Food, drug, insect sting allergy, and anaphylaxisDietary baked milk accelerates the resolution of cow’s milk allergy in children
Section snippets
Participants
Subjects were recruited from the Mount Sinai pediatric allergy clinics from June 2004 to October 2007. The study was approved by the Mount Sinai Institutional Review Board, and informed consent was obtained. Eligible subjects were aged 0.5 to 21 years, had positive skin prick test (SPT) responses or detectable serum milk-specific IgE, and had a history of an allergic reaction to milk within 6 months before study entry or milk-specific IgE levels or SPT responses greater than 95% of predicted
Unheated milk tolerance within the active group
Eighty-nine children (median age, 6.6 years; range, 2.1-17.3 years) were enrolled17; 1 subject was not followed beyond baseline. Over a median of 37 months (range, 8-75 months), 88 children were challenged to progressively less heated forms of milk at varying intervals (range, 6-54 months). Among 88 “active” children, 41 (47%) now tolerate unheated milk, 21 (24%) tolerate some form of baked milk/baked cheese in their diet, and 26 (30%) avoid all forms of milk (Table I, intent-to-treat).
Unheated milk tolerance within the active group stratified by initial baked milk challenge outcome
Among 88
Discussion
Cow’s milk is the most common food allergen among children. Currently, there is no cure for food allergy. The standard of care focuses on strict dietary avoidance,1 which is extremely difficult but has been the cornerstone of food allergy therapy for decades. The advice is practical because the amount of allergen necessary to induce an allergic reaction varies22 and the severity of reactions is unpredictable.23, 24 Additionally, there has been a theory that lack of exposure will result in
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Supported by grant AI 44236 from the National Institute of Allergy and Infectious Diseases and in part by grant CTSA ULI RR 029887 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR or NIH.
Disclosure of potential conflict of interest: J. S. Kim receives research support from the National Institutes of Health. S. H. Sicherer has consultant arrangements with the Food Allergy Initiative, is an advisor for the Food Allergy and Anaphylaxis Network, and receives research support from the National Institute of Allergy and Infectious Diseases and the Food Allergy Initiative. S. Noone has received speaker’s honoraria from the Food Allergy and Anaphylaxis Network, is a reviewer for Up-to-Date, and is a volunteer newsletter reviewer for the Food Allergy and Anaphylaxis Network. H. A. Sampson has consultant arrangements with Allertein Therapeutics, LLC, and the Food Allergy Initiative; receives research support from the Food Allergy Initiative and the National Institutes of Health/National Institute of Allergy and Infectious Diseases; is a consultant/scientific advisor for the Food Allergy Initiative; is a Medical Advisor for the Food Allergy and Anaphylaxis Network; is a Scientific Advisor for the University of Nebraska—FARRP; and is 45% owner of Herb Springs, LLC. The rest of the authors have declared that they have no conflict of interest.
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These authors contributed equally to this work.