Verelst Sophie, Sinnesael Robbe, Taïbi Firoz, Tuyls Sebastian, Coorevits Lieve, Breynaert Christine, Bullens Dominique, Schrijvers Rik
Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium.
Clinical Division of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium.
Nutrients. 2025 Jul 22;17(15):2393. doi: 10.3390/nu17152393.
: Cow's milk allergy (CMA) is the most common food allergy in children, typically resolving by adolescence. In contrast, the clinical spectrum of allergies to non-cow mammalian milk and their patterns of IgE cross-reactivity are less well documented. Nutritional differences between various mammalian milks may also impact dietary management in milk-allergic patients. To characterize clinical features, onset age, and IgE cross-reactivity patterns of non-cow mammalian milk allergies in adult patients seen at a tertiary allergy center, and to compare these findings with published cases. A retrospective analysis of patients included in the "Extended Laboratory Investigation for Rare Causes of Anaphylaxis study" with mammalian milk allergy was performed using clinical history, skin testing, and serum-specific IgE measurements. Cross-reactivity patterns were assessed in selected cases using immunoblotting, specific IgE inhibition, and basophil activation testing, and compared with published reports of non-cow mammalian milk allergy. : In our case series of 22 patients with mammalian milk allergy and 10 healthy control subjects, 3 patients were identified with isolated adult-onset non-cow mammalian milk allergy ( = 1 buffalo milk; = 2 mare milk), confirmed via immunoblotting and basophil activation testing. Streptavidin-based specific IgE measurement for buffalo cheese was positive in the buffalo milk allergic patient. The literature review identified 82 cases of non-cow mammalian milk allergy. These cases typically showed late onset (mean age 8.6 years; range 1-70 years), severe reactions (CoFAR (Consortium for Food Allergy Research) grade 3 or 4 in 66%, and one fatality), and selective sensitization (affecting sheep and/or goat, camel, mare, buffalo, donkey, or combinations thereof in 56, 10, 5, 5, 4, and 2 cases, respectively). : Non-cow mammalian milk allergies are rare but generally present later in life with selective IgE cross-reactivity, differing from the broader cross-reactivity observed in CMA. This selectivity may allow for safe dietary alternatives. These findings underscore the need for improved diagnostics and personalized dietary management in this patient population.
牛奶过敏（CMA）是儿童中最常见的食物过敏，通常在青春期缓解。相比之下，对非牛乳类哺乳动物奶的过敏临床谱及其IgE交叉反应模式的记录较少。各种哺乳动物奶之间的营养差异也可能影响牛奶过敏患者的饮食管理。为了描述在三级过敏中心就诊的成年患者中非牛乳类哺乳动物奶过敏的临床特征、发病年龄和IgE交叉反应模式，并将这些发现与已发表的病例进行比较。对纳入“过敏性休克罕见病因扩展实验室研究”且患有哺乳动物奶过敏的患者进行回顾性分析，采用临床病史、皮肤试验和血清特异性IgE测量。在选定病例中使用免疫印迹、特异性IgE抑制和嗜碱性粒细胞活化试验评估交叉反应模式，并与已发表的非牛乳类哺乳动物奶过敏报告进行比较。在我们的22例哺乳动物奶过敏患者和10例健康对照受试者的病例系列中，通过免疫印迹和嗜碱性粒细胞活化试验确诊3例患有孤立性成人期非牛乳类哺乳动物奶过敏（1例对水牛奶过敏；2例对马奶过敏）。对水牛奶过敏的患者中，基于链霉亲和素的水牛芝士特异性IgE测量呈阳性。文献综述确定了82例非牛乳类哺乳动物奶过敏病例。这些病例通常起病较晚（平均年龄8.6岁；范围1至70岁），反应严重（66%为食物过敏研究联盟（CoFAR）3级或4级，1例死亡），且有选择性致敏（分别有56例、10例、5例、5例、4例和2例对绵羊和/或山羊、骆驼、马、水牛、驴或其组合过敏）。非牛乳类哺乳动物奶过敏很少见，但通常在生命后期出现，具有选择性IgE交叉反应，这与牛奶过敏中观察到的更广泛的交叉反应不同。这种选择性可能允许选择安全的饮食替代品。这些发现强调了在这一患者群体中改进诊断和个性化饮食管理的必要性。
