Baked Tolerance in Cow’s Milk Allergy: Quite Frequent, Hard to Predict!

Abstract

<b><i>Introduction:</i></b> Cow’s milk protein allergy (CMA) is the most common type of food allergy in childhood and exclusion diet is a challenge for patients. <b><i>Objective:</i></b> The study aim was to investigate the frequency of tolerance to baked foods containing milk and evaluate immediate skin prick test (SPT) and specific IgEs for different cow’s milk (CM) protein types as predictors of tolerance to baked foods containing milk for CMA patients. <b><i>Methods:</i></b> A cross-sectional study was performed. Fifty-four CMA patients were enrolled and oral food challenge (OFC) was performed with baked product, 6 different milk SPTs and specific IgEs to CM, casein, α-lactalbumin, and β-lactoglobulin. <b><i>Results:</i></b> Thirty-nine (72.2%) patients tolerated OFC with baked milk cupcake. CM-specific IgE and casein SPT showed statistical difference between positive and negative OFC groups. Probability curves for baked milk tolerance were created for specific CM IgE (<i>Z</i> = 2.542, <i>p</i> < 0.0110) and casein SPT (<i>Z</i> = 2.290, <i>p</i> < 0.0220) using logistic regression. <b><i>Conclusions:</i></b> The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. Specific CM IgE and casein SPT demonstrated to be useful predictors in relation to baked milk tolerance.

Immunonutrition for Pediatric Patients With Cow's Milk Allergy: How Early Interventions Could Impact Long-Term Outcomes

“…Moreover, CMP exposed to high temperatures in culinary recipes associated with a matrix (e.g., a muffin) showed a final reduced immunoreactivity compared with heated milk (180 • C for 10 min), not included in a matrix (68,69).…”

“…Cow's milk contains ~3–3.5 g of proteins per 100 mL characterized by different molecular structures and thermal and digestive characteristics, resulting in different allergenic properties ( 68 , 69 ). Based on their solubility at pH 4.6 and 20°C, CMP are classified into two different categories: Caseins (αS1-casein, αS2-casein, β-casein, and β-casein) are precipitating proteins and represent 80% of CMP; while the group that remain soluble are known as serum or whey proteins: ß-lactoglobulin (ß-LG), α-lactalbumin (ALA), lactoferrin (LF), bovine serum albumin (BSA), and bovine immunoglobulins (Ig), and correspond to 20% of the total CMP content ( 68 ).…”

Current Guidelines and Future Strategies for the Management of Cow’s Milk Allergy

“…Journal of Asthma and Allergy 2021:14 1250 families. 130 Some authors even suggest that yoghurt is tolerated in infants with CMA. 131 While some authors report almost absence of adverse effects, other report these are frequent, notably aversion to the allergen and oral syndromes as well as systemic allergic symptoms.…”

“… 129 The role of sIgE levels of milk, casein, and beta-lactoglobulin is controversial as some authors conclude that these did not predict the tolerance of unheated milk, while others came to opposite conclusions. 129 , 130 The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. 130 Some authors even suggest that yoghurt is tolerated in infants with CMA.…”

“… 129 , 130 The high percentage of patients able to tolerate baked goods enables an improvement in intake possibilities and quality of life of CMA patients and families. 130 Some authors even suggest that yoghurt is tolerated in infants with CMA. 131 …”