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

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.