Anaphylaxis to cow's milk protein in a probiotic not detected by the electronic medical record

A 13-year-old female with a history of congenital left lower leg lymphedema, multiple food allergies, including an immunoglobulin E mediated severe cow's milk allergy, and well-controlled moderate persistent asthma was hospitalized with left lower leg erysipelas and Group A Streptococcus septicemia. While hospitalized, immediately after exposure to cow's milk protein as an inactive ingredient within a probiotic, she developed anaphylaxis with respiratory failure requiring intubation. This is only the third reported case of anaphylaxis due to a probiotic. Additionally, it raises issues inherent to the electronic medical record with respect to its inability to identify allergens in supplements as opposed to medications.