Paeds Cases · allergy-and-immunology
Counsel a family on a cow's-milk protein allergy diagnosis and formula choice — OSCE
OSCE communication and shared-planning station: explaining a cow's-milk protein allergy diagnosis to a family, the elimination-and-rechallenge approach, the stepwise formula ladder, why goat's-milk and A2 formulas are not appropriate alternatives, and how tolerance is built over time — without making the family fear anaphylaxis in a non-IgE-mediated phenotype.
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You are the paediatric registrar in the outpatient clinic. The parents of a four-month-old boy have ten minutes with you. The baby has had blood and mucus in the stools and a flare of eczema for two weeks; he is growing well and is well in himself. The parents have read online that he has a 'dairy allergy' and have brought a goat's-milk and an 'A2' formula, asking which to switch to. They are frightened he will stop breathing if he has any milk, and that he will be allergic for life. Explain the likely diagnosis, why a planned elimination and rechallenge is the right next step, why neither goat's-milk nor A2 is the answer, what formula is appropriate, and how he will likely outgrow this. Use plain language, check understanding, and agree a clear plan. [1]
References4ShowHide
- [1]Koletzko S, Niggemann B, Arato A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr, 2012.PMID 22569527
- [2]Luyt D, Ball H, Makwana N, et al. BSACI guideline for the diagnosis and management of cow's milk allergy. Clin Exp Allergy, 2014.PMID 24588904
- [3]Greer FR, Sicherer SH, Burks AW The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children. Pediatrics, 2019.PMID 30886111
- [4]Leonard SA, Nowak-Węgrzyn AH Baked Milk and Egg Diets for Milk and Egg Allergy Management. Immunol Allergy Clin North Am, 2016.PMID 26617232