Hill, Duke et al. 1 challenged 135 consecutive infants with suspected milk allergy, and 68 proved to be positive. Furthermore, skin prick testing and milk-RAST were carried out. Previous symptoms had included urticaria, atopic eczema and other skin eruptions, vomiting, diarrhoea, bronchitis, stridor and anaphylactic reactions. Twenty-eight patients developed eczema to the milk challenge and eight of them initially developed an itchy red rash, which quickly turned into an exacerbation of a pre-existing rash.
Høst and Halken 2 monitored a cohort of 1,749 newborn infants for 12 months for the development of milk allergy. 117 exhibited symptoms that were suggestive of milk allergy. Thirty-nine (2.2 %) were positive with challenge testing. Cutaneous manifestations were provoked in 64 % (92 % had two or more symptoms and 72 % had symptoms originating from ≥ 2 organ systems). Of the cutaneous symptoms, 22 (56 %) were atopic eczema, 6 (15 %) were urticaria and 4 (10 %) included both.
Jakobsson and Lindberg 3 reported of a prospective study where children born at particular time periods during 1977 were monitored up to the age of 2 years. The total of 1,079 children were enrolled into the study. Twenty (1.9 %) were diagnosed as being intolerant to milk. The diagnosis was based on the disappearance of symptoms when milk products were eliminated from the diet and re-emerged with a repeated, open challenge with milk. Five children manifested only cutaneous symptoms (three had eczema, one exanthema and one urticaria + exanthema). Six children had both skin and gastrointestinal symptoms and two had eczema and bronchitis. Some of the children developed simultaneously both eczema and urticaria and/or exanthema.
Rancé et al. 4 carried out a prospective study in 703 patients (544 < 15 years of age) with food allergy confirmed with challenge testing. Of these children, 50.5 % had atopic eczema, 30 % had urticaria and angioedema.
Goldman et al. 5 carried out a prospective multicentre study in patients whose milk allergy had been diagnosed with challenge testing. Seven hundred children, aged 0 - 11 years, were tested and 150 challenged. The milk challenge was positive in 89 patients. Of these 89 patients, 31 developed atopic eczema and 10 urticaria as a response to the challenge. One child had a history of atopic eczema but the response to the challenge testing was not cutaneous. On the other hand, of the children who developed urticaria during the challenge, four had not manifested this symptom before. This finding is important when planning the site of challenge since the patient's history is not always consistent with the mode of reaction to the challenge.
Gerrard, Lubos et al. 6 collected data during ten years on 150 children with cow's milk allergy. In these children, exclusion of milk removed the symptoms and reintroduction of milk provoked a new symptom emergence. Only twenty of these 150 children had atopic eczema as a symptom of their milk allergy; no other cutaneous manifestations were mentioned. The researchers noted that, based on the study, it could not be concluded that cutaneous symptoms are a more rare manifestation than gastrointestinal or respiratory symptoms; patients with cutaneous symptoms are usually referred to a dermatologist.
Hill, Firer et al. 7 analysed 100 children (mean age 16 months), with a positive milk challenge test, for the speed of symptom emergence during challenge testing. The number of cutaneous manifestations in the entire cohort was: 33 cases of acute urticaria and 20 cases of chronic atopic eczema.
Gerrard, MacKenzie et al. 8 studied 787 consecutive children for milk allergy. Milk challenge was positive in 59 children, 26 of whom were still being breast-fed. Twenty-seven of these 59 children had atopic eczema; there is no mention of other skin reactions.
Saarinen and Savilahti 9 prospectively followed 6,209 newborn infants to detect possible milk-induced symptoms. At a mean age of 6.7 months, a total of 118 infants (1.9 %) reacted adversely to a challenge with cow's milk. Seventy-five infants had a positive cow's milk RAST, and the challenge provoked urticaria or exanthema in 76 % of these infants and atopic eczema in 28 %. Forty-three infants were cow's milk RAST-negative, and 9 % of these developed urticaria or exanthema and 72 % developed atopic eczema. Before the challenge the corresponding figures in the RAST-positive group were 67 % and 91 %, and in the RAST-negative group 9 % and 88 %.
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