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The diagnosis of milk allergy was confirmed in 89 children by oral challenge with milk and/or purified milk proteins. Most of these patients were diagnosed as allergic during the first 2 years of life. The symptoms of milk allergy usually began during the first few months of life. Eighteen of the total patients experienced spontaneous remission of milk hypersensitivity. Multiple symptoms were produced by oral milk challenge in 77% of the patients. Vomiting, diarrhea, abdominal pain, asthma, rhinitis, and atopic dermatitis were frequently presenting and challenge symptoms. Several patients had central nervous system symptoms, urticaria, or anaphylactic reactions following milk challenge. Seventy-eight per cent of the presenting symptoms were reproduced by oral milk challenges. Challenge feedings produced symptoms not found in the history in 18% of the patients. No consistent patterns of symptom combinations were found. The onset time of oral challenge reactions was usually within the first 12 to 24 hours. Some reactions occurred within a few minutes while others required 2 days or more before they were discernible. The duration of challenge reactions was usually between 12 to 24 hours. Allergic symptoms appeared much sooner after oral challenge in the patients who required less milk to elicit an allergic reaction. Forty-five patients were challenged with amounts of the purified milk proteins, casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin, present in the challenge doses of 100 ml skim milk. Every patient had an allergic reaction to one or more milk proteins. The frequencies of reactions were casein, 57%; BSA, 51%; beta-lactoglobulin, 66%; and alpha-lactalbumin, 54%. The reactions from oral challenge to skim milk or purified milk protein in a given patient were very similar. No correlation was found between the symptoms produced and the specific protein which produced these reactions. By oral challenge tests few patients (13%) were allergic solely to the heat labile protein, BSA. Only two of these patients could be actually managed on a processed milk in which BSA was inactive by laboratory tests.

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