Correspondence Anaphylactic Shock Due to Cow’s Milk Allergy in the Neonatal Period Mehmet Demirdo ¨ ven, Esengu ¨ l Keles x, Arzu Gebes xc ¸ e, Hamza Yazgan, Mahmut Kaya, and Alparslan Tonbul Dear Editor: W e wish to report a case of anaphylactic shock in a neonate after intake of cow’s milk–based formula. The infant was a 38-week-gestational age neonate with a prenatal diagnosis of holoprosencephaly. Her birth weight, height, and head circumference were 2,760 g (10th percentile), 50 cm (50–70th percentile), and 32 cm (3–10th percentile), respec- tively. Initial physical examination was remarkable for the presence of hypotonia, relative microcephaly, and mild re- spiratory distress. Postnatal cranial magnetic resonance im- aging confirmed a diagnosis of holoprosencephaly. Initially she was exclusively breastfed. Postnatally she developed polyuria and hypernatremic dehydration second- ary to diabetes insipidus and was treated successfully with vasopressin. On postnatal Day 16 she developed urticaria and shock after the initial feeding of a cow’s milk–based formula. She was treated with intravenous adrenalin, antihistaminics, and dexamethasone and nebulized salbutamol (albuterol) and recovered fully. The infant was subsequently exclusively fed breastmilk, and the mother was placed on a cow’s milk–free diet. Of note is that the mother had a history of atopic dermatitis. Anaphylaxis related to cow’s milk or cow’s milk–based formula milk is a rare event. 1,2 Cantani and Micera 3 sum- marized the experience of 143 infants ranging in age from 1 to 8 months diagnosed as having milk allergy, of which nine exhibited anaphylactic shock. Lifschitz et al. 4 reported a case in a newborn (an 8-day-old infant) of anaphylactic shock due to cow’s milk protein following the use of formula. Tarım et al. 5 reported a 7-week old baby with a history of atopy in his family and who died due to anaphylactic shock after being given partially hydrolyzed formula milk. In this case the patient developed eczema after being given formula milk at the age of 2 weeks. Because the eczema persisted the patient was first given a soy-based formula and then shifted to a partially hydrolyzed formula at 7 weeks of age, when he was admitted to the hospital with cardiac arrest resulting from anaphylaxis and died 21 hours later. Thus in infants who have an atopic family history and suggestive symptoms of cow’s milk allergy (e.g., colic, persistent emesis and/or diarrhea), the possibility of ana- phylaxis to cow’s milk should be considered. An exclusive breastmilk diet from a mother on a cow’s milk–free diet or amino acid–based formula milk is recommended in these situations. 2 References 1. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Im- munol 2014;133:291–307. 2. Luyt D, Ball H, Makwana N, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy 2014;44:642–672. 3. Cantani A, Micera M. Neonatal cow milk sensitization in 143 case-reports: Role of early exposure to cow’s milk formula. Eur Rev Med Pharmacol Sci 2005;9:227–230. 4. Lifschitz CH, Hawkins HK, Guerra C, et al. Anaphylactic shock due to cow’s milk protein hypersensitivity in a breast- fed infant. J Pediatr Gastroenterol Nutr 1998;7:141–144. 5. Tarım O, Anderson WM, Lifshitz F. Fatal anaphylaxis in a very young infant possibly due to a partially hydrolyzed whey formula. Arch Pediatr Adolesc Med 1994;148:1224– 1229. Address correspondence to: Mehmet Demirdo ¨ven, MD Sahil Yolu sok, No. 16 Dragos Maltepe/Istanbul _ Istanbul 34844, Turkey E-mail: mdemirdoven@faith.edu.tr Department of Pediatrics, Fatih University Medical Faculty, Istanbul, Turkey. BREASTFEEDING MEDICINE Volume 10, Number 6, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2015.0065 341