Outcomes of 109 Consecutive Open Food Challenges to Extensively-Heated (baked) Milk

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

“…The CM-specific IgE presented a better profile to predict the OFC results in our study. The median CM IgE value in the OFC+ was 13.2 kU/L, similar to the levels re-ported in the literature (8.14-12.0 kU/L), while in patients who presented negative OFC, the median was 3.2 kU/L, which is also comparable the previous reports (4.2-4.8 kU/L) [11,12]. Different from other studies, caseinspecific IgE in our cohort showed no difference between reactive and nonreactive individuals [14,16,17].…”

“…The cupcake was offered in quarters every 20 min until the consumption of the total portion. The OFC was considered positive and interrupted if the child presented objective signs of an allergic reaction such as hives, angioedema, pruritus, wheezing, dyspnea, cough, vomiting, diarrhea, hypotension, or fainting, and drug treatment was started immediately [11]. Symptoms, period, and cupcake intake were recorded in case of reaction.…”

“…The CM protein exposed to high temperatures, especially in culinary recipes associated with a matrix (wheat, vegetable oil, and sugar), demonstrated the changes in its structure and reduction of the allergenic potential [5,[8][9][10]. In this context, baked foods containing CM protein could be an opportunity to increase options for CMA children; however, some patients remain reactive and could present anaphylactic reactions [8,10,11]. Therefore, introduction of baked recipes containing CM for allergic patients should be done under medical supervision by oral food challenge (OFC), a procedure not accessible in most of the medical units, leading to a limited use of baked goods for CMA patients.…”

“…Therefore, introduction of baked recipes containing CM for allergic patients should be done under medical supervision by oral food challenge (OFC), a procedure not accessible in most of the medical units, leading to a limited use of baked goods for CMA patients. Studies comparing baked CM goods OFC and allergic tests could help the introduction, once allergy tests are largely accessible and relatively inexpensive, but these studies are scarce in the world literature [1,[10][11][12].…”