in so many foods, has a massive impact upon a child and their family,' says Dr Scott Hackett, consultant paediatrician in allergy at Heartlands Hospital, Birmingham.

One study of 40 children, half with a food allergy and half with diabetes, found those with food allergies reported more fear about their health and eating, and more restrictions on their life overall.

When it came to Molly's brother Samuel, now seven, we avoided giving him any dairy products for his first year.

We were overjoyed when, aged one, he had a blood test which showed his risk of milk allergy was very low. He has eaten freely since.

With the help of my husband, Dave, 46, a communications manager, I found we could make dairy-free cake and obtain dairy-free ice cream for Molly.

Her annual hospital tests showed little change in the allergy. The tests checked her levels of IgE antibodies which trigger an allergic reaction. A normal reading is 0 to 6 - at the age of six, Molly's result was 78, slightly higher than when she was younger.

 'She had three spoonfuls and screamed. Her face quickly began to swell. By the time I had dialled 999, Molly's left eye had disappeared under the swelling.'

Most children do grow out of their milk allergies - with about 80 per cent becoming fully tolerant by school age. It's thought this is due to a natural reduction in the IgE antibodies, and a rise in IgG4, which blocks the antibodies from binding to the allergen.

'We used to say 90 per cent will grow out of a milk allergy by school age, but we're now seeing a growing number of children whose allergy persists longer, sometimes beyond age ten,' says Dr Hackett.

This seems particularly the case for children with more severe milk allergies. Even eight months ago, Molly became itchy after mistakenly having a few spoonfuls of porridge made with cow's milk.

But a new scheme could offer these children an alternative to a life spent anxiously avoiding dairy. Dr Luyt has established the UK's first cow's milk tolerance system, which manipulates the immune system to actually cure the allergy.

It's an approach more widely used in Europe and the U.S. and based on immunotherapy, a long-established treatment for hay fever sufferers.

'The principle is if you give someone very small doses of the allergen, very slowly building it up over time, their sensitivity to it will decrease,' says Dr Luyt.

The programme is for children with a milk allergy which has persisted to the age of six.

They start by having a drink which is 1 per cent milk to 99 per cent water.

The dose is incrementally increased over 67 consecutive days up to full cow's milk.

So far 50 patients have completed the course, with 23 completely overcoming their allergy and nine developing partial tolerance - for example, they could eat cake made with butter, because the milk proteins have been partially broken down during baking.

'We've worked with children who had really severe milk allergies who went on to develop full tolerance,' says Dr Luyt.

Beating the allergy: Molly's experience and Dr Luyt's scheme demonstrate it is possible to cure the allergy

'It can be challenging for them - children usually have tingling lips and sometimes suffer nausea and vomiting.

'But this has enormous implications because it means we can offer families more than avoiding the allergy or hoping their child will outgrow it.'

The one-third for whom it does not work are not necessarily the ones with the strongest allergies. Some struggle with the side-effects of the programme, such as nausea and mild sickness, and do not complete it.

A  similar programme exists for nut allergy sufferers at Addenbrooke's Hospital, Cambridge, and UK experts are likely to follow colleagues in mainland Europe and Japan in setting up a tolerance programme for egg allergies.

But in her own way, Molly had already stumbled across the approach by herself. Last year during breakfast, she mistakenly had a piece of toast with butter.

She kept quiet, but came into the kitchen ten minutes later, asking whether the toast had butter on and grinning broadly as we realised it had.

'Nothing happened, Mum,' she said. We were both excited about what this could mean.

She later tried cheese-flavoured crisps, and then a teaspoon of dairy ice cream. The second caused her lips to tingle, but she said it was 'OK because it will go away soon'.

She had recognised the familiar symptoms of an allergic reaction, but also had the confidence to sense they were mild and temporary. If anything, I had a greater fear of Molly eating foods containing milk than she did.

And Molly became increasingly determined  to overcome her restrictive diet. Once she had eaten dairy ice cream several times, the lip tingling disappeared. Soon, there was nothing on the 'forbidden' list.

By the time Molly tried a cake at school, she'd eaten enough similar food at home to give her the confidence to go ahead.

The time from Molly's first taste of butter through to full tolerance was less than three months.

We had not heard of Dr Luyt's programme, but its principles reflected much of what I'd witnessed with Molly - motivation is important, as is confidence that symptoms can be handled and that the allergy can be overcome.

But Dr Hackett warns people with allergies to avoid trying known allergens at home without supervision.

'There can be severe and even life-threatening reactions and we see this particularly with teenagers, who are fed up with a restrictive diet,' he says.

Watching Molly tuck into her first ever ice cream on the beach on holiday recently, it seemed as if a miracle had occurred.

Moving to an unrestricted diet is surely something which, if possible, should happen for children sooner rather than later.




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