High-Risk Cow's Milk Allergic Children May Tolerate Baked Milk, Suggests Study

The study, conducted by Dr. Olga Domínguez and her team at the Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, and published in The Journal of Investigational Allergology and Clinical Immunology, explored whether baked milk (BM) could be safely introduced to children with a known history of cow’s milk allergy (CMA), including those at high risk of severe reactions such as anaphylaxis.

The findings support the growing belief that incorporating baked milk into the diets of certain allergic children may help accelerate their path to outgrowing the allergy. This approach could offer a valuable alternative to prolonged exclusion diets, which may delay natural tolerance.

The team enrolled 50 children aged between 12 months and 6 years, all previously diagnosed with CMA. A significant proportion—66%—had a history of anaphylaxis. To evaluate each child’s allergy status, researchers used a combination of diagnostic tools, including skin prick tests, specific IgE levels to cow’s milk, and milk proteins like casein, IgG4 levels, and the basophil activation test (BAT).

The study revealed the following findings:

• Each child underwent a baked milk oral food challenge (BM-OFC) with a cumulative dose of 1 gram of cow’s milk protein.
• 64% of participants tolerated baked milk without any allergic reactions.
• 36% of children experienced allergic reactions during the BM-OFC, with nearly 40% of them having a prior history of anaphylaxis.
• Predictors of adverse reactions to baked milk included age over 3 years, a history of anaphylaxis, elevated IgE levels to cow’s milk and casein, and a positive basophil activation test (BAT).
• Identified cut-off values to predict risk included: >5 mm for casein in skin prick testing, ≥8.5 kUA/L for cow’s milk-specific IgE, and ≥5.7 kUA/L for casein-specific IgE.
• Among children who tolerated baked milk and proceeded to a fresh cow’s milk oral food challenge (CM-OFC), 43.8% reacted to less than 100 mg of pasteurized milk protein.
• These findings emphasize the difference in tolerance between baked and pasteurized forms of cow’s milk.

Despite the associated risks, the researchers emphasized that a supervised baked milk challenge could offer significant dietary and therapeutic benefits for the majority of children with CMA. Early introduction, when done safely, may pave the way for a faster resolution of milk allergy.

This study highlights the importance of personalized allergy management and the potential of biomarker-based screening in identifying suitable candidates for baked milk introduction. The authors advocate for careful patient selection using clinical history and immunological profiles to guide decisions.

Reference:

Domínguez O, Riggioni C, Poyatos E, Jiménez-Feijoo RM, Piquer M, Machinena A, Folqué M, Ortiz de Landazuri I, Torradeflot M, Lozano J, Alsina L, Pascal M, Alvaro-Lozano M. Biomarkers of Tolerance to Baked Milk in Cow's Milk-Allergic Children at High Risk of Anaphylaxis. J Investig Allergol Clin Immunol. 2025 May 5:0. doi: 10.18176/jiaci.1074. Epub ahead of print. PMID: 40322909.