Milk Incorporation into Diet Influences Natural History of Milk Allergy in a Pediatric Population

Many patients with milk allergy can tolerate extensively heated or ‘baked’ forms of milk. We investigated predictors of oral food challenge (OFC) outcome, natural history, and patient consumption of baked and unbaked milk products. We performed a retrospective chart review of patients 0-20 years old who completed an unblinded OFC to extensively heated milk at allergy-immunology outpatient clinics at Lurie Children’s Hospital of Chicago. We compared atopic dermatitis (AD) status, sIgE at OFC, and natural history of milk allergy between patients who passed or failed the extensively heated milk OFC. We identified 105 patients who completed an extensively heated milk OFC, 74.3% passed, while 25.7% reacted. Of the patients who reacted at OFC, 44% required epinephrine. In patients who reacted, sIgE was higher (8.96 vs 3.76 kU/L, p=0.008), and AD tended to be more common (86% vs 74%, p=0.08). Among patients with 3 years of follow up, at least 53% of those who passed the initial OFC were incorporating baked milk products into their diets compared to 11% who reacted (p<0.0001). Additionally, patients who passed their initial OFC were more likely to have developed natural tolerance to milk (28% vs 18%, p<0.05). Patients who previously passed an extensively heated milk OFC are more likely to introduce baked milk products, as well as unheated milk into their diets at 3 years. Further review would be helpful to understand changes in AD progression, sIgE trajectories, and potential impact on growth.