Mammalian milk allergy: clinical suspicion, cross-reactivities and diagnosis.
OBJECTIVE
Cow's milk allergy affects 2-3% of young children, the economic impact of which necessitates search for simple diagnostic tools and affordable milk substitutes. This review examines recent studies on the diagnosis of cow's milk allergy as well as on the allergenicity of milk from other mammalian species.


RESULTS
Resolution of symptoms during strict milk avoidance and their re-appearance during the double-blind, placebo-controlled milk challenge remains the gold standard for the diagnosis of cow's milk allergy. Allergic eosinophilic esophagitis/gastroenteritis requires confirmatory endoscopic biopsy. There are increasing data in various populations on cut-off points based on positive predictive values for skin prick test and milk-specific IgE measurements to aid in the diagnosis of cow's milk allergy and to decrease the number of unnecessary food challenges. For non-IgE-mediated manifestations, noninvasive diagnostic tests are still largely lacking. The significant homology between milk from cow, sheep and goat results in clinical cross-reactivity. However, mare's or donkey's milk may be tolerated by some individuals.


CONCLUSIONS
Data have been accumulating on the utility of diagnostic tools for mostly IgE-mediated milk allergy and allergenicity of milk from other mammalian species, although further studies are sought.
Division of Pediatric Allergy and Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA. kirsi.jarvinen@mssm.edu
Kirsi M
KM
Järvinen
Pantipa
P
Chatchatee
D000485:Allergens / Q000276:immunology; D000818:Animals; D000918:Antibody Specificity; D002417:Cattle; D003429:Cross Reactions; D018397:Equidae; D006041:Goats; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008892:Milk / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D016269:Milk Hypersensitivity / Q000097:blood / Q000175:diagnosis*; D008894:Milk Proteins / Q000737:chemistry / Q000276:immunology; D012756:Sheep; D012882:Skin Tests
D000485:Allergens; D008894:Milk Proteins; D007073:Immunoglobulin E