{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:07Z","timestamp":1760059987394,"version":"build-2065373602"},"reference-count":60,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical Research Council UZ Leuven (KOOR)","award":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"],"award-info":[{"award-number":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"]}]},{"name":"Fund for Scientific Research Flanders (FWO)-TBM program","award":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"],"award-info":[{"award-number":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"]}]},{"name":"KU Leuven Special Research Fund","award":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"],"award-info":[{"award-number":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"]}]},{"DOI":"10.13039\/501100003130","name":"FWO senior clinical investigator fellowship","doi-asserted-by":"publisher","award":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"],"award-info":[{"award-number":["T000623N","BOF-FKO","CM23-FKO-02","1805523N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Cow\u2019s milk allergy (CMA) is the most common food allergy in children, typically resolving by adolescence. In contrast, the clinical spectrum of allergies to non-cow mammalian milk and their patterns of IgE cross-reactivity are less well documented. Nutritional differences between various mammalian milks may also impact dietary management in milk-allergic patients. Objectives: To characterize clinical features, onset age, and IgE cross-reactivity patterns of non-cow mammalian milk allergies in adult patients seen at a tertiary allergy center, and to compare these findings with published cases. Methods: A retrospective analysis of patients included in the \u201cExtended Laboratory Investigation for Rare Causes of Anaphylaxis study\u201d with mammalian milk allergy was performed using clinical history, skin testing, and serum-specific IgE measurements. Cross-reactivity patterns were assessed in selected cases using immunoblotting, specific IgE inhibition, and basophil activation testing, and compared with published reports of non-cow mammalian milk allergy. Results: In our case series of 22 patients with mammalian milk allergy and 10 healthy control subjects, 3 patients were identified with isolated adult-onset non-cow mammalian milk allergy (n = 1 buffalo milk; n = 2 mare milk), confirmed via immunoblotting and basophil activation testing. Streptavidin-based specific IgE measurement for buffalo cheese was positive in the buffalo milk allergic patient. The literature review identified 82 cases of non-cow mammalian milk allergy. These cases typically showed late onset (mean age 8.6 years; range 1\u201370 years), severe reactions (CoFAR (Consortium for Food Allergy Research) grade 3 or 4 in 66%, and one fatality), and selective sensitization (affecting sheep and\/or goat, camel, mare, buffalo, donkey, or combinations thereof in 56, 10, 5, 5, 4, and 2 cases, respectively). Conclusions: Non-cow mammalian milk allergies are rare but generally present later in life with selective IgE cross-reactivity, differing from the broader cross-reactivity observed in CMA. This selectivity may allow for safe dietary alternatives. These findings underscore the need for improved diagnostics and personalized dietary management in this patient population.<\/jats:p>","DOI":"10.3390\/nu17152393","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T13:35:28Z","timestamp":1753191328000},"page":"2393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Belgian Case Series Identifies Non-Cow Mammalian Milk Allergy as a Rare, Severe, Selective, and Late-Onset Condition"],"prefix":"10.3390","volume":"17","author":[{"given":"Sophie","family":"Verelst","sequence":"first","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of Pediatrics, Jessa Hospital, 3500 Hasselt, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robbe","family":"Sinnesael","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Firoz","family":"Ta\u00efbi","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Tuyls","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of General Internal Medicine, Allergy and Clinical Immunology, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lieve","family":"Coorevits","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Breynaert","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of General Internal Medicine, Allergy and Clinical Immunology, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4595-9579","authenticated-orcid":false,"given":"Dominique","family":"Bullens","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rik","family":"Schrijvers","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Division of General Internal Medicine, Allergy and Clinical Immunology, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jaci.2017.11.003","article-title":"Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management","volume":"141","author":"Sicherer","year":"2018","journal-title":"J. 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