5 Month Old Allergies to Beef
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Abstruse
Approximately 13–20% of infants with milk allergies meantime showroom beef allergies. Here, we report a 24-month-old infant who exhibited both pork and beef allergies, concurrently with a milk allergy. The infant's laboratory test results were: three.73 ISU-Eastward (ISAC standardized unit for IgE) for cow milk β-lactoglobulin, 23.8 ISU-Eastward for casein, 12.8 ISU-E for cow milk Bos d 6 of serum albumin, and 4.85 ISU-E for true cat Fel d ii. This case report summarizes an infant patient diagnosed with a meat allergy that was associated with cow's milk allergy, using ImmunoCAP ISAC®. Non but ImmunoCAP ISAC® but likewise immunocap can be used to diagnose milk allergy and meat allergy at the same time, immunocap testing for component antigen is rare. ImmunoCAP ISAC® is used to diagnose these allergies in our case report, equally information technology has advantage that only 1ml of claret is needed to run diverse component antigen tests.
Food allergy is a common disease, especially in children, with prevalence of approximately 6–eight%.1 Representative food allergy products include milk, eggs, peanut, fish, shellfish, soybean, wheat, and rice,two although people from unlike countries or age groups show allergic reactions against different food types.3 The primary food allergy products for Korean children include eggs, milk, peanut, tree basics, wheat, fish, meat, sesame, and fruit.iv Milk is one of the about common causes of food allergy, accounting for 20% of all food allergies, with a prevalence ranging from 0.five% to 3.ii% in South Korea.4 Simply, the prevalence largely varied between dissimilar studies, from 1.9% to seven.v%.567
The prevalence of beef allergies in infant patients is relatively higher (3.3% to half dozen.5%) for infants with atopic dermatitis.8 And beefiness allergy may be present in 0.iii% of the pediatric population.nine A previous written report has shown that 13–twenty% of infants with cow'southward milk allergy also exhibit beef allergy. On the other mitt, the risk of developing cow'southward milk allergy in the infants with beefiness allergy is even college.ix Here, we report a 24-months-onetime boy with cow's milk allergy concurrent beef and pork allergies.
Instance
The patient was a 24-month-quondam male, whose father had a history of bronchial asthma and atopic dermatitis. The patient was born past vaginal commitment, with birthweight of iii.2 kg and without any medical history. There were no pets in the household, and the patient started exhibiting skin flares, itching, and oozing on the skins most the face up, cervix, and ears at three months of age. At approximately iv months of age, he experienced urticaria and itching afterward irresolute from breast milk to powdered formula. When he started weaning onto food, the urticaria reoccurred afterward meat (beef, pork) intake. Ever since, patient's mother avoid meat equally weaning formula ingredients, and fish and bean was included instead of meat for patient'southward poly peptide supply.
Based on these observations, the patient was suspected to have food allergies and atopic dermatitis. When urticaria occurred, the patient's vital signs were normal, and no cardiac or pulmonary murmurs were detected via stethoscope. Withal, skin flares and oozing were observed on the skin almost the face, neck, and ears. With the suspicion of allergies, we performed an allergic blood test by immunocap. The allergic test showed accented eosinophil count (AEC) of 2,210; total IgE level 248.9 U/mL; and specific IgE for moo-cow's milk 72.one kUA/L and for casein 23.3 kUA/Fifty (Table one). The patient exhibited high antigenicity against milk and casein; and thus, the patient was put on a nutrition restriction from dairy products, including milk. Furthermore, milk powered formula was changed to casein hydrolytic formula. All the same, the patient'southward rash symptoms persisted, and somewhen, we changed his diet to an amino acid formula. Amino acrid formula was supplied to the patient equally non just casein allergy, but also lactoglobulin and serum albumin allergy were accompanied to the patient. Whereas casein hydrolytic formula is normally plenty for the moo-cow's milk allergy patients who suffer merely casein allergy.
He continued to exhibit atopic dermatitis, and an allergic test was performed once more at the age of 12 months. This test resulted in AEC 430; full IgE level 994.2 U/mL; and specific IgE for casein 100 kUA/L, for beta-lactoglobulin 26.7 kUA, for beefiness 38.6 kUA/50, and for pork xix.1 kUA/Fifty (Tabular array i). These values suggested a meat allergy; and thus, the patient continued to avert beef and pork.
At 24 months, we performed an ImmunoCAP ISAC® examination for and observed the following the examination measurements: 3.73 ISU-E (ISAC standardized unit for IgE) for cow milk β-lactoglobulin, 23.eight ISU-Due east for casein, 12.eight ISU-E for moo-cow milk Bos d 6 of serum albumin, and 4.85 ISU-Eastward for cat Fel d ii (Table 2). The reference values for these results are outlined in Table 3.
Based on the patient's characteristic medical history and examination results, we diagnosed him with cow's milk allergy and concurrent beef and pork allergies. In addition, the patient was besides allergic to egg, wheat, and potatoes. The patient was treated with antihistamine and steroid ointment, and was recommended to avoid consuming eggs, dairy products, beef, and pork. The patient no longer exhibits nutrient allergic symptoms and is currently existence followed-upwardly at an outpatient clinic.
DISCUSSION
There are iii main categories of meat allergies: the immediate meat allergy that is associated with cow'due south milk allergy, pork-cat syndrome, and alpha-gal syndrome. Pork-cat syndrome is seen in patients sensitized to cat epithelium, which nowadays symptoms suggestive of IgE-mediated hypersensitivity upon ingestion of pork meat. And alpha-gal syndrome, seen in patients with IgE antibodies confronting the sugar epitope galactose- alpha-1, 3-galactose, have reported severe allergic reactions later on consumption of red meat. Historic period, onset time after intake, and symptoms vary, and component-resolved diagnostics facilitate the differential diagnosis.x
The majority of reported reactions to beef in childhood take occurred in cow's milk allergic children. Previous studies have reported that approximately 13–20% of infant patients with cow's milk allergies also exhibit beef allergies, while 26 out of 28 (92.9%) infant patients with beefiness allergies were found to have cow's milk allergies through a double-blinded, placebo-controlled food challenge test and skin prick examination.9
Fundamental antigens that cause moo-cow'south milk allergies include casein, β-lactoglobulin, α-lactalbumin, and bovine serum albumin.eleven The key allergen proteins from meat that have been discovered hitherto include a l kDa poly peptide from chicken, a 51 kDa protein from pork, 67 kDa bovine serum albumin, and 60 kDa bovine gamma globulin from beefiness.1213 More specifically, the key poly peptide antigens that cause beefiness allergies have been shown to act as fundamental antigens for pork and lamb as well, playing an of import role every bit central causative antigens that promote cross-reactions among these meats.8 A previous study reported that when an babe patient with beef allergies underwent a skin prick test with lamb and pork antigens, positive results were obtained for 100% and 50% of the patients, respectively. In improver, the amino acrid sequences for lamb and pork serum albumin show 92.three% and 78.eight% similarity to the amino acid sequence for bovine serum albumin, respectively.8 Therefore, the possibility of cross-reaction between the meat antigens of different species can be explained by the similarity in biochemical construction of serum albumin antigens. This high rate of cross-reaction between beefiness and milk proteins is caused by bovine serum albumin, a protein antigen that usually exists in both beef and milk.89
Recently, in South Korea, a case was reported in which an developed patient with milk allergy simultaneously showed allergic symptoms to beefiness and pork every bit measured with the immunoCAP system.5
In this instance, the patient with cow's milk allergy exhibited identical symptoms after consuming beef, which allowed the clinicians to suspect a possible cantankerous-reaction. Therefore, bovine serum albumin – a protein with the greatest possibility for cantankerous-reaction – was measured using ImmunoCAP ISAC®, and we observed significantly higher values compared to the control (normal) group. Furthermore, the level of cat serum albumin was also significantly elevated, suggesting a possible clan with serum albumin. Simultaneous allergic symptoms confronting milk, beef, and pork are idea to be due to sensitization against bovine serum albumin and true cat serum albumin.
The case was cross-reacted to cats and pork with milk and beefiness, and was tested with ImmunoCAP ISAC®, a test that has not yet been performed in Korea. This may be different from other cases. The child may likewise be associated with meat allergy associated with moo-cow's milk allergy and pork-true cat syndrome.
Although the prevalence of meat allergies in infant patients is relatively low compared to other nutrient allergies, meat is an important nutritional source, specially for growing infants. Therefore, clinicians must consider the possibility of cross-reaction with other meat antigens in babe patients with cow's milk allergy and perform necessary examinations, when required.
Figures and Tables
Table ane
ImmunoCAP results of the patient
Tabular array 2
ImmunoCAP ISAC results of the patient at 24 months.
Table iii
ImmunoCAP ISAC reference value in ISU-E (ISAC Standardized Units for IgE).
References
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