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Cow's milk allergy in a patient with hyper-IgE syndrome.

AbstractBACKGROUND:
Both hyper-IgE syndrome and food allergies can result in the early onset of skin rash, eosinophilia, and markedly elevated serum IgE. Occasionally, it can be difficult to distinguish the 2 disorders. Most patients with hyper-IgE syndrome do not have food allergy.
OBJECTIVE:
To describe a child with cow's milk allergy associated with hyper-IgE syndrome manifesting as failure to thrive (FTT).
METHODS:
Epicutaneous skin prick test to cow's milk, CAP radioallergosorbent test, atopy patch tests, and double-blind, placebo-controlled milk challenge (DBPCMC) were performed.
RESULTS:
During initial presentation at 3 weeks of age, the circulating eosinophil count increased from 13,800/mm3 to 44,254/mm3 within 2 weeks while taking cephalexin. Despite treatment, he had worsening rash and FTT at 10 weeks of age with an IgE level of 8,454 U/mL. After changing from an infant milk formula with whey protein to an amino acid-based formula in combination with oral antibiotic treatment, his rash and growth velocity improved markedly within 2 months. IgE decreased to 2,747 U/mL. He remained clinically well for 12 months. He subsequently developed additional food and inhalant allergies with an increase in IgE to 12,150 U/mL. Cow's milk allergy was confirmed by epicutaneous skin prick test, atopy patch test, and DBPCMC.
CONCLUSIONS:
Traditional prophylactic antistaphylococcal antibiotics, in combination with Neocate formula, were effective in treating the early skin manifestations of hyper-IgE syndrome and FTT in this infant. Cow's milk protein allergy should be considered in patients with hyper-IgE syndrome and FTT.
AuthorsVivian P Hernandez-Trujillo, William T Nguyen, Joseph T Belleau, Michael Jeng, Mary Ellen Conley, D Betty Lew
JournalAnnals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 92 Issue 4 Pg. 469-74 (Apr 2004) ISSN: 1081-1206 [Print] United States
PMID15104201 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Milk Proteins
  • Immunoglobulin E
Topics
  • Double-Blind Method
  • Humans
  • Immunoglobulin E (blood)
  • Infant, Newborn
  • Job Syndrome (blood, complications, etiology)
  • Male
  • Milk Hypersensitivity (blood, complications, etiology)
  • Milk Proteins (adverse effects)
  • Radioallergosorbent Test
  • Skin (pathology)
  • Skin Tests

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