Allergy to topical and oral goat products

To the Editor: A woman was assessed after an episode of goat cheese anaphylaxis. She had been using goat milk soap (various brands) to treat dry skin and mild eczema since 2009. In 2010, she experienced itchy mouth while eating goat cheese, and later in the year, she had contact urticaria after applying goat milk moisturiser (use discontinued). In early 2011, she developed tongue and throat swelling after eating goat and sheep cheese. Similar symptoms developed in late 2011 after she ate fetta cheese (animal origin uncertain). In early 2012, she experienced generalised urticaria, upper airway angioedema, bronchospasm and confusion after she accidentally ate goat cheese, requiring treatment with adrenaline. Although she tolerated dairy products, the results of skinprick testing were positive for cows milk (8 mm weal), as well as for 10% weight/volume freshly prepared extracts in saline of goat cheese (8 mm weal), sheep fetta (7 mm weal), cow ricotta cheese (3 mm weal) and goat milk soap (4 mm weal), in the context of appropriate control substances (saline solution used as a negative control; 10 mg/mL histamine solution used as a positive control).