Safety and effectiveness of milk and egg ladders in children with IgE-mediated food allergy-A case series.

Abstract

Objectives: Introducing baked cow's milk and egg proteins to children with severe immunoglobulin E (IgE)-mediated food allergies is controversial. This case series aimed to evaluate the safety and efficiency of the 5-step milk ladder (5-ML) and the 4-step egg ladder (4-EL) in a group of "high risk" children with IgE-mediated cow's milk (CMA) and hen's egg (HEA) allergies in the real-life settings.

Methods: Twenty-nine children with IgE-mediated CMA and/or HEA, with a history of severe allergic symptoms and/or asthma and/or elevated specific IgE levels (defined as "high risk"), were included. Tolerance acquisition to baked products was assessed via open-label supervised oral food challenges (OFCs), subsequent steps of the food ladders were performed in the majority through home-based reintroduction.

Results: Five out of 15 children (33%) developed tolerance to raw cow's milk proteins, while 11 children (73%) tolerated baked cow's milk (muffins). Three out of 23 children (13%) developed tolerance to any form of egg. Seventeen children (74%) tolerated baked egg in the form of muffins, 11 children (48%) tolerated pancakes, and 8 (35%) tolerated hard-boiled egg or well-cooked scrambled eggs. Tolerance loss occurred in two cases due to inconsistent introduction. In one case, parental concerns led to temporary withdrawal, but tolerance was reconfirmed. During OFCs, no anaphylaxis occurred; antihistamines were used in 10 children for minor reactions.

Conclusion: This case series provides evidence that assessing tolerance following the 5-ML and 4-EL in a "high-risk" group of children with IgE-mediated food allergies is safe. However, regular monitoring of these children is essential.