Methods: 126 patients challenged to BM from 2009-2011 were reviewed. OFC success was defined as consumption of ¼ cup BM. Logistic regression was performed utilizing milk-IgE level (log-transformed), age, gender, duration of follow-up, and OFC outcome to determine predictors of subsequent milk intake.
99 patients (4 months-18 years) old were included. Median duration of follow-up was 51 months (range 1.9-85 months). 65% passed the BM OFC. Among those failing, 91% were permitted to introduce specified quantities of BM. Of those passing, 75% progressed to unlimited BM or more, 61% advanced to baked cheese or more, and 38% advanced to direct milk, compared to 48%, 40%, and 26% of those failing the BM challenge (p=0.004,0.046, and 0.234, respectively).
Milk-IgE was significantly associated with OFC outcome (OR 0.19, p=0.001) and progression to unlimited BM (OR 0.35, p=0.046) or baked cheese (OR 0.38, p=0.05) but not direct milk (OR 0.96, p=0.16). Patients with milk-IgE >10kU/l were less likely to tolerate unlimited BM (10% vs. 54%, p=0.015), baked cheese (8% vs. 45%, p=0.04), or direct milk (4% vs. 29% p=0.06). Gender, duration of follow-up, and age were not significant predictors.
Conclusions: OFC outcome and milk-IgE were the most important predictors of persistent tolerance to BM or more concentrated forms of milk.