To determine the clinical and serological characteristics of type I food allergy to cow milk proteins in adults, we investigated all 34 patients (aged from 16 to 58 years) who were diagnosed between 1981 and 1991 to have IgE-mediated reactions to cow milk and cheese. Women represented 91.2 of the study group and 39 of them suffered from the first symptoms during or soon after a pregnancy. So far, 47 of the patients were nonatopic and showed a monovalent sensitization to cow milk proteins. According to RAST results (score ≥ 2) the predominant allergen was casein with a sensitization frequency of 71, whereas sensitization to whey proteins (α-lactalbumin and β-lactoglobulin) in this adult group was rare. In cow milk allergy (CMA) patients, significantly lower levels of milk-specific IgG were observed than in normal controls. The main organ manifestations of CMA in adults were the respiratory tract and the skin, with gastrointestinal and cardiovascular symptoms occurring less often than in children. Only 28 of CMA adults could enjoy an unlimited symptom-free intake of milk products after 4 years of disease. Compared with the existing studies on CMA in children, the results suggest that allergies to cow milk proteins in adults are less frequent and tend to persist longer. They are likely to be misdiagnosed for years due to symptoms that initially often refer to only one organ system such as the respiratory tract. Besides oral provocation tests and RAST, the intracutaneous test of milk/casein is a valuable diagnostic screening tool in adults and an easy way to increase the sensitivity of the skin prick test without losing specificity. Due to a high cross-reactivity between caseins of different animals, an elimination diet in most cases also has to exclude milk products of animal species other than
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