Clinical manifestations of cows' milk allergy in childhood. I. Associations with in-vitro cellular immune responses.

In this study 51 children who presented with symptoms of cows' milk allergy (CMA) were categorized clinically by their response to cows' milk challenge. Forty-two patients had unequivocal evidence of CMA and nine were milk tolerant. Of the patients with CMA two groups were identified. The first, made up of 32 patients, had immediate-type hypersensitivity reactions to milk associated with both positive skin-prick test (SPT) and RAST. The second group of 10 late reacting patients developed symptoms of CMA over several hours or days; significant increases in irritability, frequency of bowel actions, and rhinitis following milk ingestion were noted in this group. Leucocyte inhibition factor (LIF) produced in response to alpha-lactalbumin, beta-lactoglobulin and alpha-casein was assessed in the immediate and late reacting CMA patients as well as in the milk-tolerant group. There was no difference in LIF production between the milk-tolerant group and those with immediate reactions. However, these two groups produced less LIF than the late reacting patients for alpha-lactalbumin (P = 0.02), alpha-casein (P = 0.03) and beta-lactoglobulin (P = 0.05). A clinical dairy score card was found to be a useful instrument to assess the response of non-immediate reactions to milk ingestion.