title: Delayed-type hypersensitivity to cow's milk protein in Melkersson-Rosenthal syndrome: coincidence or pathogenetic role?
abstract: BACKGROUND
  Intolerance to cow's milk protein is frequently seen in children and rarely in adults. Non-IgE-mediated hypersensitivity to cow's milk protein has been suspected in children based on in vitro evidence. Food intolerance may play a pathogenetic role in some cases of Melkersson-Rosenthal syndrome, which is often of unknown origin.
  
  
  OBJECTIVE
  We describe an adult female patient who developed a Melkersson-Rosenthal syndrome and at the same time was found to have in vivo and in vitro evidence of a delayed-type hypersensitivity to cow's milk protein.
  
  
  METHODS
  Allergic and immunologic examinations, including skin prick tests, patch tests, serology, lymphocyte transformation tests and biopsies were performed.
  
  
  RESULTS
  A positive patch test to alpha-lactalbumin, a positive lymphocyte transformation test to whole cow's milk and an immunohistology with infiltration of CD4+ and CD8+ T cells were found.
  
  
  CONCLUSIONS
  There is a possible pathogenetic relation between delayed-type hypersensitivity to cow's milk protein and Melkersson-Rosenthal syndrome in the patient presented.
authors.affiliation: Division of Allergy, University of Basel, Switzerland.
authors.forename: F S
authors.initials: FS
authors.lastname: Levy
authors.forename: A J
authors.initials: AJ
authors.lastname: Bircher
authors.forename: S A
authors.initials: SA
authors.lastname: Büchner
mesh_terms: D000818:Animals; D018753:Diet, Protein-Restricted; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000150:complications / Q000276:immunology*; D007073:Immunoglobulin E / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D008556:Melkersson-Rosenthal Syndrome / Q000150:complications* / Q000276:immunology*; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000150:complications* / Q000276:immunology; D008894:Milk Proteins / Q000009:adverse effects*; D010328:Patch Tests
chemical_list: D007074:Immunoglobulin G; D008894:Milk Proteins; D007073:Immunoglobulin E