The many faces of milk problems

“There is nothing magical that happens in your gut that says, ‘oh, now you’re ready for cow’s milk.’ — Dr. Farah Khan

Milk has a special talent for creating chaos in clinic. One day it’s mucousy stools and a terrifying diaper photo, the next it’s hives after yogurt, delayed vomiting with lethargy, or a family that’s been dairy-free for years with no improvement in eczema. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and clinical immunologist Dr. Farah Khan to walk through the many ways “milk problems” show up — and how allergists can avoid overdiagnosis, unnecessary testing, and prolonged elimination diets that may do more harm than good.

On this episode:

• Why allergic proctocolitis (cow’s milk protein intolerance) is often overdiagnosed
• When skin testing and IgE testing are useful 
• Understanding the difference in lactose intolerance 
• How baked milk can be used to improve quality of life in IgE-mediated milk allergy
• What makes FPIES to milk tricky, including earlier-than-expected reactions
• Why dairy elimination for eczema or EOE needs caution and frequent reassessment

Across each of these scenarios, Dr. Khan returns to the same principle: eliminating dairy should never be a one-and-done decision. Revisiting the diagnosis, retrying thoughtfully, and weighing quality of life alongside risk are essential — especially when prolonged avoidance can set the stage for the very allergy clinicians are trying to prevent.

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The Allergist is produced for CSACI by PodCraft Productions