Three year old, Elijah Silvera, was attending a regular day of preschool in New York City recently, when preschool workers fed him a grilled cheese sandwich despite school papers which formally documented his severe dairy allergy. Elijah had a severe allergic reaction and went into anaphylaxis. Standard procedure for anaphylaxis is to administer epinephrine and call 911 immediately. Instead, the school called Elijah’s mother, who picked up her child and drove him to the hospital herself. Doctors in the emergency room tried but were unable to save him.
Dairy allergy is the most common food allergy among young children. And, although the peanut can produce some of the most severe allergic reactions (as well as some of the most tragic headlines), an allergy to milk products can be life-threatening. The myth that a dairy allergy is not serious and doesn’t require as much vigilance causes great frustration to many who are allergic to milk, as does the idea that a food is “allergy free” if it does not contain nuts. To those who live with it, a dairy allergy requires an enormous amount of preparation and education since milk is an ingredient in so many products.
Dairy is cow’s milk and found in all cow’s milk products, such as cream, butter, cheese, and yogurt. Doctors sometimes advise patients with a dairy allergy to avoid other animals’ milk (such as goat) because the protein it contains may be similar to cow and could cause a reaction. Reactions to dairy vary from hives and itching to swelling and vomiting, to more severe symptoms such as wheezing, difficulty breathing, and anaphylaxis. Strictly avoiding products containing milk is the best way to prevent a reaction. The only way to help stop a severe food allergy reaction is with epinephrine; patients should always carry two epinephrine auto-injectors with them at all times.
Just like other allergens, cross contamination is a concern for those with a dairy allergy. Even a small amount of milk protein could be enough to cause a reaction. For example, butter and powdered cheese (like the kind you might find on potato chips) are easily spreadable in a pan, within a classroom or on a playground. And, as with other allergens, hand sanitizer does NOT remove the proteins that cause allergic reactions. Doctors recommend hand washing with good old soap and water – but wipes work in a pinch.
Those allergic to dairy must not only avoid food; they often have to look out for health and beauty products too. Dairy can be found in vitamins, shampoo, and lotions. It is critical to read the ingredient labels of every product you buy each time you buy it as ingredients and manufacturing procedures may change.
In the United States, any food product containing milk or a milk derivative must be listed as DAIRY or MILK under the current labeling laws (see The Ins and Outs of Reading Food Labels, Aug. 2016). If you are living or traveling elsewhere, this list of some alternative names for dairy may be useful:
milk (in all forms: goat, whole, skim, 1%, 2%, evaporated, dry, condensed, etc)
butter (including artificial butter and margarine)
half and half
whey (all forms)
caseinates (all forms)
lactalbumin (all forms)
Let’s spread the facts about dairy allergy so that our schools and teachers better understand how to accommodate and care for students with food allergies. Any allergen can produce severe, life-threatening allergic reactions and all food allergies should be taken seriously and managed with attention. I sincerely hope that by informing others we can prevent another tragedy like the one the Silvera family was forced to experience.