Kim JS et al. - Tolerance of baked milk is a marker of transient IgE-mediated cow’s milk allergy, whereas reactivity to baked milk portends a more persistent phenotype. The addition of baked milk to the diet of children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.Methods
- The authors report on the outcomes of children who incorporated baked milk products into their diets.
- Children evaluated for tolerance to baked milk (muffin) underwent sequential food challenges to baked cheese (pizza) followed by unheated milk.
- Immunologic parameters were measured at challenge visits.
- The comparison group was matched to active subjects (by using age, sex, and baseline milk-specific IgE levels) to evaluate the natural history of development of tolerance.
- Over a median of 37 months (range, 8-75 months), 88 children underwent challenges at varying intervals (range, 6-54 months).
- Among 65 subjects initially tolerant to baked milk, 39 (60%) now tolerate unheated milk, 18 (28%) tolerate baked milk/baked cheese, and 8 (12%) chose to avoid milk strictly. Among the baked milk–reactive subgroup, 2 (9%) tolerate unheated milk, and 3 (13%) tolerate baked milk/baked cheese, whereas the majority (78%) avoid milk strictly.
- Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk–reactive subjects.
- Subjects who incorporated dietary baked milk were 16 times more likely than the comparison group to become unheated milk tolerant.
- Median casein IgG4 levels in the baked milk–tolerant group increased significantly; median milk IgE values did not change significantly.