TYPE-I ALLERGY TO COW MILK-PROTEINS IN ADULTS - A RETROSPECTIVE STUDYOF 34 ADULT MILK-ALLERGIC AND CHEESE-ALLERGIC PATIENTS

To determine the clinical and serological characteristics of type I fo od allergy to cow milk proteins in adults, we investigated all 34 pati ents (aged from 16 to 58 years) who were diagnosed between 1981 and 19 91 to have IgE-mediated reactions to cow milk and cheese. Women repres ented 91.2% of the study group and 39% of them suffered from the first symptoms during or soon after a pregnancy. So far, 47% of the patient s were nonatopic and showed a monovalent sensitization to cow milk pro teins. According to RAST results (score greater than or equal to 2) th e predominant allergen was casein with a sensitization frequency of 71 %, whereas sensitization to whey proteins (alpha-lactalbumin and beta- lactoglobulin) in this adult group was rare. In cow milk allergy (CMA) patients, significantly lower levels of milk-specific IgG were observ ed than in normal controls. The main organ manifestations of CMA in ad ults were the respiratory tract and the skin, with gastrointestinal an d cardiovascular symptoms occurring less often than in children. Only 28% of CMA adults could enjoy an unlimited symptom-free intake of milk products after 4 years of disease. Compared with the existing studies on CMA in children, the results suggest that allergies to cow milk pr oteins in adults are less frequent and tend to persist longer. They ar e likely to be misdiagnosed for years due to symptoms that initially o ften refer to only one organ system such as the respiratory tract. Bes ides oral provocation tests and RAST, the intracutaneous test of milk/ casein is a valuable diagnostic screening tool in adults and an easy w ay to increase the sensitivity of the skin prick test without losing s pecificity. Due to a high cross-reactivity between caseins of differen t animals, an elimination diet in most cases also has to exclude milk products of animal species other than cow.