Objective: There is limited knowledge regarding the long-term outcomes of milk allergic patients who tolerate baked milk (BM) products. We evaluated the long-term safety and efficacy of this intervention.
Study design: Children with IgE-mediated milk allergy underwent an oral challenge with BM. In six months, those who tolerated BM were then challenged with baked cheese pizza (BC). Six months after that, the patients who tolerated BC underwent a challenge with unheated milk (UM).
Results: 85 children (median 5.2 years; range 15 months to 15 years) were prospectively followed for a median of 29 months (range 15-50 months). Fifteen (18%) reacted to the initial BM challenge, including mild reactions in 12 and only 3 had anaphylaxis. Among 70 (82%) children who initially tolerated BM challenge, 26 (37%) tolerated unheated milk at last follow up, 16 (23%) tolerated BM/BC and 25 (36%) avoided all forms of milk despite successful initial BM/BC challenges. Three patients (4%) were lost to follow-up. Predictive parameters of reactivity to initial BM challenge include age (median - 7; range 2.5-15 years vs. 3.5; range 1-14.5 years; P= 0.02), asthma (53% vs. 14.3%, P< 0.01) and a larger SPT to casein (median 14; range 8-28 mm vs. 6; range 0-18 mm; P<0.01)
Conclusions: For most of our patients, ingestion of BM was found to be safe and well tolerated. However, initial successful challenge with BM/BC does not always guarantee ongoing consumption of these products. Better predictors of response are needed to provide guidance for patient selection and improved long-term outcomes.
