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Meet Antonio & Isabel

Antonio and Isabel, 18-month-olds, who both have a history of eczema and milk allergy visit their healthcare professional for additional insight into their milk allergy.

Antonio and Isabel's healthcare professional conducts a full clinical history and physical examination and decides to test using milk whole allergen with component reflex.

Patient History – Antonio

Family history

  • None 

Personal history 

  • Severe eczema since 2– 3 months of age

  • Stomach ache and loose stools 

Skin prick test results at 6 months
Test Type Results
Milk Whole Allergen +4


Negative skin prick test to egg
 

ImmunoCAPTM results (kUA /l) at 6 months
Test Type Results
Milk Whole Allergen 18


His previous physician recommended eliminating cow’s milk from the diet and substitute with milk-free formula

Patient History – Isabel

Family history

  • None 

Personal history 

  • Severe eczema since 2– 3 months of age

  • Stomach ache and loose stools 

Skin prick test results at 6 months
Test Type Results
Milk Whole Allergen +5


Negative skin prick test to egg
 

ImmunoCAP results (kUA /l) at 6 months
Test Type Results
Milk Whole Allergen 25


Her previous physician recommended eliminating cow’s milk from the diet and substitute with milk-free formula 

New Test results – Antonio

These results, together with this patient's case history and symptoms, help confirm the diagnosis.  

ImmunoCAP results (kUA /l)
Test Type Results
Milk Whole Allergen 10.2
Bos d 4 (α-lactalbumin) Allergen Component 3.8
Bos d 5 (β-lactoglobulin) Allergen Component 0.7
Bos d 8 (casein) Allergen Component 1.4

New Test results – Isabel

These results, together with this patient's case history and symptoms, help confirm the diagnosis. 

ImmunoCAP results (kUA /l)
Test Type Results
Milk Whole Allergen 20.6
Bos d 4 (α-lactalbumin) Allergen Component 2.2
Bos d 5 (β-lactoglobulin) Allergen Component 1.0
Bos d 8 (casein) Allergen Component 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 professional's treatment plan for Antonio

  • Antonio's healthcare professional advises him to undergo an oral food challenge to confirm tolerance to baked milk

Follow Up

Antonio is seen by his healthcare professional 1 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.
 

Differential diagnosis - 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 Professional's management plan for Isabel

  • 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.

Refrences
  1. 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 

  2. 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.