The Risk of Failing Oral Food Challenge to Baked Egg and Milk Increases with Wheat Flour Replacers

Rationale: Eating baked egg (BE) and milk (BM) proteins hastens outgrowing the respective allergies. To determine the effects of wheat on BE and BM tolerance in vivo, we studied the outcomes of oral food challenges (OFCs) to BE and BM.

Methods: A 3-year retrospective chart review was performed in 139 egg (mean age 5.9y, range 0.86-16.75y) and 81 milk (mean age 6.79y, range 0.72-16.56y) allergic children. Children were sensitized to egg or milk by skin test and/or specific IgE. The effect of wheat flour versus wheat replacer (rice flour) on OFCs to BE and BM was assessed.

Results: In egg allergic children, 27.5% (33/120) failed OFC to BE muffins containing wheat flour, compared to 57.9% (11/19) challenged with muffins containing rice flour. In milk allergic children, 13.6% (9/66) failed OFC to BM with wheat, compared to 35.7% (5/14) with rice flour. After adjusting for age, gender, and atopic dermatitis, the odds ratio (OR) of failing OFC to BE without wheat was 5.4 (1.87, 16.81; p=0.002) compared to BE with wheat. The OR of failing an OFC to BM without wheat was 4.06 (1.01, 16.14; p=0.05). Absence of atopic dermatitis (AD) independently increased the risk of reaction to BE with an OR of 3.7 (1.66,8.49; p=0.001), but not to BM.

Conclusions: Children who pass OFC to BE or BM with wheat flour are at risk for reacting to baked goods made with non-wheat flours. Absence of AD alone increases the risk of reaction to BE, independent of the flour used.