Hypogammaglobulinaemia secondary to cow-milk allergy in children under 2 years of age
Article first published online: 11 MAY 2007
Volume 122, Issue 1, pages 140–146, September 2007
How to Cite
Bezrodnik, L., Raccio, A. C. G., Canil, L. M., Rey, M. A., Carabajal, P. C., Fossati, C. A. and Docena, G. H. (2007), Hypogammaglobulinaemia secondary to cow-milk allergy in children under 2 years of age. Immunology, 122: 140–146. doi: 10.1111/j.1365-2567.2007.02628.x
- Issue published online: 11 MAY 2007
- Article first published online: 11 MAY 2007
- Received 21 November 2006; revised 7 March 2007; accepted 22 March 2007.
- cows' milk;
- food allergy;
- immunoglobulin E
Symptomatic hypogammaglobulinaemia in children younger than 2 years of age was studied to rule out a primary immunodeficiency. Thirty-four patients were referred to the Immunology Service to study the hypogammaglobulinaemia-associated clinical picture. Food allergy was documented in 10 patients by personal and familial history, presence of specific immunoglobulin E (IgE) and elevated total serum IgE levels. Coeliac disease and human immunodeficiency virus infection were also ruled out. Protein loss through stools was assessed by clearance of α1-antitrypsin (AAT). Serum immunoglobulin levels were determined by nephelometry and functional antibodies were studied by enzyme-linked immunosorbent assay. The cellular immune response was assessed by in vitro lymphocyte proliferation in response to mitogens and cell subsets were analysed by flow cytometry. In five patients of the 10 patients we suspected a protein loss through the mucosa. Four of these five patients showed an increased AAT and the other showed an extensive cutaneous lesion. Immunological studies revealed normal antibody function, in vitro lymphoproliferative responses and cell numbers in four of the 5 patients. One patient showed abnormally low numbers of CD4+ T cells as well as a defective proliferative response to mitogens. After diagnosis of cow milk allergy, milk was replaced with infant milk formula containing hydrolysed proteins. Recovery of immunoglobulin values and clinical resolution were achieved. Hypogammaglobulinaemia during early childhood in some children may be secondary to cow milk allergy, and immunoglobulins and cells may leak through the inflamed mucosa. Resolution of symptoms as well as normalization of immunoglobulin values may be easily achieved by avoidance of the offending allergen.