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Home‐based cow's milk reintroduction using a milk ladder in children less than 3 years old with IgE‐mediated cow's milk allergy
Author(s) -
Ball Heidi Britt,
Luyt David
Publication year - 2019
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13366
Subject(s) - medicine , milk allergy , oral food challenge , allergy , anaphylaxis , cow's milk allergy , attendance , pediatrics , food allergy , ingestion , immunology , economics , economic growth
Summary Background The development of tolerance to cow's milk in allergic children is best determined by supervised baked milk exposure. Widely recommended hospital‐based challenges can potentially delay contact because of resource limitations. Objective We sought to determine the efficacy and safety of our low‐dose home‐based reintroduction programme. Methods In our allergy service, children with IgE‐mediated cow's milk allergy who met set criteria (presenting with skin and/or gastrointestinal symptoms only and skin prick test < 8 mm) are considered for home‐based milk reintroduction (HMR). Early contact is low‐dose ingestion of a commercial baked milk biscuit with slow gradual further exposure followed by increasing milk contact using a milk ladder. We retrospectively reviewed 4‐6 monthly attendance records assessing allergic symptoms, evolving milk tolerance, and compliance. Tolerance was determined using a 7 scale scoring system based on the milk ladder. Results The clinic attendance and dietetic contact records of 86 children (49 girls) who underwent HMR were reviewed. HMR was started at a median of 13 months with 49% 8‐12 months, 40% 13‐18 months and 11% 19‐33 months. Allergic symptoms were reported in 81 (43%) of 189 dietetic reviews, 65 (80%) of which were from the milk ladder; no patient experienced anaphylaxis requiring treatment with intramuscular adrenaline. After four reviews, only eight patients were not tolerating almost all dairy products, and there was a high rate of completion with only a further seven patients lost to the programme. Conclusion and Clinical Relevance Cow's milk can be successfully and safely reintroduced in a cautious low‐dose exclusively home‐based programme in the appropriate clinical and family setting.