Serum albumin sensitization in children with cow's milk allergy: Clinical relevance to red meat reactions.

INTRODUCTION: Sensitization to serum albumins (SAs) in cow's milk allergy (CMA) may contribute to red meat (RM) allergy. This study evaluated the prevalence of SA sensitization, patterns of cross-sensitization, and clinical relevance to RM allergy in children with CMA. METHODS: Seventy children with CMA (58 current, 12 resolved) who underwent multiplex microarray testing were assessed for allergen sensitization profiles and reported reactions to RM. RESULTS: Bos d 6 sensitization was identified in 61.4% of patients, and 18% had been advised to avoid RM. Among Bos d 6-sensitized patients, 39.5% were monosensitized. Co-sensitization rates were 46.5% for Sus s 1, 25.5% for Equ c 3, 23.2% for Fel d 2, and 16.2% for Can f 3. A strong correlation was observed between Bos d 6 and Sus s 1 (r = .79), with moderate correlations to Equ c 3 and Can f 3. Hierarchical clustering grouped Bos d 6 with Sus s 1, Equ c 3, and Can f 3. While milk allergen sensitization decreased in the resolved-CMA group, Bos d 6 persisted in some patients. Although all children tolerated well-cooked RM, 10% reported allergic reactions via various exposure routes, including one patient with resolved-CMA. All RM-reactive patients were sensitized to Bos d 6. CONCLUSIONS: Bos d 6 sensitization is common in children with CMA, yet clinical reactivity to RM is infrequent. Cultural and culinary practices may shape exposure and symptom expression, though avoidance behaviors remain common. Integrating allergen profiles into clinical care may guide risk stratification/avoidance recommendations.