Sterilization of milk may reduce risk of milk-induced eosinophilic oesophagitis

SPAIN: Most patients with a history of eosinophilic esophagitis caused by milk proteins did not develop eosinophilic esophagitis (EoE) after consuming sterilized milk, states a study published in the journal Alimentary Pharmacology and Therapeutics.

Cow's milk is the most frequent food source of EoE, a chronic inflammatory disorder brought on by type 2 inflammation and characterized by immune cell buildup in the esophagus, including eosinophils, basophils, and mast cells. Dysphagia, impaction, regurgitation, chest and/or stomach pain, and vomiting are all signs of EoE that differ depending on the patient's age.

Recent studies have demonstrated that many people with IgE-mediated food allergies may tolerate baked milk, and some studies have also demonstrated that this approach is effective in treating some EoE cases. However, it is questionable if EoE patients can consume sterilized liquid milk.

The researchers of the study aimed to determine whether patients with milk-triggered EoE of all ages can tolerate sterilized cow's milk that has been boiled rather than subjected to UHT processing in terms of dietary intake, allergic sensitization, maintaining EoE remission and other factors.

20 patients were enrolled in this trial, which was carried out in Spain between 2018 and 2021, and 18 of them were chosen to participate. Most of them (13) were men with EoE in remission. Eosinophil counts were part of baseline evaluations, and patients were included if endoscopy and biopsies were negative and the peak eosinophil count was less than 15 cells per high-power field.

The subjects failed to respond to proton pump inhibitors, the standard treatment for EoE. For exacerbations, some medications for asthma and rhinitis were permitted, but other treatments for allergies and asthma were often discontinued. For eight weeks, participants received 200 ml of sterilized cow's milk twice daily. Prior to and following the procedure, endoscopic evaluation, peak eosinophil counts, symptoms associated with the esophagus, HRQOL, blood eosinophils, eosinophil cationic protein, skin prick test, and serum total and specific IgE to key milk proteins were tracked.

Key findings of the research:

• While EoE relapsed in 6 people, 12 of the 18 participants continued to be in remission.
• The dysphagia and eosinophil count of the six patients who were unable to tolerate the sterilized milk worsened. In terms of food and social/emotional aspects, in particular, they also reported worse HRQOL. IgE that is specific to cow's milk appeared a little more in these patients.
• 10 patients who tolerated sterilized milk well and kept their remission were followed up for one year; they also consumed products containing baked milk.

The authors concluded that in the long or short term, sterile milk did not cause EoE in two-thirds of patients with reported milk-induced EoE.

REFERENCE

González-Cervera, J, Arias, Á, Navarro, P, Juárez-Tosina, R, Cobo-Palacios, M, Olalla, JM, et al. Tolerance to sterilised cow's milk in patients with eosinophilic oesophagitis triggered by milk. Aliment Pharmacol Ther. 2022; 56: 957– 967. https://doi.org/10.1111/apt.17171