IgE and non-IgE mediated symptoms assotiated with cow's milk protein allergy

Cow’s-milk protein is the leading cause of food allergy in infants and young children younger than 3 years.CMPA does seem to peak in the first year of life, with a prevalence of approximately 2% to 3% in the infant population.The clinical spectrum ranges from immediate-type reactions,presenting with urticaria,angioedema,stridor,wheezing to intermediate and late-onset reactions,including atopic dermatitis and symptoms from gastrointestinal tract. A 7-month-old male infant presented with swelling and redness of the lips and cheeks after few minutes of ingestion of cow's milk.He has had atopic dermatitis on the cheeks since he was 3 months old.Family history:infant’s first cousin with a proven CMPA.On examination with pale skin and present eczematous changes on the cheeks and on a small area on the lateral sides of both upper legs.Due to suspicion of CMPA,the infant was set on elimination diet without CMP(mother continued breast-feeding while avoiding all milk products from her diet and all infant’s complementary feedings were free of CMP). Immunoelectrophoresis showed total IgE =181 IU/ml and specific IgE grade 3 directed to milk, alpha-lacalbumin, beta-lactoglobulin, casein and specific IgE grade 2 directed to white and yolk egg.The infant was fed with extensive hydrolyzate, breastmilk and all infant’s complementary feedings were free of CMP.On the last control without eczematous changes on the skin. If acute and objective symptoms of skin occur immediately,or up to 2 hours after a clear history of ingesting dairy products,then CMP should be strictly excluded.Testing for specific IgE against CMP should be performed.A positive test for specific IgE at the time of diagnosis predicts a longer period of intolerance.The child should be given a strict CMP-free diet at least 1 year.Approximately 50% of affected children develop tolerance by the age of 1 year,>75% by the age of 3 years, and>90% are tolerant at 6 years of age.