Contamination of probiotic preparations with milk allergens can cause anaphylaxis in children with cow's milk allergy

Probiotics open new therapeutic possibilities for the management of atopic diseases.3-8 Randomized placebo-controlled trials show a reduction of the severity of atopic dermatitis because of mother and/or infant supplementation with Lactobacillus.4-7 Probiotics could be beneficial in atopic dermatitis associated with food allergy.3,6,7 Recently, we reported the case of an infant with CMA who presented anaphylaxis, including generalized urticaria and laryngeal edema, 15 minutes after ingestion of Bacilor (Lyocentre Laboratories, Aurillac, France), a probiotic preparation prescribed for E coli gastroenteritis.9 Skin prick tests (SPTs) to milk and Bacilor were positive, and the specific cow's milk (CM) IgE value was 49 kU/L. No binding was observed with 2 control sera (Fig 1, D, row b). [...]probiotic-contaminating BLG contains linear epitopes that bind human IgE from patients with CMA.