This information leaflet is for guidance only and to be used by parents/guardians, wishing to carry out a milk challenge on their child at home with the advice of your doctor / dietitian.

It is only a guide to support advice from your doctor or dietitian which must be obtained prior to considering a milk challenge.

The North West Paediatric Allergy Network accept no responsibility for allergic reactions that occur as a consequence these home challenges.

Why should I challenge my child to milk products now?

Most children who previously developed an allergic reaction to milk will outgrow their milk allergy. The sooner dairy products are reintroduced into your child’s diet the sooner their life will return to normal and concerns about future reactions can be allayed.

Avoiding milk product unnecessarily can make the allergy worse and also make it more difficult for your child to grow out of it later.

Exactly when your child should try milk products should be discussed with your healthcare professional. Timing will depend on what type of dairy product your child reacted to previously and the reaction they had.

In general, dairy products should be tried again if your child has not had any reactions over the last six months.

Before starting the challenge

  • Ensure your child is well. If your child has had a flare of their eczema, asthma, hay fever, or has taken antihistamines in the last five days do not undertake the challenge.
  • Do not attempt the challenge at home if your child has ever had any breathing problems or faintness/floppiness after having milk. Seek medical advice.
  • Have a supply of antihistamine, for example Piriton available in case a reaction occurs.
  • Pick a day when you will be able to observe your child for at least four hours.

The Challenge

  1. Give the child a drop of milk or equivalent dairy product recommended by your doctor or dietitian. (Dip a clean finger in milk, shake off the excess and then touch your child’s tongue with the finger). Wait 15 minutes, if no reaction occurs continue.
  2. Give your child ¼ of a teaspoon(1¼ ml) of milk. Wait 15 minutes, if no reaction occurs continue.
  3. Give your child half a teaspoon(2½ ml) of milk. Wait 15 minutes, if no reaction occurs continue.
  4. Give your child a teaspoon(5 ml) of milk. Wait 15 minutes, if no reaction occurs continue.
  5. Double this amount every 15 minutes if no reaction occurs, until a cup (200 ml) of milk has been taken, provided this does not exceed their normal intake volume.

Stop the challenge if any of the following develop

    • Red, raised, itchy rash
    • Swelling where the food has been applied
    • Vomiting/tummy pain/loose stools
    • Difficulty/noisy breathing
    • Wheeze/persistent cough
    • Dizziness/feeling faint/floppiness

    If a rash or swelling develops give your child an antihistamine. Symptoms should resolve within half an hour.

    In the unlikely event of breathing problems or faintness, call for help dialling 999 stating anaphylaxis. Do not challenge again but seek medical advice.

What should I do after the challenge?

If no reaction occurs over the next two hours, you can introduce milk back into to your child’s diet.

If a reaction does occur, continue with a dairy free diet, and try challenging with milk again in 4 – 6 months’ time.

Key things to note

  • some children are often fearful (as are their parents) of taking foods that have previously caused a reaction. If your child is old enough, try to explain why the challenge is being done.
  • some challenges may only get part way through the stages and a reaction occurs. If this happens and there are no breathing problems or faintness, talk to your healthcare professional and try reintroducing the food again in 4 to 6 months.