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Case Report

Severe systemic allergic reaction induced by accidental skin contact with cow milk in a 16-year-old boy. A case report

G. Liccardi1, F. De Falco1, J. A. Gilder2, M. D’Amato1 and G. D’Amato1

1 Department of Chest Diseases, Division of Pneumology and Allergology, “A. Cardarelli” Hospital, Naples, Italy.
2 Scientific Communication, Naples, Italy

J Invest Allergol Clin Immunol 2004; Vol. 14(2): 168-171



The symptoms of food allergy are rarely induced by skin contact. A 16-year-old boy was referred to our Allergology Centre after an episode of systemic symptoms triggered by accidental skin contact with a drop of cow milk (CM) dripped from a sandwich containing fresh cheese. The patient had been allergic to CM from the age of 24 months and had experienced several episodes of urticaria-angioedema after the ingestion of tiny or
“hidden” amounts of CM proteins. In vivo and in vitro diagnostic procedures showed intense sensitisation to all CM proteins (1/100 dilutions of allergenic extracts produced large wheals, and class 4 specific IgE antibodies. Total IgE antibodies were elevate (770.0 UI/). A moderate degree of bronchial hyperresponsiveness was found (PC20 metacholine: 3.90 milligrams). This case report suggests that patients with a high degree of sensitisation to CM proteins should be alert to the danger of skin contact and should beware of “hidden” CM allergens.

Key words: Cow milk allergens, systemic reactions, food allergy, hidden allergens, skin contact, urticariaangioedema.