Long-Term Follow-Up After Baked Milk Introduction

Joan H. Dunlop, Corinne Keet, Kim Mudd, Robert A Wood

Research output: Contribution to journalArticle

Abstract

Background: Clinical trials of baked milk (BM) introduction have demonstrated accelerated resolution of milk allergy. Objective: Long-term data regarding real-world introduction of BM are lacking. We sought to characterize our experience of BM introduction. Methods: We performed a retrospective chart review of consecutive BM oral food challenges performed in our clinic from 2009 to 2014, with a minimum follow-up of 24 months. Results: Of the 206 patients challenged, 99 (48%) passed and 187 were sent home with detailed instructions to incorporate BM into their diets. After a median of 49 months of follow-up, 43% of the 187 had progressed to direct milk, 20% to less-cooked forms of milk, 10% remained ingesting BM, and 28% were strictly avoiding milk. Higher milk IgE levels were associated with decreased odds of passing a BM challenge and advancing to less-cooked forms of milk. Predictors of progressing to less-cooked forms of milk were passing the challenge and younger age. There were 79 reported milk reactions involving 68 patients (33% of total) during follow-up. Of these, 78% were classified as mild, 14% severe, and 6 patients developed eosinophilic esophagitis. Of 11 severe reactions, 4 were accidental exposures, 3 were planned escalations, and 4 occurred with previously tolerated doses. Conclusions: The majority of patients who underwent a BM challenge, including those who failed their challenge, were able to progress to direct or less-cooked forms of milk. However, adverse reactions were common, and even a successful BM challenge does not guarantee future tolerance of BM or preclude later reactions, even to previously tolerated doses.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StateAccepted/In press - Jan 1 2018

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Milk
Eosinophilic Esophagitis
Milk Hypersensitivity
Immunoglobulin E

Keywords

  • Baked milk
  • Milk allergy
  • Oral food challenge

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Long-Term Follow-Up After Baked Milk Introduction. / Dunlop, Joan H.; Keet, Corinne; Mudd, Kim; Wood, Robert A.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Clinical trials of baked milk (BM) introduction have demonstrated accelerated resolution of milk allergy. Objective: Long-term data regarding real-world introduction of BM are lacking. We sought to characterize our experience of BM introduction. Methods: We performed a retrospective chart review of consecutive BM oral food challenges performed in our clinic from 2009 to 2014, with a minimum follow-up of 24 months. Results: Of the 206 patients challenged, 99 (48{\%}) passed and 187 were sent home with detailed instructions to incorporate BM into their diets. After a median of 49 months of follow-up, 43{\%} of the 187 had progressed to direct milk, 20{\%} to less-cooked forms of milk, 10{\%} remained ingesting BM, and 28{\%} were strictly avoiding milk. Higher milk IgE levels were associated with decreased odds of passing a BM challenge and advancing to less-cooked forms of milk. Predictors of progressing to less-cooked forms of milk were passing the challenge and younger age. There were 79 reported milk reactions involving 68 patients (33{\%} of total) during follow-up. Of these, 78{\%} were classified as mild, 14{\%} severe, and 6 patients developed eosinophilic esophagitis. Of 11 severe reactions, 4 were accidental exposures, 3 were planned escalations, and 4 occurred with previously tolerated doses. Conclusions: The majority of patients who underwent a BM challenge, including those who failed their challenge, were able to progress to direct or less-cooked forms of milk. However, adverse reactions were common, and even a successful BM challenge does not guarantee future tolerance of BM or preclude later reactions, even to previously tolerated doses.",
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