Key features:
(1) infant or young child exposed to cow's milk
(2) chronic lung disease with a pulmonary infiltrate for which no other explanation is available
(3) positive precipitins to cow's milk
(4) clinical improvement following milk elimination, with disappearance of pulmonary infiltrates within several weeks
Lung disease may include:
(1) cough
(2) wheezing
(3) dyspnea
(4) hemoptysis
(3) pulmonary hemosiderosis (PH)
Additional clinical features associated with milk allergy:
(1) poor growth (failure to thrive)
(2) diarrhea
(3) iron deficiency anemia
(4) nasal congestion
(5) recurrent otitis media
(6) recurrent fever
(7) anorexia
(8) vomiting
(9) hematochezia
(10) eosinophilia
Cow milk rechallenge can help to confirm the diagnosis, but often it is unnecessary and it may expose the child to harm.
