Although Josh has several other food allergies – eggs, nuts, peanuts, fish and peas – Stephanie Wanner was relieved, even in the early going, that her son was suddenly protected against trace exposures to dairy products. Recently, Josh completed the desensitization therapy, and is continuing on a maintenace level of at least 200 millilitres (just under a cup) of milk every day.
Wanner finds it an “absolute joy” to see her son included at food-centric events like birthday parties. Dairy tolerance has also eased grocery shopping frustrations. For the past five years, she has been shopping at five different grocery stores to find bread, margarine and soy products that don’t have dairy “may contain” warnings on the label. That level of absolute avoidance, “makes you crazy,” she says.
Ethan Johnston has also finished his course of milk treatment, which took seven months, and this graduation of sorts has changed his relationship with dairy, likely forever. He regularly eats products containing dairy, and drinks a daily milk dose of about 200 millilitres, usually in a milkshake.
“Desensitization has made a huge, huge difference in our lives,” Kristie Johnston says. “I would totally recommend it for anybody it’s safe for.” Gone are the days of Johnston baking Ethan-safe cupcakes for birthday parties, or grilling the chef about cross-contamination during a family outing to a restaurant.
The milk treatment has also simplified life for the Broad-Bradstreet family. Luke isn’t downing glasses of milk yet, but the half teaspoon that he can consume safely is a huge leap for a kid who ate a Cheezie at nine months – and swelled like he’d been beaten up.
His mother is now comfortable buying products that “may contain” traces of milk. And there are the subtle big steps forward – like being able to eat a cucumber sitting beside a slice of cheese on a plate.
Bradstreet is dreaming of the freedoms greater tolerance could bring. “Wouldn’t it be great if in three years, when Luke is 11- or 12-years-old, we can go on a vacation to DisneyLand? Wouldn’t that be wonderful?”
Dairy desensitization ended up coming to Edmonton after allergists Carr and Lidman heard about the results of that 2004 study out of Rome. Investigating the research further, they were eager to try milk desensitizing – beginning with child subjects known to be anaphylactic to dairy.
“Those are the patients who need our protection, and this is the only protection we can offer right now,” Carr says. (The only other “treatment” for this allergy is total avoidance of dairy, and carrying an auto-injector for protection.)
In the Italian study, 15 of 21 children who took the milk doses were able to drink 200 millilitres without reacting within six months. Three more could tolerate some milk – which still protected them from small accidental exposures. Almost five years later, 13 of the 21 children remained fully tolerant of dairy.
The therapy may not work for everybody, but an initial 70 per cent success rate is nothing to sneeze at, Carr says. “If we were only successful in one out of 10, that’s still good. That’s turning off the allergy in one person who otherwise is still allergic to that food.”
Although Carr emphasizes that desensitization treatments are in their infancy, he finds the early patient success stories inspiring. Oral immunotherapy experiments are going on around the world with allergens ranging from peanuts to eggs and some tree nuts. The allergist finds milk particularly appealing for desensitization – it’s easy to dilute and measure precisely. But beyond that, tolerance greatly improves quality of life, since dairy ingredients are so common.
Carr is seeing children from all over Alberta with this program. To be eligible, a patient has to be able to make it to his office or another approved, controlled environment every four weeks so that the consumption of a milk dose can be medically supervised. The Edmonton allergists are enrolling children who are school-age and who have a convincing reaction during an initial oral challenge. (A recent anaphylactic reaction is adequate in some cases.)
After the first challenge session, desensitization under an allergist’s care works like this:
In the first phase at home, parents make up a 1-to-25 part dilution of milk. With an eyedropper, a parent puts one drop of that solution on the child’s tongue. That’s done daily for a week. (Many patients take the first dose in the allergist’s office.)
Assuming there are no serious symptoms, the dose increases to two drops by Day 7, and doubles every week for five weeks. By Day 49, the child is switched from the solution to five drops of undiluted milk. Those doses double weekly until the six-month mark, when the child drinks 200 millilitres of milk daily.
If this goes well, he (or she) starts eating other dairy products. The child also takes an antihistamine daily to help the treatment work and to minimize side effects. If reactions persist, families are told to slow down the dose increases.