Q:

4/3/2018
I am interested in knowing whether a selective allergy to aged cheese has been observed. I have seen a 15 year-old boy with a history of anaphylactic reactions to aged cheeses only. He has no issue with all other dairy products, including cheeses that are not aged.
 

A:

We sought the expert opinion of Dr. Scott Sicherer. See his response below.

"I do not have any additional information regarding tyramine/histamine in aged cheese but it would seem unlikely this would cause anaphylaxis even if it were a component in the cheese. When evaluating a reaction to cheese when cow’s milk is not an allergy, I typically consider the potential that there is an allergy to another mammalian milk but not cow’s (i.e., goat, sheep), or if there is an additive or other component (coloring from annatto seed). There is a mixed literature about egg lysozyme or rennet as potential allergens as well. The evaluation would need to get a good history of the exact cheeses (the term “aged” is not specific), the meals/factors that might augment a reaction (alcohol, exercise), what has been or has not been tolerated, and some skin testing/serum IgE testing and possibly food challenges."

Patricia McNally, MD, FAAAAI

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