Q:

7/3/2014
A new patient, 19 months-old was seen recently for milk allergy. He was breast fed for the first 4 months then switched to milk based formula. He experienced vomiting and was switched to Alimentum then to a soy based formula which he did tolerate well. The patient develops hives even when milk touches his skin. His PCP did a Milk IgE RAST which was 34.70 (negative being <0.35). All other RAST testing was negative. Milk skin testing was performed in the office and was completely negative. The question came from his mother who had unknowingly been feeding him baby food which contains whey protein and evaporated milk as ingredients. He tolerated these foods well without any adverse reactions. Is there any documented research on why this is possible?

A:

Thank you for your inquiry.

I am forwarding your inquiry to Dr. Julie Wang, who is a nationally recognized expert in food allergy. When we hear from Dr. Wang, we will forward her response to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Julie. Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Julie Wang:

This is a very interesting case. Since the evaporated milk and whey proteins the child is tolerating is listed as ingredients in baby food, there may only be small quantities in each jar. In addition, evaporated milk is commercially sterilized at high heat and commercial baby foods are heated during the production process. Thus, the conformational epitopes of the milk proteins are likely broken down sufficiently in these products to be tolerated by the infant described. This is not the case for the all children with milk allergies, so we generally do not advise giving products containing milk proteins to children with known milk allergies.

While many children with milk allergy have sensitization to multiple milk proteins in both the casein and whey components, there can be significant variability in sensitization patterns. Therefore, another possible explanation for this infant tolerating whey proteins is that this child may only be sensitized to the casein proteins.

Dr. Julie Wang

AAAAI - American Academy of Allergy Asthma & Immunology