Milk Allergy

Abstract

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.

Anaphylactic Shock Due to Cow's Milk Protein Hypersensitivity in a Breast‐Fed Infant

“…He developed anaphylactic shock three times within the next 26 days, once after three additional feedings of Similac, once after ingesting his mother's milk while her diet included cow's milk, and once after ingesting an infant formula that contained casein hydrolysate. Although the challenges were inadvertent, the diagnosis fulfills the criteria set by Goldman et al (2).…”

Reliability and Usefulness of Random Fecal α1‐Antitrypsin Concentration

“…A patient included in this group presented , on three different occasions, with the same symptoms a few minutes after a gluten challenge, fulfilling Goldman's criteria (11 ) for food allergy. Subsequently in this patient as in all other cases of celiac disease, the diagnosis was made according to the criteri a of the European Society for Pediatric Gastroenterology (12).…”

Diagnostic Criteria for Food Allergy with Predominantly Intestinal Symptoms

“…In infancy, adverse reactions to food often appear soon after its introduction into the diet: in most cases , cow's milk allergy appears within 1 week of the introduction of cow' s milk (7)(8)(9)(10).…”

“…Vomiting may mimic pyloric stenosis or gastroesophageal reflux . Anaphylactic shock together with acute gastrointestinal symptoms is the most dramatic, though infrequent, manifestation of food allergy (7)(8)(9)(10)(13)(14)(15)(16). Abdominal colic during the first months of life (8,9,18,19) and abdominal pains later in infancy and during childhood (2,8,9) may be due to food allergy, but only in a small fraction of individuals having these symptoms .…”

“…Deterioration of atopic eczema due to food allergy occurs more slowly. Circumoral or anal dermatitis is often seen in connection with gastrointestinal food allergy (1,2,8,9) .…”