Primary Immunodeficiency May Be Misdiagnosed as Cow’s Milk Allergy: Seven Cases Referred to a Tertiary Pediatric Hospital

Table 1

Main clinical manifestations and laboratory tests of children studied.

Patient	P1	P2	P3	P4	P5	P6	P7
Gender	M	M	M	F	M	M	M
Age—onset of symptoms	1 mo	1 mo	1 mo	2 mo	2 mo	3 mo	1 mo
Age—diagnosis of PID	6 y 5 mo	3 mo	6 mo	7 mo	11 mo	1 y 11 mo	4 mo
Clinical features of PID	Eczema; Pneumonias; Septicemia; Lung abscess	Eczema; Pneumonias; Meningitis; Septicemia	Eczema Pneumonias; Petechia Meningitis; Chronic diarrhea; Bloody diarrhea; Septicemia	Eczema; Severe diarrhea Anal abscess; Septicemia	Pneumonias Diarrhea Septicemia; Failure to thrive	Eczema; Pneumonia; Diarrhea; Failure to thrive	Neonatal septicemia; Bloody diarrhea
Signs of suspicion of CMA	Eczema	Generalized eczema	Vomiting; Eczema	Generalized eczema; Severe diarrhea	Diarrhea; Failure to thrive Gastroesophageal reflux	Eczema; Failure to thrive	Bloody diarrhea
Eosinophils/; 𝜇L	747	15872	742	170	880	159	366
Neutrophils/; 𝜇L	1460	4464	6360	5780	704	4526	6100
IgG (g/L)^*	6.85 (nl)	0.59 (<p3)	6.26 (nl)	22.10 (>p90)	0.19 (<p3)	0.78 (<p3)	1.46 (<p3)
IgM (g/L)*	0.73 (nl)	0.18 (<p3)	0.2 (<p10)	0.86 (nl)	0.47 (nl)	0.14 (<p3)	0.51 (nl)
IgA (g/L)*	0.12 (nl)	0.12 (nl)	3.17 (>p90)	1.86 (nl)	0.03 (<p3)	0.03 (<p3)	0.06 (<p3)
IgE (IU/mL)	13000	>3000	>2000	<1.5	<2	<1	3.62
S-IgE to cow’s milk	Negative	NA	NA	Negative	Negative	Negative	Negative
CD3/𝜇L	2284 (nl)	597 (<p10)	827 (<p10)	4918 (>p90)	3164 (nl)	2050 (>p90)	3382 (nl)
CD4/𝜇L	1244 (nl)	562 (<p10)	682 (<p10)	3747 (nl)	2015 (nl)	808 (<p10)	2541 (nl)
CD8/𝜇L	967 (nl)	21 (<p10)	123 (<p10)	1051 (nl)	918 (nl)	1061 (nl)	658 (nl)
CD19/𝜇L	NA	35 (<2%)	NA	NA	1994 (nl)	37 (<2%)	972 (nl)
Other tests	—	—	—	DHR	CD40L expression	—	—
PID diagnosis	HIES	SCID	WAS	CGD	CD40L deficiency	XLA	Hypogammaglobulinemia

∗Immunoglobulin levels: values compared to age-matched controls; p10, p90: 10th, 90th percentiles of age-matched reference value; nl: normal value; NA: not available; DHR: dihydrorhodamine test.