Findings from an NIAID-supported study, appearing online ahead of print in the May 23 issue of the Journal of Allergy and Clinical Immunology, show that feeding some children with milk allergy foods containing baked milk may help them outgrow their allergy at a faster rate than those who do not eat baked milk.
Allergy to cow's milk is one of the most common food allergies found in the United States. It cannot be prevented, and the only way to manage the condition is to avoid milk and treat symptoms as they arise.
Investigators led by Hugh A. Sampson, M.D., professor of pediatrics, dean for translational research, and director of the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York, are working to enable patients to tolerate milk without having allergic reactions by having them consume—rather than avoid—allergenic foods. To help some people outgrow their allergies, Dr. Sampson's team uses a form of oral immunotherapy in which a person eats increasing amounts of an allergenic food that has been baked to break down (denature) the proteins causing the allergy.
Previously, members of Dr. Sampson's team observed that children who are allergic to milk fell into two groups: some children were able to eat products that contained baked milk without having an allergic reaction, whereas other children did have an allergic reaction. But the long-term clinical effects of incorporating baked milk into a child's diet were unknown.
Results of Study
Dr. Sampson's group studied 88 children, ages 2 to 17 years old, with diagnosed milk allergy over a period of four to five years. The researchers initially gave the children a plain muffin containing baked milk. Among the 88 children, 65 ate the muffin without experiencing any allergic reactions. Parents of children who passed the muffin test were given guidance on how to incorporate baked milk into their children's diet. Children who reacted to the muffin continued avoiding foods containing milk.
For the next 6 to 12 months, the children who passed the initial muffin test ate food containing baked milk, such as muffins, cookies, or cake, following specific guidance from dieticians on Dr. Sampson's team. These children returned to the clinic for a second food test and at that point were given cheese pizza to determine if they could tolerate baked cheese. Fifty-seven of the 65 children ate the pizza without having an allergic reaction and were then able to begin incorporating baked cheese along with baked milk into their diets.
Children who could eat muffins and pizza were given regular amounts of food containing baked milk over an average of about three years. The children were then tested again, this time to determine if they could tolerate cold skim milk, yogurt, or ice cream. Of the children who passed the initial muffin test, 60 percent were able to consume these additional foods without having an allergic reaction. In addition, controlled exposure to the baked milk products appeared to accelerate the rate at which allergic children outgrew their allergies to milk in uncooked forms.
The results of this study indicate that if a child with a known milk allergy passes a baked milk challenge, he or she may outgrow the milk allergy much more rapidly than a child who does not pass the test.
Milk allergy is one of the food allergies that children outgrow as they age. Although many children can tolerate milk by age 5, milk allergy can last until age 16. Findings made by Dr. Sampson's team indicate that eating baked milk can reduce the time it takes to outgrow milk allergy.
Dr. Sampson strongly cautions that this type of food challenge should not be performed without strict guidance from a trained health specialist. The investigators observed that children who do not pass a baked milk test often experience much more severe allergic reactions than children who do, and it is nearly impossible to predict which children will have such a reaction.
Participants in this clinical study also received very specific instructions regarding what products could be eaten at home.
The take-home message from the study is that children with milk allergy should see their healthcare professional and be given a baked milk test to determine if they are likely to outgrow milk allergy and are able to safely follow a baked milk diet similar to the one developed by Dr. Sampson's team.
Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of milk allergy in children. J Allergy Clin Immunol. 2011 May 23 [Epub ahead of print].