Home‐based cow’s milk reintroduction using a milk ladder in children less than 3 years old with IgE‐mediated cow’s milk allergy

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Abstract

Background

The development of tolerance to cow’s milk in allergic children is best determined by supervised baked milk exposure. Widely recommended hospital‐based challenges can potentially delay contact because of resources limitations.

Objective

We sought to determine the efficacy and safety of our low‐dose home‐based reintroduction programme.

Methods

In our allergy service, children with IgE‐mediated cow’s milk allergy who met a set criteria (presenting with skin and/or gastrointestinal symptoms only and skin prick test <8mm) are considered for home‐based milk reintroduction (HMR). Early contact is low‐dose ingestion of a commercial baked milk biscuit with slow gradual further exposure followed by increasing milk contact using a milk ladder. We retrospectively reviewed 4‐6 monthly attendance records assessing allergic symptoms, evolving milk tolerance, and compliance. Tolerance was determined using a 7 scale scoring system based on the milk ladder.

Results

The clinic attendance and dietetic contact records of 86 children (49 girls) who underwent HMR were reviewed. HMR was started at a median of 13 months with 49% 8‐12 months, 40% 13‐18 months and 11% 19‐33 months. Allergic symptoms were reported in 81 (43%) of 189 dietetic reviews, 65 (80%) of which were from the milk ladder; no patient experienced anaphylaxis requiring treatment with intramuscular adrenaline. After 4 reviews only 8 patients were not tolerating almost all dairy products, and there was a high rate of completion only with a further 7 patients lost to the programme.

Conclusion and Clinical Relevance

Cow’s milk can be successfully and safely reintroduced in a cautious low‐dose exclusively home‐based programme in the appropriate clinical and family setting.

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