Dietary baked milk may help improve tolerance in children with dairy allergy
MedWire News: Long-term dietary inclusion of extensively baked milk products may help children with cow's milk allergy to resolve their condition, say US researchers.
"This study shows that many children with allergies do not need to completely avoid all milk products," said Anna Nowak-Wegrzyn from Mount Sinai School of Medicine in New York.
"It's also an encouraging sign that through careful medical supervision, children can grow out of their allergies much quicker."
As reported in the Journal of Allergy and Clinical Immunology, the team recruited 88 children (aged 2.1 to 17.3 years) with cow's milk allergy to undergo tolerance testing for baked-milk products. This was accomplished by consumption of food containing baked milk, which in this case was a muffin containing 1.3 g of milk protein.
Of the 88 children who underwent the initial test, 65 were found to be tolerant to baked milk, whereas 23 were not. Tolerant children were told to continue including baked-milk products such as muffins, cakes, and cookies in their diet at least 1-3 times a day.
Children who were intolerant were told to avoid milk products altogether, but were offered the chance to undergo another baked-milk tolerance test 6 months later. Five children passed the test the second time round.
After 6-12 months, the children who were baked-milk tolerant were offered a baked-cheese tolerance test. This involved consumption of cheese pizza containing 4.6 g of milk protein and subsequent consumption of baked-cheese products 4-7 times weekly if tolerant. If intolerant, the children continued to eat baked-milk products and tried the baked-cheese test again 6-12 months later.
Finally, after a further 6-12 months (median 37 months in total) the children who were tolerant to baked-milk and baked-cheese products underwent a tolerance test to unheated skimmed milk (8-10 g milk protein per serving).
Of the initial 65 children in the baked-milk tolerant group, 39 (60%) are now able to tolerate unheated milk, 18 (12%) tolerate baked milk/cheese, and 8 (12%) chose to avoid milk entirely.
In contrast, of the 23 children who were initially intolerant to baked-milk, 2 (9%) tolerate unheated milk, 3 (13%) tolerate baked milk/cheese, and 18 (78%) avoid milk entirely.
Of note, the researchers also included a control group of 60 children with cow's milk allergy who did not undertake the graduated tolerance tests and had standard clinical care for children with allergies. In this group, the probability of having tolerance to unheated milk after 60 months was 33% compared with 76% in the overall intervention group.
Interestingly, when divided by initial tolerance to baked-milk products, the probability of tolerance to unheated milk at 60 months in intervention-group participants was 80% in the tolerant group versus 24% in the intolerant group, suggesting that having tolerance to baked milk is a good sign that childhood cow's milk allergy may resolve itself.
"While we need to continue our research to determine how to best apply these results to the clinical setting, these data are an exciting step towards our ultimate goal of finding curative therapies for food allergies," said Nowak-Wegrzyn.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Helen Albert