ACQUIRED MILK PROTEIN ALLERGY IN A CHILD WITH ATOPIC DERMATITIS, AFTER COW`S MILK ELIMINATION DIET

Approximately 30%- 40% of children with moderate-to-severe Atopic dermatitis (AD) have IgE-mediated food allergy (FA). Although food avoidance may improve AD, avoidance diets do not cure AD, may even have detrimental effects such as progression to immediate-type allergy including anaphylactic reactions. An avoidance diet is only indicated in patients clearly identified as food allergic by an appropriate diagnostic food test and challenge. A 5-year-old boy presenting to the emergency department with Anaphylaxis. After eating a cow milk, coconut, tree nut ice cream. Known background of Asthma and AD treated with cyclosporine. No known allergic reaction previously. Improvement after receiving adrenalin(IM) and solumedrol(IV). Admitted to pediatric ward. Second anaphylactic event during hospitalization, after eating a cow milk protein-based yogurt. History revealed that due to severe AD they avoided certain foods. He avoided milk, corn, Peanuts for only 6 weeks before presenting with anaphylactic reaction. SPT to Milk 5-6mm(positive) Histamine control(negative). SPT to rest of tree nuts and corn, negative. He stopped cyclosporine. Avoids cow milk products and always carries auto-injection anaphylaxis. There is a considerable chance of developing acute allergic reactions to Cow milk protein (CMP), after elimination, in children with AD Who previously consumed CMP. Prolonged cow's milk elimination diet in children with Atopic dermatitis who previously consumed milk protein, may be at risk to develop anaphylaxis. Allergists and pediatrician should be aware of this risk, before recommending elimination diet of previous tolerated foods and promote patient safety by educating.