REVUE ALGERIENNE D’ALLERGOLOGIE
Volume 10, Numéro 2, Pages 36-46
2026-01-05

Unraveling A Complex Pediatric Food Allergy: Cmpa, Alpha-gal, And Pr-10–mediated Pfas



Authors : Krir Dhouha . Zamali Imen . Galai Yousr . Ben Hmid Ahlem . Ben Sghaier Ines . Nasri Yosra . Kebaier Hayet . Ouni Hajbi . Abdennadher Wassila . Ben Ahmed Mélika . Samoud Samar .

Abstract

Background: Complex pediatric polyallergy often involves overlapping primary sensitizations and cross-reactive pathways, making diagnosis and management challenging. Component-resolved diagnostics (CRD) significantly improves diagnostic accuracy in such settings. Case Presentation: We report a child with an uncommon triple-allergy phenotype combining severe IgE-mediated cow’s milk protein allergy (CMPA), alpha-gal sensitization, and PR-10–mediated pollen–food allergy syndrome (PFAS). CRD performed at ages 3 and 5 revealed persistently high whole-milk and casein-specific IgE levels (up to 78 kUA/L), extensive PR-10 reactivity (rBet v 1, rPru p 1, rMal d 1, rCor a 1, rGly m 4 all >100 kUA/L), and positive α-Gal (3.6 kUA/L). Clinically, the child experienced systemic reactions to cow’s milk, oral allergy syndrome to PR-10–containing foods, and a severe anaphylactic episode after ingestion of yogurt and peach. Management included strict exclusion of cow’s milk and beef and initiation of birch pollen allergen immunotherapy. Follow-up over nine months showed good clinical stability. Conclusion: This case illustrates the pivotal role of CRD in disentangling complex sensitization networks, distinguishing primary food allergy from pollen-driven cross-reactivity, and guiding precision-based management. The coexistence of severe CMPA, PR-10–mediated PFAS, and alpha-gal sensitization underscores the importance of individualized assessment in pediatric polyallergy.

Keywords

Cow’s milk protein allergy ; PR-10–mediated pollen–food allergy syndrome ; Alpha-gal sensitization ; Component-resolved diagnostics ; Cross-reactivity ; Pediatric polyallergy

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