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Heated milk may induce tolerance to unheated milk
If a child can ingest heated milk products, such as in baked goods, then it is likely that the child will eventually tolerate drinking milk, according to data presented during the 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology in San Francisco.
According to a study led by Jennifer S. Kim, MD, and colleagues at Mount Sinai School of Medicine, New York, heated milk may predict the development of tolerance to unheated milk, whereas heated milk reactivity portends a more persistent phenotype of immunoglobulin E-mediated milk allergy. Studies are ongoing to evaluate whether regular ingestion of heated milk accelerates development of tolerance to unheated milk.
Approximately 75% of children who are allergic to milk can tolerate heated milk.
Children enrolled in the study who tolerated heated milk, in the form of either a muffin or a waffle, underwent sequential food challenges to pizza, macaroni and cheese, and unheated milk as tolerated. A total of 94 children were enrolled in the study (median age, 6.7 years; interquartile range [IQR], 5.3-8.7 years) and were followed for a median of 31 months (IQR, 18-47 months).
Of 70 children who initially tolerated heated milk (Group A), 42 (60%) became tolerant to unheated milk; 18 (26%) regularly tolerated some form of heated milk or cheese, and nine children (13%) later chose to avoid all forms of milk. One child was lost to follow-up.
Among the 24 children who reacted to heated milk (Group B), two children (8%) tolerated the unheated milk and three (13%) tolerated heated milk or cheese; 19 (79%) children avoided milk completely.
One child in each group developed eosinophilic esophagitis; one child developed ulcerative colitis (Group A). More children in Group A developed tolerance to unheated milk compared with Group B (P<.001). median="" time="" to="" unheated="" milk="" tolerance="" (n="44)" was="" 21="" months="" (iqr,="" 13-32="" months).="">
Among the 75 children who incorporated heated milk into their diets, milk skin-prick test wheal sizes decreased a mean 8 mm to 6.7 mm, (P=.001) whereas IgG4 levels increased from 0.6 mg/L to 1.5 mg/L (P<.001); beta-lactoglobulin="" igg4="" levels="" also="" increased,="" from="" 0.4="" mg/l="" to="" 0.8="" mg/l="">P=.004). Milk-specific IgE levels did not change significantly.
“Basically, the bottom line of this study is that in milk allergy … if the child is able to tolerate the milk or the egg in the baked form, that putting it into their diet may be useful for bringing about more rapid development of tolerance,” Hugh A. Sampson, MD, one of the study’s researchers, said during a press conference at the meeting. Sampson is professor of pediatrics, allergy and immunology and dean for translational biomedical research at Mount Sinai School of Medicine, New York.
For more information:
- Kim JS. #91. Presented at: 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; March 18-22, 2011; San Francisco.
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