Delayed-Type Hypersensitivity to Cow’s Milk Protein in Melkersson-Rosenthal Syndrome: Coincidence or Pathogenetic Role?

BACKGROUND: Intolerance to cow's milk protein is frequently seen in children and rarely in adults. Non-IgE-mediated hypersensitivity to cow's milk protein has been suspected in children based on in vitro evidence. Food intolerance may play a pathogenetic role in some cases of Melkersson-Rosenthal syndrome, which is often of unknown origin. OBJECTIVE: We describe an adult female patient who developed a Melkersson-Rosenthal syndrome and at the same time was found to have in vivo and in vitro evidence of a delayed-type hypersensitivity to cow's milk protein. METHODS: Allergic and immunologic examinations, including skin prick tests, patch tests, serology, lymphocyte transformation tests and biopsies were performed. RESULTS: A positive patch test to alpha-lactalbumin, a positive lymphocyte transformation test to whole cow's milk and an immunohistology with infiltration of CD4+ and CD8+ T cells were found. CONCLUSIONS: There is a possible pathogenetic relation between delayed-type hypersensitivity to cow's milk protein and Melkersson-Rosenthal syndrome in the patient presented.