Baked Milk Oral Food Challenges Research Articles

Severity and presentation of allergic reactions during baked milk oral food challenges

Severity and presentation of allergic reactions during baked milk oral food challenges

Predicting Outcomes of Baked Egg and Baked Milk Oral Food Challenges Using a Ratio of Food-Specific IgE to Total IgE

Food-specific IgE (sIgE) and skin prick tests are used to risk-stratify patients for oral food challenges (OFCs). More accurate predictors are needed. Our objective was to evaluate the ratio of sIgE to total IgE (tIgE) (the “Ratio”) as a predictor of outcomes for OFCs to baked egg and baked milk and to determine if the Ratio better predicts the outcome of OFCs compared with sIgE alone. Data from all OFCs to baked (extensively-heated) egg and baked milk from January 2010 until January 2016 were reviewed for pre-challenge sIgE and tIgE, post-challenge outcome, and severity of reaction in failed challenges. The Ratio was calculated for egg white, ovomucoid, and milk and assessed as a predictor of OFC outcome with receiver operator characteristic (ROC) curves. The pre-challenge Ratios of egg white and milk were significantly higher in failed challenges as compared to passed challenges, 1.19% vs. 0.71% (p=0.02) for baked egg, and 3.68% vs. 0.75% (p=0.02) for baked milk. The Ratio for ovomucoid was not significantly higher in failed as compared to passed challenges for baked egg, 0.50% vs. 0.44%, (p=0.47). When assessing ROC curves, the Ratio did not perform significantly better than sIgE alone in predicting challenge outcome for egg white, 0.62 vs 0.68 (p=0.24), ovomucoid 0.54 vs. 0.58 (p=0.55), or milk 0.73 vs 0.69 (p=0.70). The Ratios for egg white and milk were predictive of outcomes of baked egg and baked milk challenges, respectively; however, the Ratio was not more predictive than sIgE alone.

Predicting outcomes of baked egg and baked milk oral food challenges by using a ratio of food-specific IgE to total IgE

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Delayed and Severe Reactions to Baked Egg and Baked Milk Challenges

Although many egg- and milk-allergic children tolerate baked egg (BE) and baked milk (BM), reactions elicited by these oral food challenges (OFCs) can be severe. Previous studies comparing BE and BM reactions to other OFC reactions are limited. To compare the clinical features of reactions to BE and BM with other OFCs to promote challenge safety. A retrospective review of OFCs eliciting objective reactions to BE, BM, lightly cooked egg (CE), fresh cow's milk (CM), peanut (PN), and tree nuts (TN) which were performed at a tertiary referral center from June 1, 2017, to June 1, 2019. We identified 174 OFCs conducted in 158 subjects, age 6 to 187 months (34 BE, 19 BM, 14 CE, 25 CM, 52 PN, and 30 TN). TN reactors were older than BE (P= .049) and PN (P < .01) reactors and had a higher frequency of persistent asthma than PN-reactive subjects (P= .02). Mucocutaneous symptoms occurred less frequently during BE (56%) and BM (42%) OFCs compared with other OFCs (P < .05). Lower respiratory tract reactions were increased during BM (37%) versus BE (12%), CM (8%), and PN (12%) OFCs (P < .05). Epinephrine was administered to more BE (44%) and TN (50%) than PN (17%) OFCs (P < .01). New reaction manifestations developed 60 minutes or later after OFC termination during 29% BE and 21% BM versus 0% PN OFCs (P < .05). One-third of anaphylactic reactions to BE began more than 60 minutes after OFC termination. BE and BM challenge reactions differed phenotypically from other OFC reactions, including significantly increased frequencies of new symptoms beginning 60 minutes or later after challenge termination. Consider amended dose-escalation and prolonged observation after BE and BM OFCs.

Delayed Anaphylaxis to Baked Egg and Baked Milk Oral Food Challenges

Delayed Anaphylaxis to Baked Egg and Baked Milk Oral Food Challenges

LONG TERM TOLERANCE OF MILK IN ALLERGIC PATIENTS UNDERGOING BAKED MILK FOOD CHALLENGES

Introduction Many cow's milk allergic children can tolerate extensively heated forms milk. Tolerating baked milk products can even accelerate tolerance to less heated milk. The aims of this study are to follow-up patients who tolerated baked milk oral food challenges (BMC) and characterize their tolerance of less heated forms of milk. Methods We performed retrospective chart reviews of milk allergic patients who visited our pediatric allergy clinic from January 2008 to December 2017 and passed BMCs to muffin. We characterized their progression to lesser (un)heated milk products. Results Preliminary data demonstrates approximately 77 % of milk-allergic patients continued to tolerate baked products for at least 1 year after their BMC. 44% of subjects who passed a BMC and introduced baked milk at home ultimately tolerated unheated milk within the time frame of the study. Baked milk tolerant patients required a median of 36 months (IQR 38.5-37) to progress towards tolerance of unheated milk. Consumption of baked products after the BMC was not associated with severe symptoms including respiratory distress or anaphylaxis. Mild symptoms noted with ingestion of baked milk included oral itching, localized hives, and/or abdominal pain. Conclusions Overall, preliminary results confirm consuming baked products at home after challenges is safe, with minimal risk of severe reaction. Tolerance to lesser/ unheated milk is likely to be achieved if baked products are regularly kept in the diet.

Baked Milk Oral Food Challenges: A Single-Center Pediatric Hospital Experience

Baked Milk Oral Food Challenges: A Single-Center Pediatric Hospital Experience

Dietary Baked Milk Accelerates the Resolution of Cow’s Milk Allergy in Children

To evaluate outcomes of children with cow’s milk allergy that incorporate extensively heated (baked) milk products into the diet.Eighty-nine subjects aged 0.5 to 21 years were recruited from a large academic pediatric allergy clinic. Subjects were diagnosed with milk allergy based on a positive skin prick test (SPT) or detectable serum milk-specific immunoglobulin (Ig) E and history of allergic reaction to milk. Subjects were also included if milk-specific IgE or SPT responses were >95% of predicted value for clinical reactivity.Subjects underwent an initial baked milk oral challenge with a muffin containing 1.3 g of milk protein baked at 350°F for 30 minutes. Subjects who were reactive to baked milk (n = 23) were instructed to completely avoid all forms of milk and were offered a repeat challenge ≥6 months from the initial challenge. Patients who were tolerant to baked milk (n = 65) were instructed to incorporate baked milk products daily into their diets. After ≥6 months, these patients were offered challenges to baked cheese products (cheese pizza with 4.6 g of milk baked at 425°F for >13 minutes). After 6 months of tolerating baked cheese, subjects were offered challenges to unheated milk. A historical comparison group of subjects who fulfilled the inclusion criteria but were not initially ingesting baked milk was included. Serum samples were collected for measurement of IgE and IgG4 antibodies to milk, casein, and beta-lactoglobulin. All food challenges were performed openly.Challenges were conducted over a median of 37 months (range: 8–75 months). In the group of 65 subjects initially tolerant to baked milk, 39 (60%) now tolerated unheated milk. Over the same time period, 2 (9%) of the 23 subjects who were originally reactive to baked milk tolerated unheated milk. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk–reactive subjects (P < .001). Subjects who introduced dietary baked milk were 16 times more likely than comparison group subjects to become unheated milk tolerant (P < .001). Median casein IgG4 levels in baked milk–tolerant group increased significantly (P < .001), but median milk IgE values did not change significantly.Tolerance of baked milk suggests a transient IgE-mediated cow’s milk allergy. The addition of baked milk to the diet in children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.This and other supportive studies now suggest a change to the mantra of strict avoidance of known food allergens for a subset of foods. For milk-allergic patients, allergists can now offer baked milk oral food challenges with the hope of accelerating clearance of their food allergy. Additional studies directed at determining which patients would be at increased risk for reacting to a baked milk challenge would be helpful because those reacting sometimes experience anaphylaxis.