Cow's milk allergy in a patient with hyper-IgE syndrome.
BACKGROUND
Both hyper-IgE syndrome and food allergies can result in the early onset of skin rash, eosinophilia, and markedly elevated serum IgE. Occasionally, it can be difficult to distinguish the 2 disorders. Most patients with hyper-IgE syndrome do not have food allergy.


OBJECTIVE
To describe a child with cow's milk allergy associated with hyper-IgE syndrome manifesting as failure to thrive (FTT).


METHODS
Epicutaneous skin prick test to cow's milk, CAP radioallergosorbent test, atopy patch tests, and double-blind, placebo-controlled milk challenge (DBPCMC) were performed.


RESULTS
During initial presentation at 3 weeks of age, the circulating eosinophil count increased from 13,800/mm3 to 44,254/mm3 within 2 weeks while taking cephalexin. Despite treatment, he had worsening rash and FTT at 10 weeks of age with an IgE level of 8,454 U/mL. After changing from an infant milk formula with whey protein to an amino acid-based formula in combination with oral antibiotic treatment, his rash and growth velocity improved markedly within 2 months. IgE decreased to 2,747 U/mL. He remained clinically well for 12 months. He subsequently developed additional food and inhalant allergies with an increase in IgE to 12,150 U/mL. Cow's milk allergy was confirmed by epicutaneous skin prick test, atopy patch test, and DBPCMC.


CONCLUSIONS
Traditional prophylactic antistaphylococcal antibiotics, in combination with Neocate formula, were effective in treating the early skin manifestations of hyper-IgE syndrome and FTT in this infant. Cow's milk protein allergy should be considered in patients with hyper-IgE syndrome and FTT.
Hernandez-Trujillo
Vivian P
VP
Department of Pediatrics, Allergy/Immunology, University of Tennessee, Memphis, Tennessee, USA.
Nguyen
William T
WT
Belleau
Joseph T
JT
Jeng
Michael
M
Conley
Mary Ellen
ME
Lew
D Betty
DB
D004311:Double-Blind Method; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007231:Infant, Newborn; D007589:Job Syndrome / Q000097:blood / Q000150:complications / Q000209:etiology*; D008297:Male; D016269:Milk Hypersensitivity / Q000097:blood / Q000150:complications / Q000209:etiology*; D008894:Milk Proteins / Q000009:adverse effects*; D011852:Radioallergosorbent Test; D012867:Skin / Q000473:pathology; D012882:Skin Tests
D008894:Milk Proteins; D007073:Immunoglobulin E