Supplementary Files
Keywords
Anaphylaxis
Adult
Skin sensitization
Tryptase
Abstract
Background: Allergy to cow's milk proteins is the most frequent food allergy and its prevalence has increased in the last decade. Although most patients have symptoms after the intake of dairy milk, other routes of sensitization through skin and mucous membranes have been described.
Case report: A 31-year-old male patient who is a professional chef and started with oropharyngeal symptoms after the intake of milk. Since he tolerated other dairy products, he did not suppress them from his diet. However, the clinical picture progressed and cutaneous symptoms were added; finally, anaphylaxis occurred by contact with bread dough that contained butter and milk. The patient was treated in the emergency department, where an increase in serum tryptase was verified. Skin prick tests and serological tests were positive for milk and its fractions.
Conclusion: Reports of anaphylaxis caused by dermal contact with cow’s milk are very scarce and they have been reported only in children. We believe that repeated food handling could favor cutaneous sensitization in adults with a personal history of atopy.
References
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. Pediatr Allergy Immunol. 2010;21 (Suppl 21):1-125. DOI: 10.1111/j.1399-3038.2010.01068.x
Kim EH, Burks W. Immunological basis of food allergy (IgE-mediated, non-IgE mediated, and tolerance). En: Ebisawa M, Ballmer-Weber BK, Vieths S, Wood RA, editores. Food allergy: Molecular basis and clinical practice. Chem Immunol Allergy. 2015;101:8-17.
Tan BM, Sher MR, Good RA, Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunol. 2001;86(5):583-586. DOI: 10.1016/S1081-1206(10)62908-0
Jarmoc LM, Primack WA. Anaphylaxis to cutaneous exposure to milk protein in a diaper rash ointment. Clin Pediatr (Phila). 1987;26(3):154-155. DOI: 10.1177/000992288702600312
Liccardi G, de Falco F, Gilder JA, D’Amato M, D’Amato G. Severe systemic allergic reaction induced by accidental skin contact with cow milk in a 16-year-old boy. A case report. J Investig Allergol Clin Immunol. 2004;14(2):168-171. Disponible en: http://www.jiaci.org/issues/vol14issue02/14.pdf
Macdougall CF, Cant AJ, Colver AF. How dangerous is food allergy in childhood? The incidence of severe and fatal allergic reactions across the UK and Ireland. Arch Dis Child. 2002;86(4):236-239. DOI: 10.1136/adc.86.4.236
Eigenmann PA, Zamora SA. An internet-based survey on the circumstances of food-induced reactions following the diagnosis of IgE-mediated food allergy. Allergy. 2002;57(5):449-453. DOI: 10.1034/j.1398-9995.2002.13494.x
Ramírez DA, Bahana SL. Food hypersensitivity by inhalation. Clin Mol Allergy. 2009;7:4-10. DOI: 10.1186/1476-7961-7-4
Simons FER, Ardusso LFR, Biló MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37. DOI: 10.1097/WOX.0b013e318211496c
Hussain M, Borcard L, Walsh KP, Pena RM, Mueller Ch, Kim SB, et al. Basophil-derived IL-4 promotes epicutaneous antigen sensitization concomitant with the development of food allergy. J Allergy Clin Immunol. 2018;141(1):223-234. DOI: 10.1016/j.jaci.2017.02.035
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