D1.277 - Selective goat’s and sheep’s milk anaphylaxis: Advocacy for mandatory food labeling of milk origins

Background:

Food allergy to goat’s and sheep’s milk (GSM) with tolerance to cow’s milk (CM) is severe in most cases. Fatalities have been reported. The risk of recurrent anaphylaxis is high, due to accidental ingestion of food containing GSM in a hidden form or as a contaminant. We present a case of GSM-induced anaphylaxis by contamination of milk in a prepackaged industrial sweet treat.

Case:

An 11-year-old girl with medical history of asthma, known GSM anaphylaxis, epilepsy and type 1 diabetes, presented à grade 3 anaphylaxis after eating for the first time a Hazelnut Cream Wafer of the brand Sondey, sold at a discount grocery store. She usually ate similar wafers of different brands with good tolerance. Immediately after eating the whole Sondey wafer, she presented with urticaria, eyelid edema, intense abdominal pain, respiratory distress with wheezing, and alternating hot flashes and chills, treated by her mother with an adrenaline injection. The mother monitored the child by herself at home.

At 8 years of age, allergy to GSM was discovered after having eaten twice a vegetarian meal containing GSM in a hidden form at school, leading to grade 3 anaphylaxis. The girl had since early childhood refused eating GSM products.

Skin prick tests to the different ingredients of the wafer (wafer, chocolate coating, hazelnut cream, milk cream) were positive only to the milk cream, which demonstrated the responsibility of this ingredient. Skin prick tests remained negative for CM and highly positive for GSM.

Conclusion:

In France anaphylaxis to GSM accounts for 3% of all food induced anaphylaxis. As GSM has gained increased popularity and is growingly used in a variety of products, such as infant formula, nutritional supplements, cosmetics and pharmaceuticals, anaphylaxis to GSM is expected to rise in the future.

Our case illustrates the difficulty of GSM avoidance in patients with selective GSM allergy, as contamination by GSM can occur in industrial food products of any kind containing CM. It pleads for mandatory food labeling of milk origins to prevent recurrent and severe, possible fatal anaphylaxis to GSM in patients with selective GSM allergy.