Outcomes of 109 Consecutive Open Food Challenges to Extensively-Heated (baked) Milk

Rationale: Cow milk (CM) is one of the most common food allergens among children. Majority of milk-allergic children tolerate baked-milk.  In a process of acquiring tolerance to unheated milk, higher doses of less extensively baked foods with milk are being tolerated. Additionally, regular ingestion of baked-milk may accelerate development of tolerance to unheated milk products.

Methods: Open OFCs to muffin and pizza conducted at a food allergy referral center were reviewed.  OFCs were undertaken based on allergists’ interpretation of history, results of allergy testing and family preference.  OFC to pizza was offered to those already tolerating muffins.

Results: Of 85 children challenged to muffin, 16 (18.8%) developed allergic symptoms; 1 (6.3%) received epinephrine.  Average serum CM-specific IgE levels [kIU/L] of those who passed and failed muffin were 4.24 (95% CI, 3.01 – 5.47) and 8.14 (95% CI, 4.66 – 11.61), p <0.05.  Average CM-skin prick test wheal diameters of those who passed and failed muffin were 7.3 mm (95% CI 6.7 – 8.1) and 8.1 mm (95% CI 6.1 – 10.1), p > 0.40.  Of 23 children challenged to pizza, 2 (8.7%) developed allergic symptoms; none received epinephrine.  Average serum CM-specific IgE levels for those who passed and failed were 6 and 4.1 kIU/L.  Average CM-skin prick test wheal diameters of those who passed and failed were 9.9 mm and 8.5 mm.

Conclusions: The majority of milk-allergic children tolerate baked-milk in a form of a muffin and many tolerate pizza. Physician-supervised, office-based baked-milk challenges are safe and generally well tolerated by milk-allergic children.