Cows milk-dependent exercise-induced anaphylaxis under the condition of a premenstrual or ovulatory phase following skin sensitization

Allergol Int. 2008 Dec;57(4):437-9. doi: 10.2332/allergolint.C-08-62. Epub 2008 Dec 1.


Background: A 24 year-old woman with atopic dermatitis occasionally developed symptoms, including dyspnea and generalized urticaria, following ingestion of food containing cows milk. Similar episodes had continued, and had been treated empirically since the age of 16 years.

Case summary: Although a skin test and IgE RAST showed positive reactions to cows milk, a provocation test with cows milk alone did not induce any symptoms. Therefore, food-dependent exercise-induced anaphylaxis (FDEIA) was suspected, but examination using various combinations of cows milk, aspirin and exercise failed to elicit any symptoms. Finally, a provocation test during the ovulatory phase with cows milk followed by aspirin and exercise evoked systemic urticaria, dyspnea and hypotension.

Discussion: The symptoms against cows milk began when she took baths with bath salts containing cows milk as its main ingredient for one year at the age 15 years. Sensitization to cows milk through eczematous skin is indicated from this history. Hormonal change during a premenstrual or ovulatory phase is also an important factor for the development of FDEIA in this case.

Publication types

  • Case Reports

MeSH terms

  • Anaphylaxis / complications
  • Anaphylaxis / diagnosis*
  • Anaphylaxis / physiopathology
  • Animals
  • Asthma, Exercise-Induced / complications
  • Asthma, Exercise-Induced / diagnosis*
  • Asthma, Exercise-Induced / physiopathology
  • Baths
  • Chronobiology Phenomena / immunology
  • Dermatitis, Atopic / complications
  • Dermatitis, Atopic / diagnosis*
  • Dermatitis, Atopic / physiopathology
  • Dyspnea
  • Female
  • Hormones / genetics
  • Hormones / immunology
  • Hormones / metabolism*
  • Humans
  • Immunization
  • Immunoglobulin E / blood
  • Luteal Phase / immunology
  • Milk Hypersensitivity / complications
  • Milk Hypersensitivity / diagnosis*
  • Milk Hypersensitivity / physiopathology
  • Salts
  • Skin Tests
  • Urticaria
  • Young Adult


  • Hormones
  • Salts
  • Immunoglobulin E