[Anaphylaxis caused by dermal exposure with cow's milk in an adult with food allergy. A case report]

Rev Alerg Mex. Jan-Mar 2020;67(1):73-78. doi: 10.29262/ram.v67i1.669.
[Article in Spanish]

Abstract

Background: Allergy to cow's milk proteins is the most frequent food allergy and its prevalence has increased in the last decade. Although most patients have symptoms after the intake of dairy milk, other routes of sensitization through skin and mucous membranes have been described.

Case report: A 31-year-old male patient who is a professional chef and started with oropharyngeal symptoms after the intake of milk. Since he tolerated other dairy products, he did not suppress them from his diet. However, the clinical picture progressed and cutaneous symptoms were added; finally, anaphylaxis occurred by contact with bread dough that contained butter and milk. The patient was treated in the emergency department, where an increase in serum tryptase was verified. Skin prick tests and serological tests were positive for milk and its fractions.

Conclusion: Reports of anaphylaxis caused by dermal contact with cow's milk are very scarce and they have been reported only in children. We believe that repeated food handling could favor cutaneous sensitization in adults with a personal history of atopy.

Antecedentes: La alergia a proteínas de leche de vaca es la alergia alimentaria más frecuente y su prevalencia se ha incrementado en la última década. Aunque la mayoría de los pacientes presenta síntomas por ingestión, se ha descrito sensibilización cutánea y de mucosas. Caso clínico: Hombre de 31 años, chef de profesión, en quien se iniciaron síntomas orofaríngeos después de la ingesta de leche. No suprimió de su dieta otros productos lácteos que toleraba en ese momento, sin embargo, los cuadros alérgicos fueron progresando y se añadieron manifestaciones cutáneas; finalmente presentó anafilaxia por contacto con masa de pan que contenía mantequilla y leche. El paciente fue atendido en urgencias, donde se comprobó la elevación de la triptasa sérica. Las pruebas cutáneas y serológicas resultaron positivas para leche y sus derivados. Conclusión: La anafilaxia por contacto con leche es infrecuente y solo se ha informado en niños. Consideramos que la manipulación repetida de alimentos pudiera favorecer la sensibilización cutánea en adultos con historia personal de atopia.

Keywords: Adult; Anaphylaxis; Cow's milk allergy; Skin sensitization; Tryptase.

Publication types

  • English Abstract