Cow's milk allergy in adults is rare but severe: both casein and whey proteins are involved

Clin Exp Allergy. 2008 Jun;38(6):995-1002. doi: 10.1111/j.1365-2222.2008.02968.x. Epub 2008 Apr 1.


Background: Studies on cow's milk allergy (CMA) in adults are scarce. Little is known about the clinical symptoms, eliciting doses (ED), and allergens involved.

Objective: The aim of this study was to analyse the clinical symptoms, ED and allergen recognition in adult CMA patients, compared with cow's milk (CM)-sensitized, but tolerant controls.

Methods: Adult CMA patients were evaluated by standardized questionnaires (n=30), skin prick tests (SPTs) and specific IgE for CM allergens (n=18), and a double-blind placebo-controlled food challenge (DBPCFC, n=10). A control group (n=25) of CM-sensitized, but tolerant adults was included.

Results: The majority of CMA patients (20/30, 67%) reported severe symptoms. In all patients participating in DBPCFC, CMA was confirmed. ED for subjective symptoms (0.3-300 mg CM protein) were significantly lower than that for objective symptoms (300-9000 mg CM protein). The severity of CMA by history and ED was not correlated with SPT or IgE. Patients had higher SPT reactivity than controls for CM, alpha-lactalbumin and beta-lactoglobulin (P=0.002, P=0.014 and P=0.004) but not for casein. Specific IgE to CM tended to be higher (P=0.068) and IgE to casein was higher in patients than that in controls (P=0.016). No difference was observed for IgE to alpha-lactalbumin and beta-lactoglobulin.

Conclusion: Adult CMA is severe in nature. ED are low, starting from 0.3 mg CM protein. Patients with CMA recognize the same major allergens (casein and whey proteins) as controls, but display a stronger SPT and IgE reactivity.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Animals
  • Case-Control Studies
  • Caseins / adverse effects*
  • Cattle
  • Double-Blind Method
  • Female
  • Humans
  • Immune Tolerance / immunology
  • Immunoglobulin E / blood
  • Lactalbumin / adverse effects
  • Lactoglobulins / adverse effects
  • Male
  • Middle Aged
  • Milk Hypersensitivity / blood
  • Milk Hypersensitivity / classification
  • Milk Hypersensitivity / complications
  • Milk Hypersensitivity / immunology*
  • Milk Proteins / adverse effects*
  • Severity of Illness Index
  • Skin Tests
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Whey Proteins


  • Caseins
  • Lactoglobulins
  • Milk Proteins
  • Whey Proteins
  • Immunoglobulin E
  • Lactalbumin