RATIONALE: Baked milk challenges and milk ladders (ML) are currently recommended to determine the development of tolerance to baked milk in children with IgE and Non-IgE-mediated Cow’s Milk Allergy (CMA). However, there is still relatively little known about the parental perceptions of the gradual reintroduction of baked milk. This is the first qualitative study to explore parents’ experiences, understanding and their level of satisfaction in using milk in baked goods and the impact/outcomes of these products in the management of their children’s milk allergy.
METHODS: Twenty two semi-structured individualised phone interviews were conducted with mothers (UK residents) of children (n=7; IgE-mediated CMA and n=15; Non-IgE-mediated CMA, 15months-8years) who followed or completed a ML (recruited via social networking sites and analysed using thematic analysis).
RESULTS: It emerged that mothers of children following the ML experienced: 1)Confusion when there was not an explicit nationally recommended ML that all healthcare professionals (HCPs) adhere to. 2)Restricted healthcare support due to limited communication between parents and HCPs/lack of counselling or follow ups. 3)Dissatisfaction with the lack of healthy food choices or alternative food options in each stage of the ML. 4)Concerns about how to recognize potential symptoms of a baked milk reaction. 5)Uncertainty regarding the time spent on each stage of the ML. 6)Insecurity around home reintroduction in case of severe reaction.
CONCLUSIONS: Gradual milk reintroduction is usually a long process and mothers need an improved ML based on national recommendation, and local healthcare support, to ensure the efficacy and safety of this process.