Anaphylaxis from cow's milk casein

Abstract

The case of a 35-year-old woman who suffered anaphylaxis after the ingestion of milk or milk-containing products is presented. Symptoms also appeared after the patient used a cosmetic which contained casein. Skin prick tests, specific IgE measurement, and immunoblotting were carried out with cow's milk extract, and its purified proteins: casein, beta-lactoglobulin, and alpha-lactalbumin. Specific IgE to cow's milk casein was detected with the three tests. Immunoblotting revealed one band of 24 kDa approximately corresponding to the beta-fraction of casein. Negative results to beta-lactoglobulin and alpha-lactalbumin were obtained with the three methods. Symptoms were controlled by rigorous dietary and behavior measures.

Cow's milk protein‐specific IgE concentrations in two age groups of milk‐allergic children and in children achieving clinical tolerance

“…However, some studies have indicated that children with CMPA have higher concentrations of specific IgE antibody to proteins comprising the whey fractions of milk [8] while IgE directed to the proteins in the casein fraction appeared to be dominant in older children and adults with CMPA [9,10].…”

Sensitization patterns of cow’s milk and major components in young children with atopic dermatitis

“…Nevertheless, in vitro measurement is preferred in patients with skin diseases such as AD or urticaria. In addition, numerous studies have suggested that the component is the best discriminator between persistent and transient CM allergy [6, 8, 11]. Severe reactions to CM can be predicted by the high levels of CM-IgE and Cas-IgE in combination with asthma [11, 24].…”

“…In addition, numerous studies have suggested that the component is the best discriminator between persistent and transient CM allergy [6, 8, 11]. Severe reactions to CM can be predicted by the high levels of CM-IgE and Cas-IgE in combination with asthma [11, 24]. Moreover, casein was often found to be the cause of reactions in patients with CM allergy who ate so-called non-dairy products that actually used casein as an extender (e.g., sausage, soups, and stews) [11, 25].…”

“…Severe reactions to CM can be predicted by the high levels of CM-IgE and Cas-IgE in combination with asthma [11, 24]. Moreover, casein was often found to be the cause of reactions in patients with CM allergy who ate so-called non-dairy products that actually used casein as an extender (e.g., sausage, soups, and stews) [11, 25]. However, those previously quoted reports were mostly performed in Western countries.…”

“…Further studies have documented that children with persistent CM allergy have elevated levels of casein-specific IgE antibodies (Cas-IgE) compared with children who have transient CM allergy [8, 10]. Hence, Cas-IgE is dominant in older children and adults with CM allergy [11, 12]. …”