In Reply.—It is clear that cow's milk has the potential to contribute to respiratory symptoms by both immunologic and nonimmunologic mechanisms. The former are accurately designated as allergy, although misuse of this term has made it nearly useless.1 Clinical experience suggests that nonimmunologically mediated adverse reactions are important, and we and others currently are studying possible mechanisms to explain these reactions. However, Bahna and Heiner2 emphasize the need for caution in diagnosing allergic (or other adverse) reactions to cow's milk lest "overzealousness" obscures appropriate diagnosis and treatment. A rational approach to the possibility of adverse reactions to foods has been outlined and certainly hinges on double-blind challenges.3
The role of cow's milk—induced respiratory symptoms was considered in many of the patients we described.4 None who had undergone immediate hypersensitivity skin testing had positive responses to cow's milk, and none had been noted to have a
SMITH TF. Cow's Milk Allergy-Reply. Am J Dis Child. 1986;140(4):330. doi:10.1001/archpedi.1986.02140180064024
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