Q:

6/21/2012
I have a child that has hives and angioedema with ingestion of cow's milk. However, he can consume any amount of ice cream, cheese and yogurt with no problems. Milk IgE levels have been at 38.40 for the past 5 years. No skin testing has been performed. Is this explained with denaturing of the casein and beta lactoglobulin in the processed products? Any other explanation? Thank you.

A:

Thank you for your inquiry.

I am going to ask Dr. Anna Nowak-Wegrzyn, who is an internationally known expert on milk allergy, to reply to your inquiry. As soon as we receive her response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received the following response from Dr. Anna Nowak-Wegrzyn. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Anna Nowak-Wegrzn:
This is an unusual case of milk allergy and I am not aware of any published reports of such patients. Unless this is a question of a lower dose of milk protein that is tolerated in a form of ice cream, yogurt and cheese, I would assume that this child is allergic to a milk protein that is very sensitive to any heat or enzymatic processing, perhaps bovine serum protein or whey proteins such as beta-lactoglobulin or alpha-lactalbumin (although these protein lose their IgE binding after 20 minutes of boiling). Casein is relatively stable upon heating as it does not have a fixed tertiary structure. To better understand this child's situation, the information about the tolerated amount of different forms of dairy would be important.

Kind regards,
Anna Nowak-Wegrzyn, MD

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