Sudden loss of cow's milk tolerance in a long-sensitized patient

The prevalence of food allergy and anaphylaxis in children is reported to be increasing in recent years. Evidence suggests that exposure to large doses of antigen favors the maintenance of tolerance. We report a case of sudden loss of cow's milk tolerance in a long-sensitized girl with celiac disease after a short period of milkless diet. We hypothesize that the continuous intake of high quantities of antigen sustained tolerance despite high levels of specific IgE and that, in the presence of epithelial barrier dysfunction caused by celiac disease, the few weeks of allergen-free diet led to a rapid loss of tolerance.