the Allergy and Asthma Network; is on the Nutricia specialty advisory board; is an unpaid member of the National Peanut Board educational advisory council; is employed by the University of Michigan; is an associate editor for the Annals of Allergy, Asthma, and Immunology; testified to the Michigan State Legislature on behalf of food allergy legislation for the Michigan Allergy and Asthma Society; has received lecture fees and payment for developing educational presentations (outside of this manuscript) from Nutricia; and is a paid medical advisory board member to the Kids with Food Allergies Foundation, Food Allergy and Anaphylaxis Connection Team (advisory board chair), and the International Association for Food Protein Enterocolitis. The rest of the authors declare that they have no relevant conflicts of interest.

The era of food allergy began with the post-millennial generation, the same faction who received new immunizations during early childhood. Many of these vaccines contain alum, an adjuvant known to induce allergic phenotypes. We detail a child with peanut and cow's milk allergy and her response to immunizations, allergen avoidance, and oral desensitization. METHODS: IgE (IU/mL) and IgG4 (mcg/mL) were measured by ImmunoCAP. RESULTS: From ages 8 to 12 months, our patient's total IgE decreased from 61.4 to 44.1; peanut decreased from 13.6 to 11.2, and cow's milk decreased from 3.84 to 2. She then received 12-month vaccines. Three weeks later, her IgE sharply increased from 44.1 to 75.6; her peanut IgE increased from 11.2 to 16.5, and her milk IgE increased from 2 to 5.06. She then avoided alum-containing vaccines and, by age 16 months, her IgE decreased to 51; her peanut decreased to 13.7, and her milk decreased 1.54. Despite peanut-avoidance, Arah2 IgE continued to rise while all other IgE values decreased. She began cow's milk oral desensitization around 13 months-old. Peanut component IgG4 values exhibited minimal changes. Bosd4, Bosd5, and Bosd8 IgG4 changed minimally after vaccines; however, post-desensitization IgG4 values were remarkably higher-Bosd4 increased from 0.46 to 16, Bosd5 increased from 0.54 to 5.32, and Bosd8 increased from 0.75 to 2.94 at 16 months. CONCLUSIONS: Alum-containing vaccines increased IgE, a phenomenon we have previously observed, whereas milk desensitization increased milk-component IgG4, a trend we have reported post-peanut OIT.