Q: My 2 years old grandson is allergic to milk and milk products like curd, butter, etc. He is also allergic to soya milk, nuts and few lentils. He eats all vegetables. We give him rice milk though. Recently we got his blood tested and following is the report. Leucocytes - 7.6, erythrocytes - 4.47, haemoglobin - 11.9, packed cell volume - 33.3, MCV – 74, MCH - 26.7, MCHC - 35.9, RDW - 14.9, platelet count – 173, MPV - 7.6, neutrophils – 38, lymphocytes – 52, monocytes – 50, eosonophils – 50, total IgE – 163. Is the report fine? He looks pale in front of other kids. Please advise.

A:Milk allergy is a food allergy / adverse immune reaction to one or more of the proteins in cow’s milk. However, one also needs to know about milk protein intolerance (MPI), which is a delayed reaction to food protein that is normally harmless to the non-allergic, non-intolerant individual. Milk protein intolerance produces a non-IgE antibody and is not detected by allergy blood tests. The range of symptoms is very similar to milk allergy symptoms, but can also include blood and/or mucous in the stool. Saving grace, however, is that the treatment for milk protein intolerance is the same as for milk allergy. As you have mentioned in your mail that your grand son is allergic to milk and milk products including curd & butter, it is only advisable to have total avoidance of milk proteins in his diet and this you are already adhering to. It is relatively uncommon to see some individuals allergic to other products also such as soya milk, nuts, etc. which are generally prescribed as replacements of milk. This is so because it is commonplace for milk or milk derivatives to be included in processed foods such as bread, crackers, cookies, cakes, prepared meats, soya cheese, soups, gravies, potato chips, margarine, and products labelled non-dairy, such as whipped topping and creamer (non-dairy simply means less than 0.5% milk by weight). Also, many processed foods that do not contain milk may be processed on equipment contaminated with dairy foods, which may cause an allergic reaction in some sensitive individuals. This is probably the reason for his reaction to soya milk, nuts, and few of lentils. As far as his blood reports are concerned, they are all within the biological reference interval for the age, meaning they are normal for age. At a haemoglobin of 11.9 g/dl, his pale appearance with respect to other kids may just be incidental.