The Spectrum of IgE-Mediated Acute Allergic Reactions to Cow's Milk in Children as Determined by Skin Testing with Cow's Milk Protein Hydrolysate Formulas

Abstract

Children with adverse reactions to cow's milk (CM) often are given infant formulas containing CM proteins (casein or whey proteins) modified by hydrolysis to reduce their allergenicity. Recently, a few reports of acute allergic reactions to these CM hydrolysates have appeared in the medical literature. Therefore, between January 1, 1989, and August 31, 1989, we studied 26 children with a current history of recurrent acute respiratory (asthma, 19/26) or cutaneous (26/26, urticaria) reactions to CM. They were prick skintested with CM, two whey hydrolysates (Good Start HA and Alfare), and two casein hydrolysates (Nutramigen and Alimentum). Serum-specific IgE (sIgE IU/ml) to CM was measured by the 3M Fast method. Unexpectedly, high frequencies of positive prick tests were found to the whey (69%) and to the casein (38%) hydrolysate products. On the basis of skin test positivity, patients could be separated into three groups: group A (n = 8, positive only to CM), group B (n = 8, positive to CM and whey hydrolys...