A retrospective study of allergic diseases in children with food hypersensitivity.

Cow's milk allergy (CMA) is the most common childhood food allergy, 1 affecting 2–3% of the general population. 2 After a correct diagnosis, complete avoidance of cow's milk proteins (CMP) is the only proven measure currently available to prevent symptoms. CMA is frequently detected in the first year of life when nutritional requirements are critical and adequate substitute is mandatory. Formulas available for allergic children are extensive hydrolysates of whey proteins, casein or mixed, amino acid based formulas (AABF) and vegetable formulas such as soy, rice or oat products. 3 In Europe, extensively hydrolysed formulas (EHF) are the first-line substitution formulas for CMA, especially recommended for infants under 6 months of age with non-anaphylactic reactions. 4,5 AABF are recommended for children with EHF allergy and, according to some authors, can be the best option for infants with suspected multiple food allergy (MFA), previous anaphylaxis or eosinophilic oesophagitis. 5,6 Regarding allergenic potential, it is now evident that EHF can induce adverse reactions in a substantial number of infants with cow's milk allergy. Extensively hydrolysed formulas have 95% of peptides with less than 1500 Da and only 0.5% superior to 6000 Da. 3 Greater weights are less safe as they have higher antigenic potential. Allergy to EHF has been reported as rare and some authors suggest intolerance rates of approximately 10% among CMA patients. 6 We report six children, attended at Hospital Dona Estefa-nia's Immunoallergy Department, for IgE mediated CMA and hypersensitivity to EHF, from the years 2005 to 2008 (Ta b l e 1). Initial diagnosis was based on suggestive clinical manifestations , skin prick tests (SPT) and specific IgE determination for milk and protein fractions (casein, alfa-lactoalbumin and beta-lacto-globulin). Prick-prick tests with the implicated EHF (PeptiJunior s) were performed in all patients Wheal reactions equal or larger than 3 mm were considered positive. The reported cases are four boys and two girls, with ages from 10 months to 6 years old (average age is 2.8 years). First adverse reaction to CMP occurred in the first 6 months of life for all patients and, in most cases (4:6) immediately after first ingestion of whole milk substitution formula or other CMP form (ice cream or yogurt). Immediate adverse reactions on contact with CMP occurred in all patients and anaphylaxis was described in four children, with mucocutaneous symptoms (urticaria and/or angio-oedema) present in all anaphylactic reactions. Only one boy (12 months old) had …