Anaphylaxis to goat’s milk proteins after specific oral tolerance induction to cow’s milk

Abstract

Cow’s milk protein allergy (CMPA) is the most common food allergy in pediatric age. We described two patients with severe and persistent IgE-mediated CMPA who successfully underwent a specific oral tolerance induction (OTI) protocol to cow’s milk proteins, in whom during the maintenance phase of OTI anaphylaxis was triggered after the accidental intake of goat’s milk proteins, in one case 6 years and in the other case 2 years after starting OTI. The patients maintain tolerance to cow’s milk proteins, with daily intake of maintenance dose of 200mL of cow’s milk. We emphasized that after completing an OTI protocol on cow’s milk proteins, it is important to maintain avoidance of goat’s and sheep’s milk and cheese, until tolerance is assessed by oral provocation test.