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I am asking Dr. Scott Sicherer, who is an internationally known expert in food allergy and anaphylaxis in infants, to comment on your question. As soon as we receive a response from Dr. Sicherer, we will forward it to you.
Thank you again for your inquiry.
Phil Lieberman, M.D.
We received a response from Dr. Scott Sicherer regarding your Ask the Expert inquiry. Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.
Response from Dr. Scott Sicherer:
I agree that this seems awfully early for anaphylaxis but all of the details appear to fit: introduction of a food after a period of abstinence (milk), a common allergen (milk), immediate reaction after that ingestion, multiple symptoms consistent with anaphylaxis, no apparent alternative explanations, a positive IgE test to the apparent trigger, and, apparently, no symptoms, physical exam abnormalities or lab abnormalities apart from the event.
The differential diagnosis (partial) of SOME of these symptoms in an infant could include: urticaria pigmentosa/mastocytosis, respiratory (upper or lower) obstruction, congenital problems (eg, laryngeal web, vascular ring), aspiration, bronchiolitis, asthma, asphyxiation/suffocation, breath-holding, gastrointestinal issues (eg, intussusception), septic shock, cardiovascular problems, central nervous system issues (seizure, trauma, child abuse, increased intracranial pressure), metabolic disorders, infection, toxins, etc.
The tryptase levels run a bit higher in younger children,(1) but the baseline here was normal.
Given your presentation, it seems like food induced anaphylaxis as you give no real indication of other issues to consider.
For a wonderful discussion of infant anaphylaxis please see the review article by Dr. Estelle Simons.(2)
(1) Komarow HD, Hu Z, Brittain E, Uzzaman A, Gaskins D, Metcalfe DD. Serum tryptase levels in atopic and nonatopic children. J Allergy Clin Immunol
(2) Simons FE. Anaphylaxis in infants: can recognition and management be improved? J Allergy Clin Immunol
Scott H. Sicherer, MD
Professor of Pediatrics
Jaffe Food Allergy Institute
Mount Sinai School of Medicine
New York, NY