Outgrowing milk allergy: Identifying a patient whose milk allergy is resolving
Vanessa, a 4-year old girl with a history of milk allergy, visits her healthcare provider after recently accidentally eating ice cream at a birthday party. Her mother reported that Vanessa experienced no apparent reaction after this event and is wondering if Vanessa has grown out of her allergy.
Vanessa's healthcare provider conducts a full clinical history and physical examination and decides to test using milk components.
A girl with a history of milk allergy accidentally eats ice cream. A test using milk components reveals more to her story.
Patient History
Family History
- None
Vanessa's Personal History
- Vanessa started experiencing eczema at 3 months old, and gastrointestinal symptoms when drinking milk or eating milk-containing products at 8 months old.
Her previous test results at age 1 were:
Test |
Type |
Vanessa's Results |
Milk |
Whole Allergen |
+4 |
Test |
Type |
Vanessa's Results |
Milk |
Whole Allergen |
20 |
Bos d 4 (α-lactalbumin) |
Allergen Component |
3.5 |
Bos d 5 (β-lactoglobulin) |
Allergen Component |
2.8 |
Bos d 6 (bovine serum albumin) |
Allergen Component |
0.4 |
Bos d 8 (casein) |
Allergen Component |
15.2 |
Vanessa’s test results at age 3 were:
Test |
Type |
Vanessa's Results |
Milk |
Whole Allergen |
+3 |
Test |
Type |
Vanessa's Results |
Milk |
Whole Allergen |
14 |
Bos d 4 (α-lactalbumin) |
Allergen Component |
2.8 |
Bos d 5 (β-lactoglobulin) |
Allergen Component |
2.5 |
Bos d 6 (bovine serum albumin) |
Allergen Component |
0.3 |
Bos d 8 (casein) |
Allergen Component |
8.5 |
Vanessa's ImmunoCAP Test Results
These results, together with this patient's case history and symptoms, help you confirm the diagnosis.
| Allergen | Type |
Vanessa's Results |
| Milk | Whole Allergen |
6.3 |
| Bos d 4 (α-lactalbumin) | Allergen Component |
1.9 |
| Bos d 5 (β-lactoglobulin) | Allergen Component |
1.8 |
| Bos d 6 (bovine serum albumin) | Allergen Component |
<0.1 |
| Bos d 8 (casein) | Allergen Component |
2.3 |
Differential Diagnosis
Vanessa’s decreasing levels of IgE to Bos d 8 casein and other milk components strengthens the indication that her milk allergy is resolving and also indicate she may tolerate baked milk.1
HEALTHCARE PROVIDER MANAGEMENT PLAN
Vanessa's healthcare provider:
- Refers her to an allergy specialist for an oral food challenge with milk.
- Performs an oral milk challenge in the clinic, which Vanessa passes without any symptoms.
- Advises her mother to gradually re-introduces milk into her diet.
FOLLOW UP
- Vanessa with her mother visit her healthcare provider one year later. Milk is now part of Vanessa’s diet and she 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, K.A., Sicherer, S.H., Shreffler, W.G., Noone, S., Wanich, N. et al, Tolerance to extensively heated milk in children with cow's milk allergy. J Allergy Clin Immunol. 2008;122:342–347.
