Use of baked milk challenges and milk ladders in clinical practice: a worldwide survey of healthcare professionals

A patient‐specific approach to develop an exclusion diet to manage food allergy in infants and children

“…Sesame allergy is frequently encountered in the Middle East and Israel, but sesame allergy is infrequently encountered outside of these countries and Europe. 40 Although many clinicians make the decision about OFC location on clinical experience, 55 introduction of BM or BHE at home may pose a risk, particularly with IgE-mediated allergy and some forms of non-IgE-mediated food allergy such as severe food protein-induced enterocolitis syndrome (FPIES). 63,67 In the USA, a recent death associated with a physician-supervised baked milk challenge in a child with IgE-mediated cow's milk allergy highlights the risk.…”

“…The BSACI guideline for the diagnosis and management of cow's milk allergy (CMA) suggests gradual home introduction of BM in children who have had only mild symptoms on "noteworthy exposure" to milk (such as a mouthful) and no reaction in the past 6 months and (for those with IgE-mediated CMA) a significant reduction in sIgE/ SPT 54. Although many clinicians make the decision about OFC location on clinical experience,55 introduction of BM or BHE at home may pose a risk, particularly with IgE-mediated allergy and some forms of non-IgE-mediated food allergy such as severe food protein-induced enterocolitis syndrome (FPIES) 63,67. There is considerable debate around the aforementioned, as Nowak-Wegrzyn et al64 found that of the children who were reactive to BM on challenge, 35% experienced symptoms of anaphylaxis and 4% of those challenged to BHE received epinephrine 65.…”

“…There is considerable debate around the aforementioned, as Nowak-Wegrzyn et al64 found that of the children who were reactive to BM on challenge, 35% experienced symptoms of anaphylaxis and 4% of those challenged to BHE received epinephrine 65. Box 3 proreflux and constipation) although no prospective studies have been performed to assess efficacy of these ladders 55. The Mount Sinai cohort indicated that those with lower serum egg white, ovomucoid and ovalbumin-specific IgE levels and lower ovomucoid and ovalbumin IgE/IgG4 ratios were more likely to tolerate baked egg 58,65.…”

Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy

“…40 Unfortunately, there seems to be limit evidence to suggest that this approach speeds up outgrowth although it may simplify meals times for families. A popular approach is to initiate patients with cow's milk or egg allergy on baked milk or baked egg, respectively.…”

“…A popular approach is to initiate patients with cow's milk or egg allergy on baked milk or baked egg, respectively. 40 Unfortunately, there seems to be limit evidence to suggest that this approach speeds up outgrowth although it may simplify meals times for families. 41 A potential treatment strategy is omalizumab, and Vetander and colleagues publish data to suggest that an individualized dosing can prevent reactions in patients with food allergy.…”