Milk allergy nuance: Making a precise assessment in the case of milk allergy
Antonio and Isabel, 18-month-olds who both have a history of eczema and milk allergy, visit their healthcare provider for additional insight into their milk allergy.
Antonio and Isabel's healthcare provider conducts a full clinical history and physical examination and decides to test using milk whole allergen with component reflex.
Antonio and Isabel were both diagnosed with milk allergy. But allergies can change over time.
Patient History
Family History
- None
Antonio and Isabel Personal History
- Severe eczema since two to three months of age.
- Stomachache and loose stools.
Test |
Type |
Antonio Results |
Isabel Results |
Milk |
Whole Allergen |
+4 |
+5 |
Antonio and Isabel had a negative skin-prick test to egg.
Test |
Type |
Antonio Results |
Isabel Results |
Milk |
Whole Allergen |
18 |
25 |
Based on history, evaluation, and testing their previous healthcare provider recommended that eliminating cow’s milk from the diet and substitute with milk-free formula.
Antonio and Isabel ImmunoCAP Test Results
These results together with this patient's case history and symptoms, help confirm the diagnosis.
Test |
Type |
Antonio's Results |
Isabel's Results |
Milk |
Whole Allergen |
10.2 |
20.6 |
Bos d 4 (α-lactalbumin) |
Allergen Component |
3.8 |
2.2 |
Bos d 5 (β-lactoglobulin) |
Allergen Component |
0.7 |
1.0 |
Bos d 8 (casein) |
Allergen Component |
1.4 |
21.5 |
Differential Diagnosis
Antonio
Antonio’s low level of sensitization to Bos d 8 casein indicates he may have a tolerance to extensively heated milk. An oral challenge with extensively heated milk may be performed to confirm the diagnosis. With components and follow-up oral challenge, Antonio’s quality of life could have been improved: No need of strict avoidance of milk and no cause of stress in the family due to the risk of eating products containing extensively heated milk, such as cakes and cookies.1,2
REFINED DIAGNOSIS
- Likely tolerant to baked milk.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Antonio's healthcare provider advises him to undergo an oral food challenge to confirm tolerance to baked milk.
FOLLOW UP
- Antonio is seen by his healthcare provider one year later—he had successfully passed the oral food challenge for milk and has been eating foods containing extensively heated milk since with no issues.
Isabel
Isabel’s significant levels of IgE to Bos d 8 indicates a risk for severe reaction to all forms of milk.1,2
REFINED DIAGNOSIS
- Milk allergy.
HEALTHCARE PROVIDER MANAGEMENT PLAN
- Dietary restriction to all forms of milk remains.
FOLLOW UP
- Isabel is retested one year later, and her results are the same. She has continued to avoid milk in all forms and is doing well.
The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.
- Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol. 2008;122(2):342-347
- Tosca MA, Pistorio A, Rossi GA, Ciprandi G. Cow’s Milk Allergy: the Relevance of IgE. Allergy, Asthma & Immunology Research. 2016;8(1):86-87. doi:10.4168/aair.2016.8.1.86.
