Sir.—I was disappointed that chronic bronchitis induced by cow's milk allergy was not mentioned in the article by Smith et al.1I noted that 12 of the 20 children reported in the article developed onset of symptoms in the first year of life. In a study of asthma and cow's milk allergy, Brasher2 noted a very high incidence of cow's milk allergy in infantile asthma. In that study, improvement was noted in all children 6 months of age or younger after cow's milk was eliminated from their diet. It has been my impression that this diagnosis is frequently missed, even by allergists. Cow's milk allergy is frequently not associated with a positive skin test or a positive radioallergosorbent test to cow's milk. This diagnosis is best established by infant feeding history, family history, and evaluation by challenge, elimination, and rechallenge with cow's milk.3-5 The most comprehensive
PFUETZE BL. Cow's Milk Allergy. Am J Dis Child. 1986;140(4):330. doi:10.1001/archpedi.1986.02140180064023
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