A Structured Gradual Exposure Protocol to Baked and Heated Milk in the Treatment of Milk Allergy

Objective: To evaluate the efficacy and safety of a structured gradual exposure protocol (SGEP) with extensively heated and baked milk in promoting allergy resolution in children with cow milk allergy (CMA). Study design: In a case control study, children with CMA aged 1-4 years who were treated with SGEP including extensively heated and baked milk, were compared with children treated with strict avoidance. Data were collected from medical records and from validated telephone questionnaires. Data analysis was performed using a nonparametric Kaplan-Meier and proportional hazard Cox regression model, after evaluation of the adequacy of the case control matching. Results: There were 43 children with milk allergy—26 (62%) males with a mean age at intervention of 21 months (range, 12-47 months)—who were treated with SGEP and followed to a mean age of 40 months (range, 20-82 months). The median age at resolution of CMA was compared with a matched group of 67 children treated with strict avoidance at least until 4 years of age or followed until earlier resolution, with a mean age at follow-up of 71 months (range, 11-176 months). The median estimated age at CMA resolution in the SGEP group was 36 months (95% CI, 34.5-49.7) compared with 98 months (95% CI, 82.4-114.1) in controls (P <.001). At last follow-up, 86% of treated children were tolerant to unheated milk proteins vs 52% of controls (P =.003). Conclusion: A structured protocol with extensively heated and baked milk seems to promote faster resolution of CMA.